Hip spica removal with movement disorder

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

Children and young people that have changes to their muscle tone and their functional abilities pre operatively will likely require greater input when having a spica cast removed. As their muscles may be stiffer, a more gradual approach to returning to a more typical sitting position and returning to equipment they would normally access. They may need medication to help manage any discomfort and muscles spasms and may require a short hospital admission to ensure all their needs are met.

After cast removal it is normal for children and young people to be stiff and uncomfortable as they have been held in the same position for an extended period. In order for your child to continue their rehabilitation journey it is important to follow the daily program as instructed by your child’s therapist.

Exercises

The exercises should be done slowly and smoothly. Some discomfort may be noted whilst doing these exercises after cast removal. 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.

Hip and knee bends

Start by lying your child on their back or in reclined sitting.

Support your child’s leg under their heel and at their knee. Bend their knee by moving the heel towards the bottom and knee towards the chest.

Do not go pass 90 degrees at the hip.

Return to the starting position. Repeat 10 times.

Hip abduction

Start by lying your child on their back.

Make sure your child’s hips are level. Support their leg under the 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 10 seconds. Keep their other leg anchored to stop any movement in it.

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

Ankle exercises

Start by lying your child on their back or propped up.

Make sure your child’s knee is straight. With one hand grasp underneath the heel, place your forearm along the bottom of your child’s foot.

Slowly apply pressure on the foot with your forearm so that the toes point up and back towards the child’s body until resistance is felt. Hold this position for 10 seconds.

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

How many times should I do these exercises?

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

What else can improve the outcome of my surgery?

Positioning

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

Now your child is out of a cast they will have been given an abduction wedge and gaiters. The abduction wedge 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 1 to 2 weeks when not sat out their chair. This will help transition from the position they were in the cast back to a typical resting position. The wedge and gaiters can be removed for completing exercises, personal care needs and sitting in their wheelchair.

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. The wedge should be used until they are comfortable enough to tolerate the knee cosy from their sleep system which can take 1 to 2 weeks from coming out of cast. If they do not have a sleep system the therapists will show you how to support your child with pillows, towels and other items you might have at home.

Either your child’s wheelchair or buggy will have been adapted to accommodate their position in cast or they will have been provided with a temporary wheelchair. Now the cast is off the therapists will have adjusted their chair as needed. It is usually necessary to allow them to sit with their legs out to the side and over the next 2 weeks gradually bring them back in. They may not be able to transfer straight back into their old chair. Your local therapists will be able to guide you on this.

They should gradually build up their sitting time once out of cast as it will feel different for them. Start with half an hour to an hour building up as able daily.

Walking, standing and hydrotherapy

Depending on the reason your child is in a cast will depend on when they can return to standing. If your child is allowed to start weight bearing once out of cast it is advised that they are comfortable completing their exercises and they can sit out for an hour before reintroducing their standing frame. This can take 1 to 2 weeks following the cast being removed. Once they start getting in their standing frame they should gradually build up the time they spend in it.

Hydrotherapy is encouraged once their cast is removed providing all their wounds have healed.

Managing pain and pressure

Increased pain or discomfort is expected following cast removal. 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 or splints being removed. If marks do not disappear and pain continues discuss this with your child’s therapist.

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

What happens next?

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 your child’s cast is removed 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, when this is appropriate varies based on each child’s individual needs.