Early detection and effectiveness of physical therapy in avascular necrosis of the hip

I’ve treated a 4-year-old boy complaining of pain in the hip (L) region. His mother noticed that he wasn’t playing and as active as he used to be and he walked differently- limping to the right side. His condition prompted them to seek medical care. After an x-ray of the hip it clearly illustrated necrosis of the left hip joint.

Legg-Calve-Perthes (avascular necrosis of the hip joint) – is a condition in children that effects the hip, where the thighbone (femur) and pelvis meet in a ball-and-socket joint. It occurs when blood supply is temporarily obstructed to the ball part (femoral head) of the hip joint. Without sufficient blood flow, the bone begins to perish — it more likely to break and heals extremely slow.


Signs and symptoms of Legg-Calve-Perthes disease include:

  • Limping
  • Pain or stiffness in the hip, groin, thigh or knee
  • Limited range of motion of the hip joint in all planes

Risk factors for Legg-Calve-Perthes disease include:

  • Age: Although Legg-Calve-Perthes disease can affect children of nearly any age, it most commonly occurs between ages 4 and 8.
  • Gender: Legg-Calve-Perthes is up to five times more common in boys than in girls.
  • Race: White children are more likely to develop the disorder than are black children.
  • Family history: In a small number of cases, Legg-Calve-Perthes appears to run in families.


Children who have had Legg-Calve-Perthes disease are at higher risk of developing hip arthritis in adulthood — particularly if the hip joint heals in an abnormal shape. The younger the child is, the better the chances are that the hip will heal correctly molding into the correct shape.

This particular patient I treated had a series of physical therapy treatments, which included a lot of stretching. A big and important part of the home treatment plan was the range of motion exercises , which required intensive parent involvement.

As a result of their perseverance and eagerness to regain their kid’s health,they were very compliant with the treatment plan, not missing a single session. And, the patient was discharged for treatment with successful results. He is now pain-free and plays like a normal 4 year old and still continues to do his home exercises. And the latest X-ray of the hip joint showed an immense improvement.




Another patient came to EEMC complaining of tightness and pain in her upper hip. Due to her condition she’s not been able to walk for long periods of time and she has limited movement in that area of the hip. She consulted an orthopedic doctor and they advised to go the surgery route.

She was looking for an alternative, more conservative option. She consulted one of our chiropractors and upon evaluation it was obvious that the muscles were tight and the range of motion in her right hip was very limited due to necrosis of the hip joint. She underwent chiropractic treatment as well as had a series of physical therapy treatments.

bridging - physio exercise

Therapeutic ultrasounds in the pre-stretch position, stretching, and contract-and-relax techniques to loosen the muscles, was all part of her treatment plan. Due to limited time, she had only 6 sessions of physical therapy and had an successful increase in range of motion with almost no pain.