Physical Therapy Guide to Slipped Capital Femoral Epiphysis
Slipped capital femoral epiphysis is the most common hip disorder in children aged 12 to 16 years. It affects one in every 10,000 children in the United States. The exact cause of SCFE is unknown. However, puberty, body mass and obesity, trauma, or other factors may contribute to it. SCFE occurs two to three times more in males than in females. It affects both hips 40% of the time. A physical therapist can help recognize early signs of SCFE in a child with a limp. Physical therapists treat SCFE by helping maintain strength, joint motion, and hip stability before or after other medical treatments. A physical therapist also can design a program to help prevent arthritis from developing in the affected hip.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
What Is Slipped Capital Femoral Epiphysis?
Slipped capital femoral epiphysis is a hip problem. It involves the long bone of the thigh (femur), the ball of the hip joint (the head of the femur), and the nearby growth plate (area of a bone where new bone forms). Growth plates are made of cartilage, which is weaker than bone. SCFE happens when the head of the femur slips along the growth plate. SCFE can occur in one hip or both hips.
How Does It Feel?
Symptoms of SCFE may include:
- Limping and trouble walking.
- Pain in the hip, knee, groin, or around the knee.
- Decreased range of motion and movement in the hip and knee.
More severe cases may result in:
- An appearance the leg is turned outward.
- Pain felt when bearing weight on the leg.
- An overall loss of function.
The most common symptom of SCFE is limping. The child often feels pain around the hip, groin, upper thigh, or inner knee. It is easier to move the hip and leg when pointing the foot outward. Doing so rotates the hip into a more comfortable position. Hip motion is limited and painful when the leg is turned and the foot points inward. There is also muscle weakness around the affected hip.
As slippage worsens, inflammation and pain occur. Everyday activities may become harder. A child may refuse to put weight on the affected leg due to pain. Not using the hip joint properly can result in muscle weakness in the hip and leg and decreased flexibility. In some cases, one leg may appear shorter than the other.
Children with SCFE are typically males, aged 10 to 15 years, who are going through a growth spurt. The disorder usually begins in just one hip. Later, slippage may occur in the other hip, even if the child has received treatment for the first hip.
A child's symptoms may disappear for periods of two to three weeks. This pattern of pain and limping followed by no symptoms may create doubt a problem exists. This doubt may cause the family to dismiss the urgency of the initial symptoms. Children with SCFE symptoms should see a health care provider as soon as possible.
How Is It Diagnosed?
Early diagnosis is linked to better outcomes. A medical doctor is often the first health care provider to diagnose SCFE. If a physical therapist is the first to observe symptoms, they will refer the child to a specialist for a diagnosis. Medical doctors diagnose SCFE based on symptoms, watching the child walk, doing a physical exam, and reviewing imaging tests. SCFE is typically found on X-rays. Your medical doctor may order an MRI or CT scan to confirm the diagnosis. Imaging also allows for precise measurement of any deformity (degree of the slip). It helps determine if the hip is at risk of slipping further. In rare cases, the cartilage on the hip joint can break down and lead to long-term loss of motion in the affected hip.
Doctors will grade the severity of the slip and joint deformity as follows:
- Pre-slip (no displacement of the head of the femur).
- Mild slip (up to one-third displacement).
- Moderate slip (one-third to one-half displacement).
- Severe slip (the head of the femur has slipped more than halfway down the growth plate).
There are two categories of SCFE:
- Category 1: A stable condition involves a mild slip of the femoral head (the ball part of the upper thigh bone). With category 1, a child is usually able to walk or use crutches for longer distances. They may have pain and stiffness in the affected leg and walk with a limp. Rest often relieves pain, but it returns with activity.
- Category 2: A significant downward slip of the femoral head creates an unstable and serious condition. A child with category 2 needs immediate treatment to protect the tissues around the hip joint. Because the hip is unstable, the child is unable to walk. The child likely will refuse to put weight on the affected leg, even when offered crutches or a walker. Symptoms of unstable SCFE are an emergency.
