SDR Recovery Timeline: Lying Flat, First Steps and the Months of Physical Therapy That Follow

The mother across the desk had already drawn the calendar. Twelve boxes on a sheet of notebook paper, one for each month after her son’s operation, and a question mark in every one. She wanted to know which box held the first steps, which held the return to school, and which one she could finally stop worrying in.

That is the honest shape of an sdr recovery timeline: not a single date but a sequence of stages, some measured in days and most measured in months. Selective dorsal rhizotomy changes a child’s nervous system in a single morning; the body then spends the better part of a year learning to use legs that suddenly feel different.

This explainer walks through those stages in order, from the hours of lying flat to the long stretch of physical therapy, and is clear about which numbers come from published evidence and which simply differ from child to child.

What actually happens during selective dorsal rhizotomy?

Selective dorsal rhizotomy, usually shortened to SDR, is an operation on the lower spinal cord that reduces spasticity in the legs. Spasticity is the involuntary tightness and overactive reflexes that develop when the brain’s signal to relax muscles is disrupted, as happens in many children with cerebral palsy. The sensory nerves entering the spine keep sending “stretch” messages, and without a brake from the brain, the muscles answer with a constant pull.

The surgeon works through a small opening in the lower back, at the level where the nerve roots fan out below the spinal cord itself. Each spinal level has two kinds of roots: ventral roots carry motor commands out to the muscles, and dorsal roots carry sensation back in. SDR touches only the dorsal, or sensory, side. That is the “dorsal” in the name.

The “selective” part is the heart of the procedure. Each dorsal root is teased into several smaller bundles, called rootlets. The team stimulates every rootlet with a tiny electrical pulse while recording the muscle response with electromyography (EMG), a way of measuring electrical activity in muscle. Rootlets that trigger an abnormal, spreading response are cut; those with a normal response are left intact. Only a portion of the rootlets at each level is divided, which is why children keep sensation and continue to feel their legs afterward.

The result is a permanent turn-down of the reflex loop that drives spasticity. What SDR does not do is repair the original brain injury, add strength, or straighten bones that have already grown into altered shapes. Those limits explain nearly everything about the months that follow: the surgery removes a brake that was stuck on, and the child then has to build the engine that was never fully used.

Who is usually offered SDR, and who is asked to wait?

Most programs describe a fairly narrow candidate: a child with spastic diplegia, the form of cerebral palsy in which spasticity affects mainly the legs, who already walks with or without support and whose main obstacle is tightness rather than weakness or poor balance. The NHS summarizes it as children whose spasticity in the legs is limiting their walking and who have enough underlying muscle control to benefit from having that tightness reduced.

Clinicians often frame this using the Gross Motor Function Classification System (GMFCS), a five-level scale describing how a child with cerebral palsy moves in daily life. Level I children walk without limitation; level V children have very limited voluntary movement. The children most often considered for SDR sit in levels II and III, meaning they walk with some difficulty or with a hand-held aid. Some centers also evaluate level I children with a bothersome gait, and a smaller number consider carefully selected level IV children, where the goal shifts from walking to comfort, positioning and easier care.

Children who are usually asked to wait, or who are steered toward other options, include those whose stiffness is mainly dystonia (involuntary twisting movements rather than steady tightness), children with significant weakness that spasticity is actually propping up, children with fixed joint contractures or spinal curvature that would not respond to nerve surgery, and children whose families cannot access the intensive rehabilitation the operation demands. A child recovering from a recent orthopedic operation is often asked to let that heal first.

Candidacy is never decided by a single specialist. A neurosurgeon, a rehabilitation physician, a physical therapist and often an orthopedic surgeon review gait videos, strength testing and imaging together. When they disagree, the disagreement itself is useful information, and a family is entitled to hear it.

What is the best age range for SDR surgery?

