Recovery after guided growth around the knee: motion, walking and return to activity.
Functional recovery generally takes weeks; growth monitoring continues throughout treatment.
The treating team selects exercises individually during the consultation. Choosing or progressing exercises without medical guidance can be dangerous. Follow only the assigned phase, activities and amounts; no progression is automatic.
Scope and before starting
For isolated hemiepiphysiodesis around the knee. Not for osteotomy or associated procedures needing different protection. Physiotherapy addresses identified deficits; not every child needs a prolonged programme.
Weight bearing and motion
Often permitted early after an isolated procedure, as specified at discharge. Use crutches while needed for controlled gait.
Follow-up
Record operation date, site/side and alignment review. Feeling well does not justify missing reviews or deciding implant removal.
Move and use the leg within discharge instructions; crutches help while you limp. If permitted loading or movements are missing from your handout, ask for these to be completed before starting.
You do not need every exercise: we select those useful for your recovery.
Do not miss alignment reviews even if you have no pain.
Treatment phases and illustrated exercises
Exercises are shown in their assigned starting phase, with their instructions and precautions. The physiotherapist selects them for the individual plan; the complete protocol is not a prescription to perform them all.
Respect the minimum times and protection required for the procedure. Time alone does not authorise progression: the treating team checks the clinical criteria.
1. Walking and movement
First days, following discharge instructions
Goals
Settle discomfort and regain independence.
Physiotherapy plan
Active knee movement without forcing; static quadriceps contractions in the permitted position.
Walking with the necessary aids and stair training.
Precautions
Protect the wound; no running or hopping while walking is painful or limping.
Criteria the treating team checks before progression
Pain controlled and no signs of wound complications.
Walking and motion improving.
Illustrated exercise options
Gentle quadriceps activation
Only if the treating clinician permits this contraction during protection; respect prescribed immobilisation and position.
Lie with the leg supported in the permitted position and gently tighten the front of the thigh.
Do not lift the heel, push on the knee with your hands or add weights.
Relax completely between attempts. Stop if joint pain develops.
Dose and progression: Use the sets, repetitions or duration, rests and frequency written in your individual handout. Stop before movement control deteriorates; do not choose the dose from the illustration.
Heel slide
After clearance for motion and any brace removal; only within the prescribed range.
Lie on your back and slide the heel towards the pelvis along the supporting surface.
Stop at the permitted movement limit, even if the figure shows greater flexion.
Return slowly without forcing, pulling with a strap or adding resistance.
Dose and progression: Use the sets, repetitions or duration, rests and frequency written in your individual handout. Stop before movement control deteriorates; do not choose the dose from the illustration.
Walking with crutches and prescribed foot contact
Only when some foot contact is permitted. The figure does not show a fully non-weight-bearing pattern: if contact is prohibited, you need specific instruction.
Have the crutches adjusted and learn the sequence appropriate to your loading limit from the physiotherapist.
Practise on a level, clear path with an adult nearby; the foot contacts the ground only as prescribed.
Stop if limping, pain or fatigue increase. Practise stairs with assistance; do not stop using crutches solely because pain decreases.
Dose and progression: Agreed short distances with rests; duration and frequency depend on prescribed loading and gait quality.
2. Functional recovery
Over the following weeks, if needed
Goals
Restore movement and everyday strength.
Physiotherapy plan
After safe walking, progress from chair rises to low steps; supported firm-ground balance, then single-leg stance if controlled. Select according to deficits.
Gradually increase walking and school activity; cycling if useful and tolerated.
Precautions
Do not train through increasing pain over the implant.
Criteria the treating team checks before progression
Walking and stairs without a significant limp.
Walking, a low step-up and single-leg stance controlled without later swelling; compare movement quality across reviews.
Illustrated exercise options
Wall-supported mini-squat
Only after clearance for full weight bearing and strengthening; use the range selected by the physiotherapist.
With your back against the wall as shown, place the feet slightly forward and keep within prescribed loading.
Slide down a short distance within the range set by the physiotherapist, with knees pointing in the same direction as the feet.
Return slowly. Do not copy the illustrated depth if it exceeds your prescribed limit.
Dose and progression: Use the sets, repetitions or duration, rests and frequency written in your individual handout. Stop before movement control deteriorates; do not choose the dose from the illustration.
Supported low step-up
After clearance for full weight bearing and single-leg strengthening; height and range selected by the physiotherapist.
Use a stable step, lower than the drawing if needed, near a handrail or secure support.
Place the whole treated foot on the step and rise slowly, keeping knee and foot aligned and the pelvis controlled.
Step down with assistance as taught. Do not add weights or increase height if pain, limping or swelling develops.
Dose and progression: Use the sets, repetitions or duration, rests and frequency written in your individual handout. Stop before movement control deteriorates; do not choose the dose from the illustration.
Firm-ground balance
After clearance for full weight bearing and single-leg support; practise first with the physiotherapist.
On firm ground with eyes open, slightly lift the other foot while keeping the pelvis level.
Keep one hand on a stable support as illustrated; an adult must be able to assist the child.
Put the free foot down before losing control. Do not add cushions, closed eyes or perturbations.
Dose and progression: Use the sets, repetitions or duration, rests and frequency written in your individual handout. Stop before movement control deteriorates; do not choose the dose from the illustration.
3. Play and sport
When function and the wound allow
Goals
Resume usual activities.
Physiotherapy plan
After normal walking and stairs, practise straight running with the physiotherapist; once tolerated, add small hops with controlled landings, then deceleration and direction changes.
Gradual return to training.
