Physical Therapy with an Ellipse Nail

General Guidelines

Activity:

1. Non-weight bearing (no walking, standing, or kneeling) on surgical leg.
2. Home exercise program twice daily.
3. May use ankle weights with mat exercises under PT guidance.
4. May pedal stationary bike with no resistance.

Note: Do not begin weight bearing on your surgical leg until your doctor advises you to do so, even after you are finished lengthening.

Positioning/Bracewear:

1. Wear knee brace as instructed.
2. Lie flat on stomach at least once daily for 30 minutes.
3. No compression garments or devices. May elevate and ice as needed for swelling.

Note: Do not modify your bracewear schedule or adjust your brace settings except as instructed to do so by your doctor.

Strengthening

Ankle pumps: With leg resting on bed and knee straight, slowly pump ankle up and down as far as possible.

Quad sets: Tighten thigh muscle and straighten knee as much as possible. Hold 5 seconds.
Glute sets: Tighten buttocks, hold 5 seconds.

Hip abduction: Slide leg slowly out to side, keeping knee straight and pointed towards ceiling.

Hip rotation: Gently roll leg inward and outward, keeping knee straight.

Heel slides: Slowly bend your knee by sliding your foot as close to your buttocks as able.

Short arc quads: Place a firmly rolled blanket under knee, with foot resting on bed. Straighten knee and hold 5 seconds.

Straight leg raise: Lie on your back with opposite knee bent. Slowly raise leg, keeping knee straight. Hold 2 seconds.

Stretching

Heelcord stretch: Pull heelbone AWAY from patient while pushing ball of foot TOWARDS patient. Hold 20 seconds.

Knee extension stretch: Gently push down on top of thigh (just above the knee) while lifting calf upward, to straighten knee. Hold 20 seconds.

Hip extension stretch: Stabilize buttocks with one hand while lifting thigh upward with other hand. Hold 20 seconds. Alternate: perform in sidelying.

Hip abduction stretch: Take leg out to side until a stretch is felt on inner thigh. Keep knee straight and avoid leg rolling outward. Hold 20 seconds.

General Guidelines

Activity:

1. Non-weight bearing (no walking, standing, or kneeling) on surgical leg.
2. Home exercise program twice daily.
3. May use ankle weights with mat exercises under PT guidance.
4. May pedal stationary bike with no resistance.

Note: Do not begin weight bearing on your surgical leg until your doctor advises you to do so, even after you are finished lengthening.

Positioning/Bracewear:

1. Wear knee brace as instructed.
2. Lie flat on stomach at least once daily for 30 minutes.
3. No compression garments or devices. May elevate and ice as needed for swelling.

Note: Do not modify your bracewear schedule or adjust your brace settings except as instructed to do so by your doctor.

Strengthening

Ankle pumps: With leg resting on bed and knee straight, slowly pump ankle up and down as far as possible.

Quad sets: Tighten thigh muscle and straighten knee as much as possible. Hold 5 seconds.
Glute sets: Tighten buttocks, hold 5 seconds.

Short arc quads: Place a firmly rolled blanket under knee, with foot resting on bed. Straighten knee and hold 5 seconds.

Heel slides: Slowly bend your knee by sliding your foot as close to your buttocks as able.

Long arcs quad: Sit with knees bent. Slowly straighten knee. Hold 5 seconds.

Straight leg raise: Lie on your back with opposite knee bent. Slowly raise leg, keeping knee straight. Hold 2 seconds.

Straight leg raise, sidelying: Bend bottom leg. Keep top leg in line with shoulder and knee straight. Lift slowly. Hold 2 seconds.

Straight leg raise, prone: Lift leg, keeping knee straight. Hold 2 seconds. Optional: place pillow under hips.

Hamstring curls: Slowly bend knee, bringing foot towards buttocks, until you feel a stretch. Hold 5 seconds.

Standing hip flexion: Stand with hand on a support. Lift leg forward, keeping knee straight.

Standing hip abduction: Stand with hand on a support. Tighten outer thigh and lift leg to the side, keeping knee straight and trunk upright.

Standing hip extension: Stand with hand on a support. Tighten buttocks and lift leg behind you, keeping knee straight and trunk upright.

Stretching

Heelcord stretch: Pull heelbone AWAY from patient while pushing ball of foot TOWARDS patient. Hold 20 seconds.

Heelcord stretch 2: Loop towel or elastic band around ball of foot. Pull towards you until stretch is felt on back of calf. Hold 20 seconds.

Knee extension stretch: Gently push down on top of thigh (just above the knee) while lifting calf upward to straighten knee. Hold 20 seconds.

Knee flexion stretch: Lying on stomach, stabilize hip while gently bending knee. Do not allow bottom to rise from bed. Hold 20 seconds.

Hip extension stretch: Stabilize buttocks with one hand while lifting thigh upward with other hand. Hold 20 seconds. Alternate: perform in sidelying.

Hip abduction stretch: Take leg out to side until a stretch is felt on inner thigh. Keep knee straight and avoid leg rolling outward. Hold 20 seconds.

Hamstring stretch: Begin with hip and knee bent in a chair position. Keeping thigh in place, gently straighten knee until stretch is felt on back of thigh. Hold 20 seconds.

Patellar mobility: Locate the top of the knee cap with one hand, and the bottom of the knee cap with the other hand.

• Gently guide the kneecap downward, towards the toes. Hold ___seconds.
• Gently guide the kneecap upward, towards the hip. Hold ____seconds.

Initially after surgery, children may feel afraid to move their limb with the ellipse nail. As the lengthening process begins, their muscles will tighten and weaken somewhat. This is to be expected. The goals of physical therapy are to help keep their muscles flexible and strong, and to help them stay as active as possible throughout the rehabilitation process.

Here are some answers to common questions and concerns your child may have.

When does physical therapy start? Physical therapists will begin working with your child the day after surgery. Your physical therapist will provide an exercise program that you will help your child perform in their room on weekends. Most children are able to go home the Monday following surgery.

If it seems too difficult... At first, your child may need help moving their limb in bed. If it involves their leg, this will include standing and taking a few steps with a walker or crutches. He or she will likely require a wheelchair to get to physical therapy. This is perfectly normal and you will work with your child to help them regain their independence. Most patients are up and walking with a walker or crutches by the time they leave the hospital, using a wheelchair only for long distances outside of the home.

How does physical therapy work? While in physical therapy, your child will work on strengthening and stretching exercises. Your physical therapist will provide an exercise program designed specifically for your child and will make recommendations on whether a walker, crutches or cane is best for them. If your child is able, your therapist will teach them how to walk up and down a small flight of stairs in the physical therapy department as well. Things may go slowly the first day or two, but it will get easier.

Will I have to do this at home? Before your child leaves the hospital, their physical therapist will ask you to demonstrate that you're comfortable assisting him or her with their home exercise program and supervising them while walking. You'll also be asked to show that you can adjust your child's ellipse nail. You will be given a written copy of your child's home exercise plan, including your therapist’s contact information in case you have any questions after you leave. It is very important that you encourage your child to continue to perform their exercise plan as instructed and follow all therapy instructions. This is the proven method to give your child the best quality of life.