Parents ask this constantly, and the honest answer is that there is a common window rather than a single best age. NHS guidance describes SDR as usually considered for children between about 3 and 9 years old; other mainstream summaries, including the Johns Hopkins overview cited below, use similar early-childhood ranges. The reasoning behind that window is practical rather than magical.

Younger than about 3, the picture is still moving. Gait patterns are not settled, children cannot yet cooperate with the demanding therapy that follows, and the pattern of spasticity can change enough that a permanent operation feels premature. Waiting a year or two lets the team see a clearer picture of what tightness is doing to the child’s movement.

By the middle of childhood, several things line up. Bones have not yet grown into fixed deformities, so reducing spasticity can still change how the hips, knees and ankles develop. Children of school age can follow instructions, tolerate repeated therapy sessions and understand why they are working so hard. Their nervous systems remain highly adaptable. Above all, the years of walking still ahead of them mean a large payoff for every improvement in gait efficiency.

Beyond roughly age 9 or 10, SDR is not off the table, and some programs treat teenagers and adults. The goals usually shift. Older candidates may already have contractures that need orthopedic correction, and the operation is more often aimed at reducing pain, easing tone that interferes with daily care, or slowing the decline in walking that many adults with cerebral palsy report. The recovery timeline also lengthens, because adult muscle rebuilds more slowly and adult habits of movement are harder to unlearn.

Age, in other words, is a proxy for readiness: readiness of the joints, readiness of the child, and readiness of the family’s schedule for a long year of therapy.

SDR recovery timeline at a glance

The table below gathers the typical stages described in the mainstream sources listed at the end of this article. Every range is a pattern, not a promise, and individual programs set their own protocols.

Stage	Typical timing	What is usually happening
Lying flat	First 2–3 days	Bed rest with the back flat to protect the incision and reduce spinal-fluid headache; pain and sensation changes managed by the ward team
Sitting and standing	Days 3–7	Gradual head-of-bed elevation, then sitting at the edge of the bed, then supported standing with a therapist
Hospital discharge	Around 1 week, longer if inpatient rehab is part of the plan	Wound check, home therapy plan, equipment such as a walker or orthoses fitted
First steps	Within the first 1–3 weeks	Short, heavily supported walking; legs feel weak and “floppy” because spasticity was masking weakness
Intensive therapy	Months 1–6	Physical therapy several times per week focused on strength, balance and new gait patterns
Consolidation	Months 6–12	Frequency tapers; endurance and community walking improve; orthotics and school supports reviewed
Long-term follow-up	Yearly	Gait analysis, growth checks, watch for orthopedic changes

Two things stand out. The dramatic-looking part of recovery, the hospital stay, is over within about a week. The part that actually determines how a child walks in five years takes twelve months of ordinary, repetitive effort. Families who plan their energy for the second phase rather than the first tend to describe the year as hard but manageable.

Why lying flat after SDR matters, and how long it lasts

The first instruction after SDR sounds almost old-fashioned: lie flat. Program descriptions, including the Johns Hopkins overview cited below, typically describe two to three days with the head of the bed kept low. Children can roll from side to side with help, and nurses turn them regularly to protect the skin, but sitting up waits.

The reason is the fluid around the spinal cord. To reach the nerve roots, the surgeon opens the dura, the tough membrane that holds cerebrospinal fluid around the cord and brain. It is closed carefully at the end of the operation, but the seal needs time to become watertight. Sitting upright too early raises pressure at the repair and increases the chance of fluid leaking, which can cause a pounding positional headache, nausea, or, rarely, a collection of fluid under the skin that needs attention.

Lying flat also protects the incision, which sits low on the back exactly where bending and sitting would stretch it. Keeping the spine level for those first days lets the deep layers begin to knit.

Pain during this phase is real, and children often describe two kinds. One is ordinary surgical soreness at the incision and in the back muscles. The other is new and strange: tingling, burning or hypersensitivity in the legs and feet, sometimes so marked that bedsheets feel unpleasant. This second kind comes from the sensory rootlets that were divided and the way neighboring nerves adjust. The team manages both with a combination of pain medicines given through the IV or by mouth, sometimes with an epidural catheter left in from surgery, and non-drug measures such as cool cloths, position changes and distraction. The specific medicines and how they are given are decisions for the anesthesia and ward teams, and parents should ask what to expect rather than assume.

