Specialista in Ortopedia Pediatrica
Perthes disease (recovery phase and sequelae)
Home Exercise Program
Not every exercise listed here is suitable for every child: the selection is individual and is defined during the consultation.
1.Abduction mobilization (priority exercise)
Maintains hip opening, the most important parameter in Perthes
Child supine on a firm surface, legs straight and pelvis level (not tilted). Slide the affected leg outward along the surface, keeping the kneecap pointing up, to the pain-free limit. An adult can guide the movement supporting the thigh. Always compare range with the healthy side.
10 repetitions with 10-20 second holds, twice daily
2.Prone internal rotation
Restores internal rotation, often limited in active phases
Child prone with knees bent to 90°. Let the legs fall slowly outward (feet moving apart): this produces internal rotation of the hips. Hold the position while breathing calmly. The pelvis stays flat on the surface.
3 × 30 seconds, once or twice daily
3.Prone lying for the hip flexors
Counteracts hip flexion contracture
Have the child lie prone on a firm surface, legs straight and slightly apart, while reading, watching a cartoon or playing. Body weight progressively extends the hip with no active effort. A small pillow under the ankles increases the effect only if it stays pain-free.
15-20 minutes, once or twice daily
4.Abductor strengthening (clam and side-lying abduction)
Strengthens gluteus medius to reduce Trendelenburg limp
Lying on the healthy side, hips and knees flexed, heels together: lift the top knee (clam) without rolling the pelvis backward. Progress with the leg straight, lifting the affected limb 30-40 cm keeping the toes pointing forward. Slow, controlled movement, with no groin pain.
2-3 sets of 10-12 repetitions, every other day
5.Swimming and low-impact activity
Maintains mobility and endurance while unloading the femoral head
Swimming (freestyle and backstroke; avoid breaststroke in active phases because of forced abduction load) and stationary cycling with a high saddle and low resistance are the activities of choice. Avoid running, jumping and contact sports until the specialist allows them.
2-3 sessions per week, 20-30 minutes
RED FLAGS - When to stop and contact the doctor immediately
Stop the exercises immediately and contact the specialist (or go to the emergency department if severe) if any of the following occur:
- Hip or groin pain during exercises
- Worsening limp
- Progressive limitation of hip movements
- Fever, redness or warmth of the joint, or inability to bear weight
In case of doubt, always prefer a check-up over continuing the exercises.
Dott. Daniele Priano
Ortopedia Pediatrica - ASST Gaetano Pini-CTO
ortopediaevolutiva.com • 26/08/2026
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MioDottoreBefore You Start
Who is this guide for?
Children recovering from Perthes disease. Exercises vary greatly depending on disease stage.
What you need
Clear floor space, mat or soft surface, comfortable clothing. Some exercises may require resistance bands or supports.
Suggested frequency
Usually 1-2 times daily, as directed during the visit. Consistency is more important than intensity.
Common mistakes to avoid
- •Performing exercises too quickly without control
- •Pushing beyond the pain threshold
- •Skipping days or doing occasional very long sessions
- •Not warming up before strengthening exercises
⚠️ Red flags — when to stop and contact the doctor immediately
Stop exercises immediately and contact the specialist if any of the following occur:
- Hip or groin pain during exercises
- Worsening limp
- Progressive limitation of hip movements
Detailed Exercises
- 1
Abduction mobilization (priority exercise)
Maintains hip opening, the most important parameter in Perthes
Child supine on a firm surface, legs straight and pelvis level (not tilted). Slide the affected leg outward along the surface, keeping the kneecap pointing up, to the pain-free limit. An adult can guide the movement supporting the thigh. Always compare range with the healthy side.
10 repetitions with 10-20 second holds, twice daily - 2
Prone internal rotation
Restores internal rotation, often limited in active phases
Child prone with knees bent to 90°. Let the legs fall slowly outward (feet moving apart): this produces internal rotation of the hips. Hold the position while breathing calmly. The pelvis stays flat on the surface.
3 × 30 seconds, once or twice daily - 3
Prone lying for the hip flexors
Counteracts hip flexion contracture
Have the child lie prone on a firm surface, legs straight and slightly apart, while reading, watching a cartoon or playing. Body weight progressively extends the hip with no active effort. A small pillow under the ankles increases the effect only if it stays pain-free.
15-20 minutes, once or twice daily - 4
Abductor strengthening (clam and side-lying abduction)
Strengthens gluteus medius to reduce Trendelenburg limp
Lying on the healthy side, hips and knees flexed, heels together: lift the top knee (clam) without rolling the pelvis backward. Progress with the leg straight, lifting the affected limb 30-40 cm keeping the toes pointing forward. Slow, controlled movement, with no groin pain.
2-3 sets of 10-12 repetitions, every other day - 5
Swimming and low-impact activity
Maintains mobility and endurance while unloading the femoral head
Swimming (freestyle and backstroke; avoid breaststroke in active phases because of forced abduction load) and stationary cycling with a high saddle and low resistance are the activities of choice. Avoid running, jumping and contact sports until the specialist allows them.
2-3 sessions per week, 20-30 minutes
Frequently Asked Questions
Why are abduction and internal rotation so important?
In Perthes disease the goal is to keep the femoral head well contained in the acetabulum (containment principle). Abduction and internal rotation are the first movements to be lost: keeping them free favours a spherical remodelling of the femoral head.
Can the child play sports?
During active phases running, jumping and contact sports are avoided. Low-impact activities such as swimming and stationary cycling are generally recommended, maintaining mobility and strength without loading the femoral head. Return to sport must always be agreed at the visit.
