Physiotherapy after SDR: what families should know

An evidence-led guide to rehabilitation after selective dorsal rhizotomy (SDR), and why intensive physiotherapy shapes the outcome as much as the surgery itself.

If your family is weighing up selective dorsal rhizotomy, you are probably reading a great deal and finding the picture is not as simple as some sources suggest. SDR is a valuable procedure for the right child, and it is one where what happens after the operation matters as much as the surgery. Here is a straight summary of where the evidence stands and what it means in practice.

Selective dorsal rhizotomy (SDR) is a neurosurgical procedure that permanently reduces spasticity in the legs of children with spastic cerebral palsy, by dividing the specific nerve rootlets that drive the stiffness.

Surgery and rehabilitation do different jobs. Spasticity reduction is what the surgery does. Function is what the rehabilitation does. Removing spasticity does not, by itself, build strength or teach a child to walk. It often reveals the muscle weakness the stiffness was masking, and the child then has to learn to move with muscles working in a new way. Across the research, the children who gain the most are consistently those who receive intensive, sustained physiotherapy afterwards. The operation creates the opportunity. The rehabilitation is what turns it into change a family can see. This is also why surgical centres will not usually proceed without a confirmed rehabilitation plan already in place.

SDR is not only for children who walk. Much of the public information frames SDR around walking, and NICE's guidance reflects this: it recommends considering SDR to improve walking ability in children at GMFCS levels II and III, and does not recommend it for more severely affected children. Beyond that recommendation, spasticity reduction can still matter a great deal for children at GMFCS levels IV and V. Reducing spasticity can make a meaningful difference to comfort, to seating and positioning, to upper-limb use, and to the ease of everyday personal care, even where independent walking is not the goal. This use sits outside NICE guidance and NHS funding, is decided case by case by the specialist team, and is self-funded, but it is a valid and important reason some families consider surgery.

Through the NHS, SDR is provided at a small number of specialist centres for children who meet defined criteria, usually those at GMFCS levels II and III aged between three and nine. Patient selection is made by a multidisciplinary team with specialist expertise in spasticity, as NICE requires. Great Ormond Street Hospital has run its service since 2013. SDR is also available on a self-funded basis in the UK, including at The Portland Hospital in London and in Bristol, which widens the options for families who do not meet the NHS criteria or who choose to fund surgery themselves.

A 2026 review led by clinicians at Great Ormond Street Hospital, published in Developmental Medicine and Child Neurology, looked across more than two hundred SDR studies spanning three decades. It found that the great majority of research has measured changes at the level of the body, such as muscle tone and motor scores, while far less has looked at participation and quality of life, and less still has asked children and parents directly about their own experience. The well documented finding is that gross motor function improves in the first couple of years after surgery. A long-term follow-up of adults who had SDR as children, some more than twenty-five years earlier, reported good quality of life and walking ability with no late complications from the surgery itself.

The research is also honest about the limits. One careful study comparing children who had SDR with a well-matched group who had conservative and orthopaedic care found that, five years on, their walking patterns had improved in broadly similar ways. This does not mean SDR does not work. It means good non-surgical management can also achieve a great deal, and that the long-term advantage of surgery over excellent conservative care is still being understood. Both of these things are true at the same time, and families deserve to hear both. It is also worth knowing that SDR does not remove the need for later orthopaedic care. Even after successful surgery, around seventy to eighty per cent of children still go on to need orthopaedic procedures as they grow.

Progress after SDR is not automatic, and it is not permanent on its own. Children can lose hard-won gains if rehabilitation lapses, which is why consistency over the months and years after surgery matters as much as intensity in the early weeks. This is one of the main reasons we deliver in the community rather than in a clinic. Travelling to appointments drains older children before a session even begins, and that fatigue eats into the work itself. Therapy delivered at home or at school removes the travel burden and lets the work happen in the environments where children are most comfortable, most engaged, and most able to practise the things that matter in their daily life.

What this means for your family: treat the rehabilitation decision as seriously as the surgical one. The evidence points repeatedly to rehabilitation as the determinant of outcome. Expect the first year to be intensive, and plan for the years after it. Measure what matters to your child, not just motor scores but the real questions about your child's life: keeping up in the playground, standing to get dressed, managing the stairs at school, or being comfortable and easy to care for. Look for clinicians who will give you a realistic picture for your own child and a clear plan to reach it. SDR is not a cure for cerebral palsy, and no responsible clinician can promise a specific result.

We provide intensive, specialist physiotherapy after SDR across South East London and Kent, working alongside your surgical centre and reporting progress to your hospital team. We deliver in your home, at school, and in the settings where your child lives their day. If your child is approaching SDR or has recently had surgery, get in touch to discuss their rehabilitation.

This article is for general information and is not a substitute for advice from your child's surgical and therapy team.