Most children find that the sensory oddness fades noticeably within the first couple of weeks, though a milder version can linger for a few months.

The first week: sitting up, standing up and going home

Once the flat period ends, the ward begins a careful sequence that physical therapists sometimes call “earning the vertical.” The bed head comes up in stages over a day. If the headache stays away and the incision looks dry, the child sits at the edge of the bed with support, then transfers to a chair.

Standing is usually attempted with two people and often a standing frame or walker, sometimes as early as day three or four. The moment tends to surprise everyone. Parents expecting to see the familiar scissoring, tiptoe posture instead see legs that flop, knees that bend under weight and feet that rest flat for the first time. Children may look worse before they look better. Therapists explain this as the unmasking of weakness: spasticity had been acting as a rigid scaffold, and now that it is gone, the true strength of the muscles is exposed.

Bladder and bowel function is monitored closely during this week. The nerve roots involved in SDR sit near those serving the bladder, and even with careful mapping, temporary changes in the urge to urinate or in control can occur. Nurses track output, and a catheter may be used for a short time. Persistent changes are uncommon and are followed by the team.

Discharge home, or transfer to an inpatient rehabilitation unit, typically happens around the one-week mark according to the program descriptions cited below. Some programs keep children as inpatients for several weeks of concentrated therapy; others send families home with an outpatient schedule. Neither is proven superior in the general evidence; the choice depends on the child’s needs, the family’s distance from services and local practice.

Before leaving, families usually receive wound care instructions, a written therapy plan, any newly fitted orthoses, and clear guidance on which symptoms mean a phone call.

When do children take their first steps after SDR?

Within the first one to three weeks after surgery, most children who walked beforehand take their first supported steps, according to the program timelines cited below. The word “supported” carries a lot of weight. Those early steps happen between parallel bars, inside a walker or with a therapist’s hands on the hips, and they rarely look like the child’s old walk.

Several things have changed at once. The calf muscles no longer pull the heels off the floor, so the foot lands flat, which feels unfamiliar. The hip adductors no longer drag the knees together, so the base widens. Reflexes that used to snap a leg straight are quieter, which means the child must actively straighten the knee instead of relying on tone to do it. Balance reactions that were suppressed by stiffness are suddenly required.

Therapists describe this stage as learning to walk on “new legs.” The nervous system is receiving different sensory information from the feet and joints, and the motor cortex is discovering that commands which once produced a jerk now produce a graded movement. Practice, not time alone, drives that discovery.

Children at GMFCS level I or II tend to reach independent walking again sooner than those at level III, who may spend longer relying on a walker or crutches. A few children who walked with difficulty before surgery use a wheelchair for community distances during the early months and gradually reduce that reliance as endurance builds. This is not a step backward; it is a deliberate way to save energy for therapy.

Parents often ask whether their child will be “behind” compared with before. For a few weeks, the answer is usually yes in terms of speed and distance, and the pattern is expected. The team should tell you in advance how they judge progress at this stage, typically by quality of movement rather than distance covered.

The first month at home: weak, wobbly and on purpose

The month after discharge is often the most tiring for families, because the hospital’s structure disappears just as the therapy load peaks. Program guidance cited below typically describes physical therapy several times a week during this period, plus daily home exercises.

Fatigue dominates. Muscles that were held tight for years are now being asked to work through their full range, and every session is, in effect, strength training for legs that have never trained. Children nap more, and school attendance is often partial. Appetite can dip and then climb.

Sensation continues to settle. Some children remain sensitive on the soles of the feet, which can make shoes and orthoses unwelcome. Therapists use gradual desensitization: textured mats, barefoot standing on different surfaces, and short wear times that lengthen day by day. Most families report this easing over the first several weeks.

