Physical therapy (PT) is required daily (5 days per week) during the lengthening. 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. All physical therapy during lengthening is included in the cost estimate for all of our stature lengthening patients.
During the consolidation phase, the patient needs 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.
Daily home exercises are required by the patient throughout both lengthening and consolidation phases. Your physical therapist at the Paley Institute will instruct you and your caregivers on the home exercise protocols.
For more information on PT at the Paley Institute, see Center for Rehabilitation & Physical Therapy.
Twenty-four to forty-eight hours after discharge from the hospital, you will begin outpatient physical therapy at the Paley Institute. The lengthening will begin one to seven days after surgery. It is desirable to achieve 90 degrees of knee motion during the first week and preserve it throughout the lengthening. If knee motion becomes too tight, the lengthening may be halted 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 degrees) 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 patient troubleshoot and avoid complications. Daily stretches include ankle dorsi-flexion with knee flexed and extended (gastro-soleus stretch), knee flexion (90 degrees) in seated and prone (quadriceps, including rectus femoris), knee extension (0 degrees) supine (hamstring and gastrocnemius), hip abduction (30 - 40 degrees), hip adduction, and Ober stretch as permitted (iliotibial band). If knee motion becomes limited, an extension dynamic splint may be utilized. Specific stretches may vary slightly depending on femoral lengthening vs. tibial lengthening.
Precautions during lengthening include 50 - 75 pounds weight-bearing, depending on size of nail; 10.7 mm = 50 lbs; 12.5 mm = 75 lbs. Weight-bearing is directed by Dr. Paley and will only progress with his clearance. No closed chain squats or strengthening are permitted. As the PRECICE nail distracts, there is a higher risk of nail breakage, so weight-bearing may decrease as lengthening occurs to minimize the risk of fracture. The physical therapists will teach you how to offload your weight to the arms while walking on crutches, in order to maintain weight-bearing precautions.
During the consolidation phase, the goals of PT are to reclaim maximum ROM, eliminate any leftover muscle restrictions, and progress gait, balance, and strength. The muscles that tend to exhibit the most weakness post-lengthening are the gluteus medius, quadriceps, and gastrocnemius. Duration of physical therapy will decrease as you regain your pre-surgical strength and flexibility. Weight-bearing will progress with Dr. Paley's clearance only and is determined based on x-rays sent once a month. High-impact activities (running, jumping, etc.) should not be undertaken until cleared by Dr. Paley.