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Physiotherapy - in the hospital

9Orthopaedics and Rheumatology

Our team includes highly specialised physiotherapists and physiotherapy assistants.

We cover a wide range of orthopaedic patients in both the ward and outpatient settings, as well as in the hydrotherapy pool. We have excellent facilities, including a gym, which we use to rehabilitate children back to normal function and fitness.

Some of the areas we cover include:

Rheumatology Physiotherapy


The Rheumatology physiotherapy team are involved in the assessment and management of patients with a diverse range of complex rheumatological conditions.

Chronic inflammatory disorders may include:

  • Juvenile idiopathic arthritis
  • Juvenile – onset systemic lupus erythematosus
  • Juvenile dermatomyasitis
  • Childhood scleroderma
  • Systemic vasculitis

Also under the rheumatology umbrella we care for patients with non-inflammatory conditions such as:

  • Hypermobility
  • Chronic fatigue
  • Chronic pain
  • Other mechanical disorders affecting the musculoskeletal system

Physiotherapy for inflammatory disorders

Some of the inflammatory conditions may be life long and have an enormous impact on the child and adolescent as well as their family.  They require a careful balance between medical management and rehabilitation.

  • Most patients are seen as outpatients
  • All children have an individual assessment
  • A muscular skeletal assessment is done looking at joint and muscle involvement, skin condition, mobility and functional ability
  • Some specific assessment tools may be used as indicated eg CMAS (Childhood Myositis Assessment Scale)
  • A variety of treatment approaches are utilised such as stretching, strengthening, proprioception, functional activities and fitness
  • Patients are continually reassessed throughout the course of treatment, monitoring their condition
  • Children may be referred to other disciplines such as orthotics and hydrotherapy
  • We work as part of a multidisciplinary team which helps communication between the different disciplines and give a more thorough treatment approach
  • Inpatient facilities are available if required


Hypermobility is a description of joint movement.  Hyper means ‘more’ and mobility means ‘movement’.  Ligaments offer stability to joints and in hypermobility, ligaments are lax and joints have more flexibility.  It is not an illness or disease, just the way someone is put together.  It is considered a normal finding by medical professionals.

Many children who are hypermobile experience no symptoms or difficulties and being hypermobile is beneficial in a lot of sports.  It is not fully understood why some children have more symptoms than others.  It is believed that these problems are related to poor muscle strength, poor muscle stamina and poor control of joint movement.

Frequent symptoms may include:

  • Clumsiness and frequent falls
  • Flat feet
  • Clicky joints
  • Tiredness
  • Reluctance to walk longer distances
  • Pain
  • Difficulty with handwriting

Physiotherapy for hypermobility

  • Patients are usually seen as outpatients
  • All children have an individual musculoskeletal assessment looking specifically at joint control through their hypermobile range
  • Individual graded treatment programs are given targeting specific target areas
  • Graded exercises may be given to promote strength fitness and self-management
  • Other members of the multidisciplinary team may  be involved in the care of your child and we have direct referral to orthotics and hydrotherapy as indicated

Chronic Pain

This umbrella term is used to describe pain that lasts longer than the usual anticipated recovery.  Examples include CRPS and widespread musculoskeletal pain.

The symptoms are varied, often including burning, sensitivity to touch, temperature change and colour change.  These symptoms often lead to reluctance to move, which increases pain and leads to secondary problems of weakness, poor function and low morale.

Treatment of chronic pain involves a multidisciplinary approach. Medicines are sometimes helpful and are used in combination with physiotherapy and hydrotherapy.

The role of the physiotherapist involves an individualised program centred around pain management tools aimed at facilitating maximal function.  This is often achieved through exercising and hydrotherapy, but also through advice, support and liaison.

The aim of a physiotherapy package is to help manage pain whilst decreasing its effect on daily life and the problems it causes.  Methods used to achieve this include:

Pain education

  • Problem solving
  • Activities and exercises
  • Pacing
  • Relaxation
  • Sleep
  • Routine and structure

Chronic Fatigue

This refers to abnormal fatigue that is not in accordance with activity.  Young people with chronic fatigue often find themselves out of school and socially isolated.  Debilitating tiredness has a profound effect on a young person and their family.

The role of the physiotherapist involves detailed assessment, analysing daily routines, activity levels and sleep patterns.

