Physiotherapy and physical activity in children with Perthes’ disease

Listen to Brian and Lisa discuss the paper 'Physiotherapy and physical activity in children with Perthes’ disease' published in the June 2025 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today we're discussing the paper titled, 'Physiotherapy and physical activity in children with Perthes’ disease', published in June 2025 by YD Hailer, DC Perry, E Schaeffer, J Li, and K Mulpuri. I am Brian and I'm joined by my co-host Lisa.

Hello, Brian. I'm quite keen to delve into today's topic. Perthes’ Disease, as we know, affects the femoral head in children leading to ischaemic necrosis. This paper aims to survey the international consensus on the recommendations for physiotherapy, physical activity, and weightbearing in these young patients.

Brian, could you tell us why this research is so significant? 

There's a lack of clear and consistent clinical guidelines for managing Perthes’ disease. Such guidelines are crucial as recommendations can vary widely across different regions and even among orthopaedic surgeons [00:01:00] within the same country.

The study aimed to find common ground and provide insights into the best practices presently in use across the globe. They distributed an online survey featuring both quantitative and qualitative questions to paediatric orthopaedic surgeons from around the world. 

Precisely. The research specifically examined factors that influenced the recommendation of physiotherapy and physical activity at various stages of Perthes’ disease.

They also looked at case scenarios to reflect real-world decision-making. The study involved 160 surgeons from 43 countries. The sheer diversity and participation alone makes the findings very interesting. 

Indeed, one of the key findings was that maintaining the range of motion and managing pain were considered vital when prescribing physiotherapy. Surprisingly, factors like the child sex were deemed unimportant by most participants. For physical activity, there was broad support for activities like swimming and cycling. While high-impact sports like [00:02:00] trampolining and gymnastics were generally discouraged, especially in the initial and fragmentation stages of the disease.

I found it interesting that there were some notable international differences. For example, recommendations from the British Isles and Scandinavia were generally less restrictive about weightbearing compared to their eastern European counterparts. Could you explain a bit more about the methods used to reach these conclusions Brian? 

Certainly, the researchers used a cross-sectional online survey, which included various questions on factors such as the importance of range of motion, pain and clinical classification. They also presented three case scenarios to explore decision-making further. Statistical analysis was performed using mixed effects linear regression models to assess the predictive strength of each factor.

That's quite comprehensive. Additionally, the study highlighted two primary types of factors influencing recommendations. Child dependent factors like compliance and hip dependent factors, such as the [00:03:00] degree of pain and range of motion. The authors pointed out that children, especially at a young age, can be challenging to guide in their behavior making treatment adherence tricky.

Exactly. It's often a balancing act between maintaining the range of motion and avoiding activities that could potentially worsen the condition. For instance, there was consensus on allowing activities like swimming and cycling, which are low-impact, but high-impact activities were off the table. This cautious approach aims to protect the vulnerable femoral head, particularly in the early stages.

And speaking of the early stages, let's discuss the intriguing point about weightbearing. Despite evidence suggesting that reducing weightbearing can be beneficial, the study found that more than one third of participants allowed weightbearing as tolerated. This shows a significant shift towards a potentially more pragmatic and child-friendly approach.

Quite so. The study also emphasized the psychological and physical benefits of [00:04:00] allowing some level of physical activity. Being too restrictive can lead to weight gain and psychological stress, which are particularly hard on children already dealing with a chronic condition. So, the surgeons seem to weigh these factors carefully.

It's clear that finding the right balance is key. Going forward, the study suggests the need for evidence-based consensus guidelines to help standardize the treatment approaches for Perthes’ disease. This would ultimately provide the best outcomes for maintaining range of motion and mitigating pain whilst allowing children to remain as active as possible.

Absolutely Lisa. To summarize, the main takeaway from this study is that there is a strong focus on maintaining the range of motion and managing pain, while being mindful of the child's quality of life. Swimming and cycling are widely recommended, but there's still no clear consensus on when high impact activities can be safely resumed. The variations and recommendations highlight the need for clearer, more standardized guidelines. [00:05:00] 

Right Brian, we hope our listeners found this episode informative. Remember, if you want to delve deeper into this study, you can find the full article in the June 2025 issue of Bone & Joint Open. Join us next time for more discussions on groundbreaking research in orthopaedics.

Thanks for tuning in everyone. Take care.