PHYSICAL THERAPY

Physical therapy (PT) is required daily (5 days per week) during the lengthening phase. The Paley Institute has a specialized physical therapy department on-site. All of the therapists have been specifically trained in the rehabilitation of lengthening patients and treat lengthening patients each and every day. This experience is crucial to ensuring a positive outcome, maximizing strength and flexibility, and preventing complications. The Paley Institute is unique among other centers in offering an on-site therapy department specifically catered to the lengthening patient. Physical therapy during lengthening is included in the cost invoice for all of our stature lengthening patients. The duration of the PT included is specified on the invoice.

During the bone-healing (consolidation) phase, you need to continue with PT but less often (2-3 days per week). This is usually done closer to home since most patients depart from West Palm Beach after lengthening. Your therapist will prepare a discharge packet for your home therapist, including all of your medical notes and videos on specific stretches. If you plan to stay locally for some time we can arrange physical therapy at our center at a discounted rate.

Daily home exercises are still required throughout both lengthening and consolidation phases. Your physical therapist at the Paley Institute will instruct you and your caregivers on the home exercise protocols.

PT PROTOCOLS
Within one to three days after discharge from the hospital, you will begin outpatient physical therapy at the Paley Institute. The lengthening will begin seven days after surgery. It is desirable to achieve 90 or more of knee motion during the first week and preserve it throughout the lengthening. If knee motion decreases we may slow the lengthening rate, increase the number of therapy sessions, or rarely halt the lengthening prematurely. We will never sacrifice length for function.

For tibial lengthening, a splint will be issued in the hospital to maintain neutral ankle position (90°) and must be worn 22 hours per day to prevent contracture.

The goals of physical therapy are to maximize range-of-motion (ROM), prevent contractures, and improve strength, mobility, and functional independence, as well as monitor rate of lengthening and help troubleshoot and avoid complications. Specific stretches will vary depending on femoral, tibial, or combined lengthening.

Daily stretches include ankle dorsi-flexion with knee flexed and extended (gastro-soleus stretch), knee flexion (90°) in seated and prone (quadriceps, including rectus femoris), knee extension (0°) supine (hamstring and gastrocnemius), hip abduction (30 – 40°), hip adduction, and Ober stretch as permitted (iliotibial band). If knee motion becomes limited, an extension dynamic splint may be utilized.

During the bone-healing phase, the goals of PT are to regain maximum ROM, eliminate any leftover muscle weakness, and progress gait, balance, and strength. Your activity level will remain the same during the bone-healing process as it was during the lengthening process. The muscles that tend to exhibit the most weakness post-lengthening are the gluteus, quadriceps, and gastrocnemius. Duration of physical therapy will decrease as you regain your pre-surgical strength and flexibility.

High-impact activities (running, jumping, etc.) will not be allowed until there is satisfactory healing which usually takes three months after the end of lengthening.