What is Perthes Disease?
Legg-Calve-Perthes Disease, or Perthes Disease for short, is a rare condition that affects children. It affects boys more than girls and usually between the ages of 4-10 years old. It affects the hip joint and involves the femoral head (the ball part at the top of the thigh bone). The blood supply to this area of the bone becomes interrupted. With insufficient blood flow, the bone begins to die (avascular necrosis). This bone death results in a flattening of the femoral head. In most cases, this only occurs on one side.
What Causes Perthes Disease?
The interruption of blood flow, as explained above, causes Perthes. The cause of this interruption remains unknown.
What are the Symptoms of Perthes Disease?
Symptoms of Perthes disease include:
- Limping- may or may not be related to pain.
- Hip joint stiffness
- Pain in the hip, groin, thigh or knee
- Decreased range of movement of the hip
- Shortening of the affected leg
- Atrophy (wasting) of the surrounding muscles
How is Perthes Disease Diagnosed?
Clinical examination findings include a visible limp with walking and decreased hip joint range of motion. An X-ray may show the flattening of the femoral head. Often in the initial stages, changes cannot be seen on an X-ray but may be demonstrated by successive x-rays. At times an MRI or bone scan may also be required.
Please consult your hip physiotherapist or doctor for diagnostic assistance regarding Perthes Disease.
Perthes Disease Treatment
For children under the age of 6, treatment is usually conservative and doesn’t require surgery. Because they are young and their bones still have a lot of growing and developing, the femoral head has more time to repair. Conservative management is where your physiotherapist can assist. Your child will require rest from high-intensity activities, including running, to prevent further damage to the hip joint.
Physiotherapy treatment will involve:
- Advice and education on the condition and providing recommendations on relevant rest to assist with decreasing pain
- Stretching exercises for the hip
- Progressive strengthening exercises for the hip and leg
- Crutches to decrease weight-bearing if walking is particularly sore
At times conservative treatment may also involve traction, where the hip is gently pulled out from the socket to help relieve pain; or casting to maintain femoral head alignment.
Surgery aims to improve joint alignment and the contour of the femoral head. Surgical methods range from releasing tight muscles around the hip to joint realignment. Surgery may occur in more severe cases. Post-surgery, your physiotherapist can help provide stretching and strengthening exercises to assist with recovery and a return to activity.
Perthes Disease Prognosis
Sometimes those who have had Perthes disease require a joint replacement later in life. Children who have had Perthes are also more likely to develop early onset of hip arthritis.
Your physiotherapist can aid in the detection and diagnosis of Perthes disease. If your child has had Perthes, the physiotherapy team at PhysioWorks can help your child get back into normal activities and sport and be a child again.
Common Causes of Hip & Groin Pain
Hip Joint Pain
- Hip Arthritis - Hip Osteoarthritis
- Hip Labral Tear
- Hip Pointer
- Femoroacetabular Impingement - FAI
- Perthes Disease
- Slipped Femoral Capital Epiphysis
- Stress Fracture
- Avascular Necrosis of the Femoral Head
Lateral Hip Pain
Adductor-Related Groin Pain
Pubic-Related Groin Pain
Inguinal-Related Groin Pain
- Inguinal hernia
- Sportsman's hernia
Iliopsoas-Related Groin Pain
- Hip Flexor Strain
Other Muscle-Related Pain
- Piriformis Syndrome
- Muscle Pain -Muscle Strain
- Poor Hip Core
- DOMS -Delayed Onset Muscle Soreness
- Core Stability Deficiency
Hip Pain Treatment
A thorough analysis of WHY you are suffering hip pain from a movement, posture, or a control aspect, is vital to solving your hip pain.
Only an accurate diagnosis of the source of your hip pain can solve the pain, quickly improve your day to day function, prevent a future recurrence, or improve your athletic performance.
The first choice of short-term therapy has been symptomatic hip treatment. This approach could include local chemical modalities such as cortisone injections or painkillers. Ice or heat could also assist along with some gentle stretching or exercise.
However, persisting hip problems will require additional investigations to assess your joint integrity or range of motion, muscle length, strength, endurance, power, contraction timing and dynamic stability control.
You should consult a healthcare practitioner who has a particular interest in hip pain and injury management to thoroughly assess your hip, groin, pelvis, lower limb and spine. Due to the kinetic chain, they all impact, especially at the high athletic performance end. A quality practitioner will educate you on your condition and combine it with exercise and manual therapy as per the Clinical Practice Guidelines. (Cibulka et al., 2017) Hip pain education should also include teaching you specific activity modification, individualised exercises, weight-loss advice (if required), and methods to unload any arthritic joints.
Recent research evidence-backed approaches have modernised physiotherapy treatment approaches to effectively managing hip pain. Together with a thorough hip assessment, your hip treatment can progress quickly to restore you to a pain-free hip and perform your regular sport or daily activities in the shortest time possible.
For specific rehabilitation advice regarding your hip pain, seek the professional advice of high quality and up-to-date physiotherapists experienced in the assessment, treatment, prevention and optimisation of hip pain and related conditions. After assessing you, they will individually prescribe therapeutic activities based on your specific needs for daily living, values, and functional activities or point you in the direction of the most suitable healthcare practitioner for you and your hip condition.
Hip Pain Treatment Options
Your hip physiotherapist may consider an extensive range of treatment options, including manual joint therapy to improve your joint mobility, muscle stretches or supportive taping. Your physiotherapist is also likely to add strengthening and hip joint control exercises as they deem appropriate for your specific functional and sporting needs. Please consult with them for advice.
Acute Injury Signs
Acute Injury Management.
Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.
For detailed information on specific injuries, check out the injury by body part section.
Don't Ignore these Injury Warning Signs
Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.
If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.
Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.
Reduced Range of Motion
If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.
Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.
Immediate Injury Treatment: Step-by-Step Guidelines
- Stop the activity immediately.
- Wrap the injured part in a compression bandage.
- Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
- Elevate the injured part to reduce swelling.
- Consult your health practitioner for a proper diagnosis of any serious injury.
- Rehabilitate your injury under professional guidance.
- Seek a second opinion if you are not improving.