Early diagnosis may reduce the severity. Diagnosis also is important to help your health care team select treatments for the best possible outcomes.
How Can a Physical Therapist Help?
The hip is the body's strongest and most stable joint. Any serious issue in the hip should be examined as soon as possible. A physical therapist may be the first health care provider to identify the symptoms of SCFE or rule out other hip problems. If you see a physical therapist first, they will refer you to a medical doctor for more diagnostic tests. In serious cases, physical therapists treat children with SCFE before and after surgery.
Evaluation is very important for guiding the treatment of SCFE. Your physical therapist will conduct a thorough assessment that includes:
- Taking a health history.
- Discussing the child's pain symptoms in detail.
- Detecting risk factors related to the condition.
- Reviewing lab tests and X-rays or other images.
- Observing the child's walking ability and movement function.
- Conducting a hands-on physical assessment.
Physical therapists work closely with children and their caregivers to develop treatment programs specific to them to help promote a return to full activity. Your physical therapist will work with you and your child to ensure they safely perform daily activities. The physical therapist also may recommend temporary ways to modify activities to protect the hip joint.
The goals of physical therapy treatment for SCFE are to reduce pain and prevent the development of arthritis in the future. The focus is on keeping the head of the femur stable while maintaining joint motion and leg strength. When surgery is needed to stabilize the bone and prevent further slippage, physical therapy can help before and after the procedure.
Treatment Following Surgery
The most common type of surgery is called screw fixation. It uses hardware to secure the head of the femur to the main femur bone through the growth plate. After surgery, the orthopedic surgeon will provide recovery and treatment guidelines. Physical therapy after surgery begins with:
- Reducing joint and soft tissue inflammation.
- Managing pain.
- Assisting muscle activation and leg movement.
As healing progresses, physical therapy involves:
- Strengthening exercises.
- Increasing range of motion.
- Helping the child increase their mobility.
- Introducing functional activities and play in the final stages of recovery.
Before and after surgery, a child may use crutches to protect the hip. Your physical therapist will help select and teach your child how to safely use an appropriate walking aid. A child who needs more support may use a walker before progressing to crutches or a cane. Physical therapists help children with SCFE return to pain-free walking, running, and other fun activities.
Can This Injury or Condition Be Prevented?
There is no sure way to prevent SCFE. There are several known risk factors for SCFE. These include:
- Obesity (due to increased weight and pressure on the growth plate).
- A family history of SCFE.
- A history of SCFE on one hip.
- Male gender.
- African American or Pacific Islander descent.
- Endocrine (hormone) disorders, such as thyroid issues, diabetes, or growth hormone imbalances.
Children can reduce the chances of developing SCFE by keeping a healthy weight, especially during the teen years. A healthy diet and regular physical activity are important throughout every child's development. Studies show that children who lose weight after having SCFE in one hip greatly reduce their risk of developing SCFE in the other hip. Correcting any potential hormone or metabolism issues (the process by which food gets converted into energy) diagnosed by your child's medical doctor may help with prevention. There is debate whether surgery to secure the other, unaffected hip is the best way to prevent future SCFE on the opposite side once it has occurred in one hip. You may consult a doctor or physical therapist for guidance to reduce your child's chances of developing SCFE. Early diagnosis is best to promote long-term muscle and bone health of the hip and leg.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat patients with SCFE. However, you may want to consider the following:
- A physical therapist who is experienced in pediatrics, developmental disorders, and orthopedics. A pediatric physical therapist may work with you and your child in the clinic, home, school, or community environment.
- A physical therapist who is a board-certified clinical specialist or who has completed a residency, fellowship, or training in pediatric or orthopedic physical therapy. This physical therapist has advanced knowledge, experience, and skills that apply to SCFE.
- An experienced pediatric physical therapist who also understands the importance of working with other health care providers to maximize outcomes for children with SCFE.
