Exercises and advice after adductor lengthening surgery

This resource has been designed to help you remember the exercises your therapist went through with you whilst in hospital.

The exercises should be done slowly and smoothly. Some discomfort may be noted whilst doing these exercises after your surgery. If pain is limiting doing the exercises, then timing them around pain relief or muscle relaxant medication may be helpful. However, if pain becomes worse please seek advice from a healthcare professional and stop the exercises.

After muscle lengthening surgery it is important for the muscles to heal in their new lengthened position. In order for the surgery to be successful it is important to follow the daily exercise program as instructed by your child’s therapist.

Exercises

Adductor muscle stretch

Start by lying your child on their back.

Make sure your child’s hips are level. Support their leg with a hand under their heel and knee.

Gently and slowly take one leg out to the side with the knee and toes pointing up and the knee straight. Continue to take the leg out to the side until resistance is felt then hold this position for 15 to 20 seconds. Keep their other leg anchored to stop any movement in it.

Return back to the starting position. Repeat 10 times on each leg.

Positioning with hip abduction wedge

Start by lying your child on their back or sitting with their gaiters or braces on.

Place the hip abduction wedge between your child’s thighs and strap the Velcro straps around their legs. It is best to fit the wedge after doing the stretches as it will fit better and more comfortable for your child.

Your child should be assisted to be in this position at all times when resting.

How many times should I do these exercises with my child?

These exercises should be done a minimum of 3 to 4 times a day and they should be staggered throughout the day. Any positive positions your child’s therapist has advised should be adopted whenever your child is resting. If your child is very active then you should make sure that they rest in the positive position for 30 minutes 3 times a day and overnight.

What else can improve the outcome of my child’s surgery?

Positioning

Positioning is an effective way of maintaining muscle length by holding a positive position for a prolonged period of time.

Sometimes a cast will be used after the operation to hold the legs apart. This type of cast is called a broomstick cast and will usually be worn for 2 to 4 weeks. Your child’s doctor and therapists will have discussed this at the pre assessment appointment if they planned to use a broomstick cast.

If your child does not have a broomstick cast then they will be given an abduction wedge and gaiters or braces. The abduction wedges is a shaped pillow that supports the legs apart. Gaiters keep the legs straight to help with positioning. These should be used day and night for the first 2 weeks then dropping to overnight and when able during the day after this time.

Sleeping and sitting

If your child has a sleep system their local therapist should adapt it to accommodate the abduction wedge and support the legs in an open position.

If they do not have a sleep system the therapists will show you how to support your child’s legs with pillows, towels and other items you might have at home.

Your child would benefit from having something between their legs when sitting in their wheelchair however it is advised to limit the amount of time they spend sitting initially.

If your child is able to rest with their knees straight do not put pillows under your child’s knees or use the bed function to allow them to bend their knees as this does not promote a good position for healing.

Walking, standing and hydrotherapy

Children who are able to walk are encouraged to do so if safe. If your child accesses a standing frame they should start using this again as soon as they can tolerate.

Standing has many benefits one being stretching the muscles of the legs. Once wounds have healed your child can return to or start hydrotherapy.

Managing pain

You child may have increased pain or discomfort when wearing gaiters and using the wedge. Having appropriate pain and muscle relaxant medication can help manage this.

It is important to make sure there is no pressure damage by regularly checking the skin for redness or evidence of rubbing. Any red marks should disappear after 30 minutes of the gaiters being removed. If marks do not disappear and pain continues discuss this with your child’s therapist.

Increased tolerance and time wearing gaiters will increase the effectiveness of the surgery but issues around pain and skin integrity must be addressed.

What about when we leave hospital?

We will contact your child’s local therapist to pass on any important information and ask them to see you at home or in school.

Your therapist will review your child’s muscles length, exercises and positioning. It is important that you see your therapist once you leave the hospital so they can continue to help with your child’s exercises and rehabilitation.

Your therapist can guide your child’s rehabilitation however it is your responsibility to make sure your child completes the necessary exercises. You should speak with your child’s therapist and school to make a plan for returning to school.