Incision care is simple but matters. The wound should stay clean and dry, bathing rules from the discharge sheet are followed, and any redness spreading beyond the edges, fluid leaking, or a soft swelling under the skin near the scar warrants a same-day call.

Orthoses are frequently adjusted or replaced during this month. Ankle-foot orthoses (rigid or hinged braces worn inside the shoe to control ankle position) that fit a spastic foot may not fit a relaxed one, and many children need a new pair or a different design. Walkers and crutches are refitted as posture changes.

The emotional texture is worth naming. Children can feel discouraged that they are working harder and walking worse than before surgery. Families who were told to expect this dip generally weather it better than those who were not, which is a strong argument for asking the care team, before the operation, to describe the first month bluntly.

How long is physical therapy after SDR surgery?

Intensive physical therapy after SDR runs for months, not weeks. The NHS describes a long program of rehabilitation following the operation, and program descriptions such as the Johns Hopkins overview cited below typically frame the intensive phase as continuing for six months to a year, with therapy several times weekly at the start and tapering as goals are met.

The content of that therapy shifts over time, and understanding the arc helps families judge whether things are on track.

In months one to three, the emphasis is on strength and alignment. Therapists work the hip extensors and abductors, the quadriceps and the calf muscles through progressive resistance, often using body weight, resistance bands and functional tasks such as sit-to-stand repetitions and step-ups. Standing posture is drilled deliberately, because the old crouched or toe-walking pattern is familiar and easy to slide back into.

Months three to six add balance and endurance. Walking distances lengthen, uneven ground and stairs are introduced, and the child practices stopping, turning and recovering from small pushes. Gait quality is often videoed and compared with pre-operative recordings.

From month six onward, therapy usually narrows to the child’s own goals: running, riding a bike, keeping up at recess, climbing onto a bus. Frequency drops toward a maintenance schedule, but home exercise continues, and many programs recommend a formal gait analysis around the one-year mark.

Occupational therapy and, where relevant, hydrotherapy are often woven in. Water is especially useful early on because it supports weak legs while letting the child practice movement.

What the evidence supports is the principle rather than a fixed dose: the operation creates the opportunity, and repeated, goal-directed practice converts it into function. Children who cannot access consistent therapy tend to show smaller functional gains despite the same reduction in spasticity, which is why rehabilitation access is a candidacy question, not an afterthought.

What can change the SDR recovery timeline?

Two children can have the same operation on the same day and reach the same milestone months apart. The variables are fairly predictable.

Baseline mobility is the strongest. A child at GMFCS level I or II usually regains independent walking within weeks, while a level III child may spend months with a walker before progressing to crutches or short unaided distances. Level IV children, where the goals are comfort and care, follow a different timeline entirely, measured in ease of dressing, sitting tolerance and reduced pain rather than steps.

Underlying strength matters nearly as much. Pre-operative testing that shows good voluntary muscle control under the spasticity predicts a faster return to function; a child whose tightness was doing most of the work will need longer to build what was missing.

Age shifts the pace. Younger children tend to adapt movement patterns quickly but tire easily and cooperate less with structured exercise; older children and adults work harder in sessions but rebuild muscle more slowly and must unlearn years of habit.

Orthopedic status can insert a whole new chapter. If contractures or rotational deformities remain after tone is reduced, an orthopedic operation may follow SDR, often a year or more later, resetting part of the timeline.

Complications, though uncommon, slow things down: a spinal fluid leak that needs bed rest or revision, a wound infection, or a prolonged change in bladder function.

Finally, the practical scaffolding around the child changes everything. Distance to therapy, a school willing to adjust, a home with space to practice and adults with the stamina to supervise daily exercises all shorten the timeline in ways no surgical technique can. When a team asks detailed questions about a family’s logistics before offering SDR, that is not gatekeeping; it is reading the recovery timeline in advance.

