These protocols are for physiotherapy following adductor lengthening.
Therapy interventions should be tailored to the individual child.
Phase 1: Post-op Day 1 to 4-6 weeks – Period in cast/full time splint
Goals: pain management, equipment, mobilize, educate and involve the family
- Provide positioning options in cast/splint
- Avoid windswept posturing during the healing period
- Frequent position changes to prevent pressure areas
- Utilize long leg casts/brace to stretch hamstrings in long sitting, if indicated
- Ankle plantarflexor stretches, if required
- Isometric contraction of the gluteus maximus, quadriceps, hamstrings, if able
- If in hip abduction splint, may remove and perform knee ROM after 10 days (earlier may lead to spasms) – Caution: splint may be difficult to re-apply if spasms present
Phase 2: Post-op 4-6 weeks to 3 months – Post cast removal
Goals: Maintain new ROM, return to previous level of function
- Use resting splint or pillow throughout the night for 3 months and use during the day when napping, floor/sitting activities (e.g. watching television)
- Out of brace for functional mobility during the day
- Return to regular wheelchair seating with wide pommel
Consider stretching the following:
- Hip in extension (ie supine) - with knee extension and knee flexion (frog leg position)
- Hip in flexion - with knee extension and knee flexion
- Ring or cross leg sitting for play
- Hip flexors
Consider strengthening reciprocal muscle groups (hip abductors and extensors, knee flexors and extensors).
Continue with current individualized therapy goals.