- A physical therapist who focuses on treating children with developmental orthopedic disorders.
You can find physical therapists in your area with these credentials and clinical expertise on Find a PT, a tool built by the American Physical Therapy Association.
The APTA Academy of Pediatric Physical Therapy contributed to this consumer resource. It is for informational purposes only and is not intended to represent the position of APTA Pediatrics.
The American Physical Therapy Association believes that consumers should have access to information to help them make informed decisions and prepare them for their visit with a health care provider.
The following resources offer some of the best scientific evidence related to physical therapy treatment for SCFE. They report recent research and provide information on the standards of practice both in the United States and internationally. They link to a PubMed* abstract (which may also offer free access to the full text) or other resources. You can read them or print out a copy to bring with you to your health care provider.
Wylie JD, Novais EN. Evolving understanding of and treatment approaches to slipped capital femoral epiphysis. Curr Rev Musculoskelet Med. 2019;12(2):213–219. Article Summary on PubMed.
Ucpunar H, Camurcu IY, Duman S, Ucpunar E, Sofu H, Bayhan AI. Obesity-related metabolic and endocrine disorders diagnosed during postoperative follow-up of slipped capital femoral epiphysis. Acta Orthop. 2018;89(3):314–319. Article Summary on PubMed .
Peck DM, Voss LM, Voss TT. Slipped capital femoral epiphysis: diagnosis and management. Am Fam Physician. 2017;95(12):779–784. Article Summary on PubMed.
Millis MB. SCFE: clinical aspects, diagnosis, and classification. J Child Orthop. 2017;11(2):93–98. Article Summary on PubMed .
Thawrani DP, Feldman DS, Sala DA. Current practice in the management of slipped capital femoral epiphysis. J Pediatr Orthop. 2016;36(3):e27–e37. Article Summary on PubMed.
Kidshealth. Slipped capital femoral epiphysis (SCFE). Kidshealth website. Reviewed September 2016. Accessed February 17, 2021.
Slipped capital femoral epiphysis. American Academy of Orthopaedic Surgeons website. Reviewed June 2016. Accessed February 17, 2021.
Clement ND, Vats A, Duckworth AD, Gaston MS, Murray AW. Slipped capital femoral epiphysis: is it worth the risk and cost not to offer prophylactic fixation of the contralateral hip? Bone Joint J. 2015;97-B(10):1428–1434. Article Summary on PubMed.
Peck K, Herrera-Soto J. Slipped capital femoral epiphysis: what's new? Orthop Clin North Am. 2014;45(1):77–86. Article Summary on PubMed.
Georgiadis AG, Zaltz I. Slipped capital femoral epiphysis: how to evaluate with a review and update of treatment. Pediatr Clin North Am. 2014;61(6):1119–1135. Article Summary on PubMed.
Podeszwa DA, Gurd D, Riccio A, et al. Increased acetabular depth may influence physeal stability in slipped capital femoral epiphysis. Clin Orthop Relat Res. 2013;471:2151–2155. Article Summary on PubMed.
Wabitsch M, Horn M, Esch U, et al. Silent slipped capital femoral epiphysis in overweight and obese children and adolescents. Eur J Pediatr. 2012;171:1461–1465. Article Summary on PubMed.
Fabry G. Clinical practice: the hip from birth to adolescence. Eur J Pediatr. 2010;169:143–148. Article Summary on PubMed.
Hart ES, Grottkau BE, Albright MB. Slipped capital femoral epiphysis: don't miss this pediatric hip disorder. Nurse Pract. 2007;32:14–21. Article Summary on PubMed.
Aronsson DD, Loder RT, Breur GJ, Weinstein SL. Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg. 2006;14:666–679. Article Summary on PubMed.
Wills M. Orthopedic complications of childhood obesity. Pediatr Phys Ther. 2004;16(4):230–235. Article Summary on PubMed.
*PubMed is a free online resource developed by the National Center for Biotechnology Information. PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.