What Is Botulinum Toxin?
Physiotherapy Advice for Patients having Botulinum Toxin – Lower Limb
What is Botulinum toxin?
Botulinium toxin (commonly referred to as Botox) is a treatment used to relax muscles.
Botox is injected into specific muscles to reduce the stiffness and tone. It prevents the nerve from over stimulating the muscle by blocking the link between the two.
This allows tight muscles to relax, stretch and grow. It may assist with function or improve pain. It may also impact on posture, possibly preventing permanent deformity or surgery.
How is the treatment carried out?
The injection is given directly into the affected muscle, usually under general anaesthetic and is performed by the Orthopaedic surgeon. This takes place often as a day case, in Dumfries and Galloway Royal Infirmary.
A number of different muscles often have to be targeted at the same time to make sure that the lower limb and pelvis are aligned in the best way possible. This will be discussed with parents prior to the Botox taking place.
When will Botox start working and for how long?
The Botox should start to work 2 - 3 days after the injection and reach its maximum effect on the muscle around 2 - 4 weeks after. Botox normally works for 3 - 4 months until the nerve makes new links with the muscle and starts to over stimulate again causing some tightness and tone to recommence.
The benefits of Botox injections can only be fully achieved if used alongside a physiotherapy programme. It is therefore essential to liaise with your physiotherapist to ensure that the correct stretches and exercises are in place prior to going for the Botox treatment.
If the Botox has had a beneficial effect, it can be repeated.
Are there any side effects?
As with all medicines, there are possible side effects. However, treatment is usually well tolerated and the side effects are mild and temporary in the first weeks.
After a Botox treatment your child may be sleepier than usual for 24 hours as the sedation wears off. Your child may experience some discomfort around the injection site which should only last for a couple of days. Other side effects may include muscle weakness, tiredness, muscle aches and pains, flu-like symptoms, sickness or temporary incontinence or constipation.
Usually your child should feel well enough to return to school a day or so after the treatment. If your child is unduly sleepy or unwell, seek medical advice.
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Are other therapies/treatments required alongside Botox?
Botox injections are not a stand-alone treatment and should only be considered as part of a wider management programme.
As the Botox only works for a relatively short period of time, it is important to make the most of this ‘window of opportunity’. Different therapies may be required to achieve the optimal outcome. These may include:
- Splinting – this involves the application of foot or ankle orthoses to help position the foot and prevent unwanted movements.
- Serial casting – this involves the application of a cast which is changed frequently to increase the range of movement at a specific joint and maximise the muscle stretch.
Physiotherapy
It is generally essential to carry out stretches pre and post Botox to maximise the effects of the injection. Common stretches for specific muscles are shown in this leaflet.
All stretches should be held for a minimum of 20 seconds and repeated 5 - 10 times depending on tolerance. Seek advice from your physiotherapist as required.
It may also be important to also carry out strengthening exercises whilst the muscles are relaxed to improve function, posture and gait and maximise long term effects. Your physiotherapist will prescribe specific exercises and activities for you/ your child during this time.
If you are having Botox and have not been contacted by your physiotherapist, please contact the department on the numbers at the end of this leaflet.
Calf Muscle/ Cup one hand around heel. Keep inside of forearm in contact with the sole of the foot towards a right angle stabilising the leg with the other hand. / / Stand leaning against the wall with the leg to be stretched behind, keep the foot pointing straight ahead and the heel down on the floor, lean forward until stretch felt in the back of the calf.
Hip flexors
/ Bend one leg up to the chest and use your hand to keep the other leg straight on the floor to stretch the front of the thigh. / / Child lies on their tummy, try to get their hips and pelvis flat on the floor.
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Hamstrings/ Hold the leg so that hips and knees are at right angles then gradually straighten the knee keeping the thigh still to gain a stretch along the back of the knee and thigh.
/ Sit up straight with legs apart and keep knees flat to the floor (no bend). Reach hand to opposite floor. To make this easier, sit with your back against the wall.
/ Stand with the leg to be stretched on a step/stool. Keep your knee straight then bend your upper body forwards from your hips keeping your back straight. You should feel the stretching behind your knee and thigh.
Hip Adductors (inner thigh)
/ With hips and knees bent and feet together, gently stretch the child’s knees apart.
or
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/ One leg straight, the other leg bent at the hip and knee. Have one hand stabilising the pelvis (on the child’s hip bone) on the straight leg side, and the other on the bent knee. Gently take the bent knee outwards towards the floor./ Sit up straight with feet together. Use your elbows to stretch your knees down towards the floor.
Useful contacts
Children’s Physiotherapy Department
The Willows
Glencaple Road
Dumfries
DG1 4TG
Telephone: 01387 244581 or 244503 or 244573
Email:
Children’s Physiotherapy Department
Waverly Medical Centre
Dalrymple Street
Stranraer
DG9 7DW
Telephone: 01776 707707 Ext. 35334
Children’s Physiotherapy
Newton Stewart Hospital
DG8 6LZ
Telephone: 07739438431
This information is also available on request in other formats by phoning 01387 244581.
Produced by Children’s Physiotherapy Services 2016 (v1) Review 2018