The aim of management is to establish a baseline of activity achievable even on a bad day in order to implement gradual increases.  The goal is to improve function, reducing the impact of debilitating fatigue via an individualised program.

Methods employed by the physiotherapist include:

  • Routine and structure
  • Sleep hygiene
  • Graded exercise therapy
  • Pacing and activities eg school and social life
  • Liaison and support and advice

Other responsibilities of the team

  • Attend weekly MDT meetings and training sessions
  • Involvement in teaching internally, as well as attending external courses
  • Networking with local and national interest groups
  • Attending and speaking at national conferences
  • Weekly attendance in clinics

Research and development

  • Currently doing an AHP (Allied Health Professional) audit on Juvenile lupus services across the UK
  • Research comparing generalised versus targeted physiotherapy in the management of childhood hypermobility
  • Ongoing audit of physiotherapy referral patterns/patient numbers

Please visit The Rheumatology department for further information

Musculoskeletal out-patients

Musculoskeletal physiotherapy deals with any problem related to your muscles, bones, ligaments and tendons, as well as issues related to growth and development, i.e. “Growing Pains”. We will help get your joints moving and re-build muscle strength and confidence after an operation or injury, and will help restore function to get you back doing the things that you enjoy doing. You will be reviewed by a specialist Physiotherapist who will advise you on exercises and stretches to help speed up your recovery, and will also use our new gym as part of your rehabilitation.  They may also decide to book you into the pool for Aquatic Therapy.


Haemophilia is a range of genetic disorders relating to abnormalities in the bodies ability to control the clotting of it’s blood, and this can lead to pains in joints and muscles caused by bleeds. Alder Hey has a regional centre for patients suffering from this condition covering an expansive region of North West England and Wales. Our therapists work closely with the doctors and nurses in the team and work, not only to rehabilitate problems caused by bleeds, but also to prevent them happening in the first place. We offer advice and education on the importance of keeping fit, healthy, strong and flexible to make sure that children with Haemophilia lead as normal a life as possible.

See factor fitness for more advice on sport and fitness with Haemophilia.

The Physiotherapy service at alder hey also carries out the Haemophilia Joint Health Score, an annual assessment of patients with Haemophilia. This is in line with national guidelines and helps monitor for any deterioration, and highlight any concerns that may damage the patient’s joints. (

Limb reconstruction and Ilizarov

11Limb reconstruction is a method of helping children with congenital and acquired problems and deformities of the bones, joints and soft tissues of their arms and legs. Alder Hey is a regional centre for Limb reconstruction and has a highly specialized team of Surgeons, Nurses and Physiotherapists who work closely together to monitor and review these patients to rehab them through the various stages of their recovery. The aim of physiotherapy in Limb Reconstruction is to maintain and maximize joint motion, muscle strength and to ensure that the children remain as mobile as possible. This may be done on the ward (if the child is an inpatient), in our department, the gym and even the Aquatic therapy pool.

Burns & Plastics


Burns Physiotherapy

Burns physiotherapy specializes in restoring or keeping movement and function after a burn injury. Input is very important during the healing stages of a burn. Burns can be very uncomfortable and children can be reluctant and scared to move which can lead to problems.

Our physiotherapist may use exercises, splints, fun activities and aquatic therapy in the rehabilitation process. Patients are seen as inpatients and outpatients and  during any dressing changes until maximum potential is realised.

We provide advice and support in returning to school and sporting activities.

Plastic Surgery

Plastic surgery involves specialist hand surgery including reconstruction and repair of tendons, arteries and nerves.

Physiotherapy aims to resolve maximum movement and function following surgery and can involve splinting, exercises and functional activities.

Please visit Plastic Surgery – Regional Paediatric Burns and Plastic Surgery Service for further information.

Major trauma

Alder Hey is a designated Major Trauma Centre for children and is part of the North West Children’s Major Trauma Network. One of our physiotherapists Sharon Charlton has a duel role and works as the Trauma Rehabilitation Co-ordinator. This role ensures that the children involved in a major trauma receive co-ordinated care throughout their rehabilitation both in hospital and the community. A team of therapists support this role at the weekend on a rota basis to ensure 7 day coverage.


Please visit Orthpaedics and Trauma for further information


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