What is the success rate of selective dorsal rhizotomy? What the evidence shows

Families search this phrase more than any other about SDR, and it deserves a careful answer rather than a percentage lifted from a website.

On the outcome the operation directly targets, the evidence is consistent: SDR produces a substantial and lasting reduction in lower-limb spasticity in appropriately selected children. Mainstream summaries from the NHS, Mayo Clinic and Johns Hopkins describe it as an established option for reducing leg spasticity in cerebral palsy, and long-term follow-up studies indexed in PubMed report that tone reduction persists into adolescence and adulthood.

On the outcomes families actually care about, walking quality, endurance, independence and comfort, the picture is more nuanced. Studies generally report improvements in gait parameters and gross motor scores in children at GMFCS levels I to III, but the size of those improvements varies widely between children and between studies, and it is difficult to separate the effect of the surgery from the effect of the intensive therapy that follows. Research comparing SDR plus therapy with therapy alone is limited, and the higher-quality trials are small. Systematic reviews therefore describe SDR as effective for spasticity and probably beneficial for function in selected children, while calling for better long-term comparative data.

Some things SDR does not reliably do: it does not prevent all later orthopedic surgery, it does not improve upper-limb function in a predictable way, and it does not change cognition or speech. A minority of children and adults report long-term back discomfort or sensory changes.

A responsible team will not quote you a single success figure. They should instead tell you what changes are likely for a child with your child’s mobility level and strength profile, what gains would count as success in your own family’s terms, and how they will measure them. That conversation, not a number, is the real answer to the question.

Risks, side effects and alternatives to SDR

SDR is a major operation on the spine, and neutral clinical language is the right way to describe its risks.

Short-term risks include those of any spinal surgery under general anesthesia: bleeding, infection at the wound, and reactions to anesthesia. Specific to SDR are cerebrospinal fluid leak from the dural repair, which can cause headache and sometimes requires further bed rest or a small revision; temporary changes in bladder or bowel control; and sensory disturbances in the legs ranging from numb patches to hypersensitivity. Most of these settle over weeks, and the treating team monitors them closely.

Longer-term concerns include excessive weakness if too many rootlets were divided, persistent sensory changes, spinal deformity such as increased curvature or slippage of a vertebra in the years after surgery, and hip problems in children whose hips were already at risk. Regular follow-up imaging and gait review exist precisely to catch these early.

Alternatives fall into a few groups, and the choice among them is the treating team’s. Muscle relaxant medicines taken by mouth act throughout the body and are usually the first tier, but they can cause drowsiness. Botulinum toxin injections weaken selected overactive muscles for a period of several months and are often repeated; they suit focal spasticity and are frequently combined with casting and orthoses. An intrathecal baclofen pump delivers medicine directly to the fluid around the spinal cord through an implanted device, is adjustable and reversible, and is more often used for severe, whole-body spasticity. Orthopedic surgery lengthens tendons or realigns bones and addresses fixed deformity rather than tone itself. Ongoing physical therapy, stretching and bracing underpin all of these.

SDR differs from the others in being permanent and non-adjustable, which is both its appeal and the reason candidacy is weighed so carefully. Families should hear how each option fits their child’s specific pattern of tightness, and why the team favors one path over another.

What people often get wrong about SDR recovery

Myths gather around any operation that promises visible change, and SDR has collected more than its share.

“My child will walk better right after surgery.” The opposite is usual. For the first weeks, children look weaker and less coordinated because spasticity was hiding weakness. The improvement comes from months of therapy, not from the operating room.

“SDR treats cerebral palsy.” It reduces one symptom, leg spasticity. The underlying brain injury, and its effects on balance, coordination, strength, speech and learning, are unchanged.

“The surgery is the hard part.” The hospital stay is about a week. The rehabilitation runs six to twelve months. Families who budget their energy, leave and childcare for the surgical week alone are the ones most often caught out.

