Hi there, sorry to hear about your daughter and her spiral fracture and subsequent casting. I know from experience what hard work spica casts are.

I am a physiotherapist, my main experience is in adult neurological rehab (head injuries, stroke etc). However my daughter was diagnosed with hip problems as a baby (developmental hip dysplasia) so has had two ops with 6 months of hip spica as a baby, and more recently (August 2007) as she required surgery with 6 weeks of casting. So I have personal experience, that I hope can help you and reassure you.

Following her last lot of treatment and casting, my daughter had a lot of muscle wasting. She lost 1 and half kilos. The physios also did not routinely see her case, and I could not even get a small walking frame for her. However with support from me she was walking within about 5 days of coming out of surgery and was able to stand independently shortly after. Children do progress along at their own rate.

I was a bit niggled that she did not have physio follow up, but to be perfectly honest (and its hard for to say this) they were completely right. She didn't need input.

Her surgeon suggested lots of swimming, and cycling is good for them if she is able to pedal yet because of the type of exercise (closed chain).

Now 6 months on, you can still see some balance problems and she has a swaying gait (lateral sway with anterior pelvic tilt) when she walks particularly when tired (more to do with her surgery I think - I am not sure you will see this in your daughters case) . She is just starting to swim for herself with reduction in buoyancy aids. She can hop, jump, run but her walking distances remains limited, as she tires. She does ballet and tap on the weekend, which I think is helping to improve her balance. She's always improving.

I go along with what physio bob suggested. I think it would be nice for someone to have a look and reassure you, if anything and maybe give you some advice. However if paying for a private physio is out of reach, be reassured that she will "get on with it". I would think she is too young to do formal exercises with - best to be inventive and give her opportunity to do kid stuff.

You should be followed up by Dr at fracture clinic so if you do have concerns you can express them there, or failing that your GP. I always find that when I have been really worried the physios down at child development clinic will also take my call.

Hope thats been useful.