Orthopaedic Physiotherapy

Targeted review into care of orthopaedics patients

We are carrying out a review into the care of some of our patients and have contacted them directly.

We asked the Royal College of Surgeons to review our paediatric orthopaedic service, after concerns were raised by a number of our patient families and staff.

We take all concerns incredibly seriously and have written directly to all those patients and their families who may be affected. We know that for them this could be a worrying time and we are sorry for the concern these letters may have caused.

We are committed to learning from every single patient that we treat, and to being open and transparent with our families when care falls below the high standards we strive for.

If you have any questions about the review, please contact our Patient Advice Liaison Service (PALs) on 0207 829 7862 or by email PALS@gosh.nhs.uk.

Orthopaedics is the specialty that treats diseases or injuries of the body's musculoskeletal system. This system includes your bones, joints, ligaments, tendons, muscles, and nerves and allows you to move, walk and be active. At Great Ormond Street Hospital (GOSH) we specialise in treating babies, children and teenagers with often rare and complex congenital (born with) and developmental orthopaedic conditions.

We primarily offer physiotherapy treatment as an inpatient service for children who have had elective orthopaedic or spinal surgery to assist with regaining mobility and function to be discharged from hospital.

In the out-patient setting we work closely with the orthopaedic and spinal consultants and the multi-disciplinary team in regards to decision making for planned surgery and post-operative management.

We also provide the following outpatient services:

  • physiotherapy-led Ponseti clinic for management of infants with congenital talipes equinovarus (CTEV, clubfoot)
  • harness treatment for infants with developmental dysplasia of the hip (DDH)
  • serial casting (plastering)
  • hydrotherapy (exercises in water)
  • spinal consultation clinics – including management of chronic back pain and scoliosis.

We do not offer ongoing physiotherapy sessions beyond the inpatient setting or a consultancy role in clinics but work closely with local therapy services to ensure a child’s ongoing physiotherapy needs are met in a setting closer to home.

A referral for an assessment by the orthopaedic or spinal team is made directly to an orthopaedic consultant at GOSH by a child’s community paediatrician, paediatric or orthopaedic consultant from another hospital. Referral information can be found in the orthopaedic and spinal surgery pages. The physiotherapy team at GOSH cannot accept direct referrals from outside of the hospital.

Conditions commonly seen by the Orthopaedic Physiotherapy Team

  • Scoliosis – we offer specialist assessment and advice in clinic and inpatient settings. We see children who are undergoing surgery including both idiopathic scoliosis and neuromuscular scoliosis with complex needs.
  • Back pain and spinal pathology – specialist assessment and triaging for further investiagtion / management.
  • Limb reconstruction– we offer a highly experienced physiotherapy service for children undergoing limb lengthening or deformity correction including with external fixators or internal lengthening nails. This may include inpatient admissions for rehabilitation.
  • Club foot (congenital talipes equinovarus) – we offer a physiotherapy-led Ponseti (serial plaster casts) service.
  • Cerebral palsy – we offer specialist assessment of children with complex movement disorders, to help determine if surgery or other interventions may improve a child’s ability to perform functional skills or sit more comfortably in their wheelchair. This may involve surgery to the bones or muscles, recommendations for orthotics or botulinum toxin injections to relax muscles.
  • Neuromuscular – We work closely with the neuromuscular service at GOSH to provide opinion and therapy input if and when orthopaedic surgery is indicated for children with neuromuscular conditions such as muscular dystrophy and peripheral neuropathies.
  • Developmental dysplasia of the hip – we offer treatment for babies in harnesses to treat under developed hips and provide rehabilitation for older children who require surgical intervention.
  • Osteogenesis imperfecta – we are experienced in providing physiotherapy for children undergoing treatment for associated fractures or preventative surgery.
  • Arthrogryposis – we offer assessment and advice for children with this condition to help with decision making for surgery and recovery afterwards. 

What a physiotherapist does and how it will help

A physiotherapist plays an essential role within the multidisciplinary team of doctors, nurses, occupational therapists, psychologists and play therapists. The aim of physiotherapy is to get joints and muscles moving and to gain functional skills, such as learning to walk with crutches or a frame.

An experienced physiotherapist will complete an assessment of all children who are going to have orthopaedic surgery. The physiotherapy assessment is essential in aiding decision-making regarding surgery or other recommendations, for example botulinum toxin, orthotics, specialist equipment and physiotherapy programmes. It also allows us to prepare you and your child for surgery, answer questions, and plan what help and further physiotherapy might be needed after you are discharged home.

A physiotherapist will help your child after surgery to regain mobility and independence in order to be discharged home.

What physiotherapy might involve

Prior to surgery or during an outpatient visit your child will have an assessment by a physiotherapist. This assessment records joint ranges, muscle length, muscle tone, and age-appropriate functional skills such as crawling, standing, balance, walking and running.

If your child requires surgery they will be seen by a physiotherapist on the ward. The physiotherapist will help your child start moving (this may involve using crutches or a walking frame) to reach a level where they are safe to go home. This can include exercises based on Sky Ward in bed, in the play room, multisensory room or in our physiotherapy gym. Other treatments might involve application of plasters or providing splints. We aim to make sessions as fun as possible and use games and toys to promote physical activity.

To ensure each child reaches their best physical outcome, we will offer advice and exercises to do at home. We will communicate with physiotherapy teams closer to your home, when required, to ensure your child’s ongoing physiotherapy requirements are met.