“If therapy is good, more is always better.” Overworked muscles and exhausted children regress. Programs build rest into the schedule for a reason, and pain or unusual fatigue after sessions is something to report, not push through.

“SDR means no more orthopedic surgery.” It may reduce the need, but many children still require tendon lengthening or bony procedures as they grow, particularly if contractures existed beforehand.

“Older children and adults cannot have it.” They can, in selected cases, but the goals shift toward pain and daily function, and the recovery timeline is longer.

“Success rates online tell me what will happen.” Single percentages rarely specify the mobility level, age or outcome measured. A number for GMFCS level I children says little about a level III child.

“The sensory changes are a sign something went wrong.” Tingling, hypersensitivity and odd temperature sensations in the feet are expected after dividing sensory rootlets and usually fade over weeks to months. Sudden new weakness, loss of bladder control or a spreading numb area are different, and belong in the section on calling your doctor.

Questions to ask your care team

A good consultation leaves a family with fewer unknowns than they arrived with. These questions tend to surface the information that matters most for the recovery timeline.

• Which GMFCS level does my child sit in, and what does the evidence say about children at that level after SDR?
• What did the pre-operative strength and gait testing show, and how does that shape your expectations for recovery?
• How many days do you expect my child to lie flat, and what is your plan for pain and for the sensory changes during that period?
• Will recovery start on the ward, in an inpatient rehabilitation unit or at home, and what is the reasoning?
• How many therapy sessions per week do you recommend in the first three months, and what should happen at home between them?
• Which functional goals would you consider a good outcome at three, six and twelve months for this particular child?
• How will you measure progress, and will there be a formal gait analysis?
• What orthoses or walking aids might need refitting, and who coordinates that?
• Which complications do you watch for in the first weeks, and how do I reach the team out of hours?
• What is the likelihood that orthopedic surgery will still be needed later, and how would you decide?
• How will you follow the spine and hips over the coming years?
• What alternatives to SDR did you consider for my child, and why did you land here?
• How should school, transport and family leave be planned around the intensive phase?

Write the answers down or ask permission to record them. Families often notice, months later, that the team predicted a hard patch that felt frightening in the moment and turned out to be exactly on schedule.

When to call your doctor

Most of the post-SDR course is uncomfortable but expected. A short list of signs, however, should prompt a same-day call to the surgical team or, when severe, emergency care.

Call urgently for a headache that is much worse when sitting or standing and eases when lying flat, especially with vomiting or clear fluid leaking from the wound, because this can signal a cerebrospinal fluid leak. Seek help the same way for a fever with redness, warmth, swelling or pus at the incision, or a soft bulge developing under the skin near the scar.

New or worsening weakness in the legs that goes beyond the expected floppiness, loss of feeling that is spreading rather than settling, or new numbness in the groin or buttocks all need prompt assessment. So does any new difficulty passing urine, loss of bladder or bowel control that was not present in the first days, or a bladder that feels full but will not empty.

Severe back pain that is not controlled by the plan the team gave you, pain with a stiff neck and sensitivity to light, or a child who becomes unusually drowsy, confused or hard to rouse warrants emergency evaluation.

Less dramatic but still important: a calf that becomes swollen, warm or painful on one side, chest pain or sudden breathlessness (rare in children but possible with prolonged immobility), skin breakdown over bony points from lying flat, and any fall that produces new pain at the incision site.

For everything in between, such as therapy that seems to be causing lasting pain, sensory oddness that is not improving after several weeks, or a child whose mood and sleep have collapsed under the schedule, the treating team and therapists want to hear about it. Adjusting the plan is part of the plan, and every decision about pace, medicines and next steps sits with them.

Frequently asked questions

How long does it take to recover from SDR surgery?

Recovery unfolds in stages rather than ending on one date. The hospital phase, including two to three days lying flat, typically lasts about a week. Supported first steps usually come within the first one to three weeks, and intensive physical therapy continues for roughly six to twelve months while strength and new walking patterns build. Program descriptions cited in this article give these ranges; your treating team will tailor them to your child’s mobility level.