Precautions
Continue growth and alignment reviews even after functional recovery.
Criteria the treating team checks at the end of the pathway
Required activity tolerated without pain or swelling.
Orthopaedic instructions followed.
Illustrated exercise options
Straight-line walk–run progression
Only after running clearance under this protocol and assessment of motion, strength and control. Also respect the protection period for the injury or operation.
On level, even ground, alternate walking with short bouts of easy straight-line jogging according to the physiotherapist’s programme.
Keep an even gait without limping. Begin without sprinting, hills, jumping or direction changes.
Increase one demand at a time. If joint pain, limping or swelling occurs during the work or the next day, stop the progression and report it to the physiotherapist.
Dose and progression: Run/walk intervals, duration and recovery set by the physiotherapist for the procedure, age and response to loading; the phase does not provide an automatic dose.
Small two-foot forward hops
Only after jump clearance and an on-the-spot landing check by the physiotherapist. The figure shows the forward progression, to introduce with them.
With the physiotherapist, make one small two-foot forward hop on a firm, even surface, as illustrated.
Land on both feet with control and pause before repeating. The physiotherapist selects distance and number of hops; no sideways or single-leg hops without further instruction.
Stop for pain or loss of control and report pain or swelling afterwards.
Dose and progression: Initial attempts and dose selected by the physiotherapist; increase only after checking the subsequent response.
Planned braking and direction changes
After tolerating straight-line running and receiving specific clearance for braking and direction changes. First practise with the physiotherapist; this is not an initial running exercise.
With the physiotherapist, begin with controlled slowing and wide turns at low speed in agreed directions.
Control the trunk, knee and foot. Increase speed and turning angle separately; sharp, reactive or contact movements require further assessment.
Stop for pain, giving way or limping; also report swelling or pain after the session and the next day.
Dose and progression: Intervals, rests and recovery days selected for age, sport and previous level. No independent maximal tests; tolerate full training before competition.
Return to sport / full activity
Sport recovery is separate from alignment correction, which continues with growth.
Healed wound and no significant knee swelling.
Controlled, pain-free walking, stairs and sport-specific movements.
Return compatible with the surgeon’s instructions.
Warning signs: stop and contact the treating team
Fever, increasing wound redness or warmth, or drainage: contact the surgical team the same day, even without fever.
Increasing pain, new locking, persistent swelling or loss of regained movement: stop progression and arrange reassessment.
A cold or pale foot, reduced sensation or severe pain under a cast/brace needs urgent assessment. Breathing difficulty or chest pain is an emergency.
Guidelines and literature
Sources inform the pathway; they do not validate every dose for an individual child.
A framework to personalise with the orthopaedic clinician and physiotherapist, not a replacement for an individual prescription. Respect protection and clinical criteria, not dates alone.
Select the exact phase assigned by the treating team, then choose each prescribed activity. No exercise is selected automatically. The team sets loading, movement, aids, dose and frequency; missing instructions must be completed before use, including by hand.
Browse illustrated exercise options
Only if the treating clinician permits this contraction during protection; respect prescribed immobilisation and position.
After clearance for motion and any brace removal; only within the prescribed range.
Only when some foot contact is permitted. The figure does not show a fully non-weight-bearing pattern: if contact is prohibited, you need specific instruction.
Only after clearance for full weight bearing and strengthening; use the range selected by the physiotherapist.
After clearance for full weight bearing and single-leg strengthening; height and range selected by the physiotherapist.
After clearance for full weight bearing and single-leg support; practise first with the physiotherapist.
Only after running clearance under this protocol and assessment of motion, strength and control. Also respect the protection period for the injury or operation.
Only after jump clearance and an on-the-spot landing check by the physiotherapist. The figure shows the forward progression, to introduce with them.
After tolerating straight-line running and receiving specific clearance for braking and direction changes. First practise with the physiotherapist; this is not an initial running exercise.
Choose the current phase to prepare a printable sheet.
Phase safety summary ·
COMPLETE BEFORE EXERCISING — The treating team must complete the blank instructions, including handwritten entries, before this sheet is used.
Follow the assigned phase and instructions confirmed by the treating team; filling in fields does not authorise exercise.
No exercises assigned. This is a safety summary, not a complete exercise prescription.
Individual instructions for this phase
Loading (how much weight on the leg): ________________________________
Brace and crutches: ________________________________
Procedure and starting conditions
Weight bearing and motion: Often permitted early after an isolated procedure, as specified at discharge. Use crutches while needed for controlled gait.
Follow-up: Record operation date, site/side and alignment review. Feeling well does not justify missing reviews or deciding implant removal.
Advice before starting
Move and use the leg within discharge instructions; crutches help while you limp. If permitted loading or movements are missing from your handout, ask for these to be completed before starting.
You do not need every exercise: we select those useful for your recovery.
Do not miss alignment reviews even if you have no pain.
Warning signs: stop and contact the treating team
Fever, increasing wound redness or warmth, or drainage: contact the surgical team the same day, even without fever.
Increasing pain, new locking, persistent swelling or loss of regained movement: stop progression and arrange reassessment.
A cold or pale foot, reduced sensation or severe pain under a cast/brace needs urgent assessment. Breathing difficulty or chest pain is an emergency.
A framework to personalise with the orthopaedic clinician and physiotherapist, not a replacement for an individual prescription. Respect protection and clinical criteria, not dates alone.
A framework to personalise with the orthopaedic clinician and physiotherapist, not a replacement for an individual prescription. Respect protection and clinical criteria, not dates alone.
💬
💙
Any questions?
For information or questions, email me or view the locations and contact details.