How long is selective dorsal rhizotomy recovery compared with other spasticity treatments?

It is longer than most alternatives. Botulinum toxin injections involve no surgical recovery, and an intrathecal baclofen pump has a shorter surgical recovery because it does not open the dura. Selective dorsal rhizotomy recovery includes a week in hospital and up to a year of intensive therapy, because the operation unmasks weakness that then has to be trained. The trade-off is a permanent reduction in spasticity that does not need repeated procedures or a device.

What is the success rate of selective dorsal rhizotomy?

There is no single reliable percentage. Mainstream sources agree that SDR produces a substantial, lasting reduction in leg spasticity in appropriately selected children. Improvements in walking, endurance and independence are reported but vary widely between children and studies, and are hard to separate from the effect of intensive therapy. Ask your team what changes are likely for a child at your child’s GMFCS level, and how they will measure them.

What is the best age for SDR surgery?

Most programs consider a window in early to middle childhood; NHS guidance describes roughly ages 3 to 9. Younger children have unsettled gait patterns and cannot yet take part in demanding therapy, while older children may already have fixed contractures. Older children and adults can still be candidates, but the goals shift toward comfort and daily function and the recovery timeline is generally longer. The right age is really about joint, child and family readiness.

Is SDR surgery for cerebral palsy permanent?

Yes. The sensory rootlets that are divided do not grow back, so the reduction in spasticity is permanent, which long-term follow-up studies confirm. Permanence is also why candidacy is assessed so carefully: unlike medicines, injections or an adjustable pump, SDR cannot be reversed or turned down. It does not, however, change the underlying brain injury, and it does not prevent all later orthopedic problems as a child grows.

Why does my child have to lie flat after SDR?

Lying flat for the first two to three days protects the repair of the dura, the membrane that holds spinal fluid around the cord, which the surgeon opens to reach the nerve roots. Sitting up too early raises pressure at the repair and can cause a fluid leak with a severe positional headache. Flat rest also protects the low back incision. Nurses turn children regularly to protect skin, and the head of the bed is raised gradually once the team is satisfied.

How much physical therapy after SDR is needed, and for how long?

Program guidance typically describes therapy several times a week in the first months, tapering as goals are met, with the intensive phase lasting six to twelve months. Early sessions focus on strength and alignment, later ones on balance, endurance and the child’s own goals such as stairs or running. Daily home exercises fill the gaps. The exact frequency is set by the treating therapists, and rest is built in deliberately because exhausted muscles regress.

Why does my child seem weaker after SDR than before?

Because spasticity was acting as a rigid scaffold that hid true muscle weakness. Once the overactive reflexes are quietened, legs that used to lock straight now have to be actively controlled, knees bend under load and feet rest flat for the first time. This early dip is expected and usually lasts weeks. Strength returns through therapy, not time alone. Sudden or worsening weakness that goes beyond this pattern, however, should be reported promptly.

What sensations are normal in the legs after SDR?

Tingling, burning, patches of numbness and hypersensitivity of the soles are common after sensory rootlets are divided, and they usually settle over weeks, with a milder version sometimes lingering for a few months. Therapists use gradual desensitization with different textures and short periods wearing shoes and orthoses. Spreading numbness, new numbness in the groin or buttocks, or changes in bladder control are different and need same-day assessment by the surgical team.

Will my child still need orthopedic surgery after SDR?

Possibly. SDR reduces spasticity but cannot lengthen a shortened tendon or straighten a bone that has already grown into an altered shape. Children with contractures before surgery, or whose gait analysis a year or more later shows persistent deformity, may be offered tendon lengthening or bony procedures. Regular follow-up of the spine and hips is standard after SDR. Whether and when further surgery is needed is a decision for the orthopedic and rehabilitation team.

References

• NHS: Cerebral palsy, Treatment
• MedlinePlus: Cerebral Palsy
• CDC: About Cerebral Palsy

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.