Child & Family Development Child & Family Development

January 16, 2024

Serial Casting

What is Serial Casting?

  • Serial casting is a process where a therapist applies a “series” of casts weekly to a specific joint with limited range of motion
  • Each cast is applied to the joint in a stretched position, with each week providing a slightly great stretch, until the desired range of motion is achieved

Who could benefit from serial casting?

  • Serial casting is beneficial to patients with a moderate to severe joint contracture
  • Diagnoses often treated with casting include (but are not limited to)
  • Increased muscle tone/spasticity of a joint
  • Status post injury or surgery with a joint contracture
  • History of toe walking that has not responded to conservative treatments

What does the casting process look like?

  • A physical referral and PT evaluation are needed to begin
  • Risks and benefits are assessed
  • Range of motion of the affected joint is obtained
  • Orthotics for post casting are often necessary and discussed with families to maintain the newly achieved range of motion
  • Joint/extremity is prepped with padding and barrier cream to protect the skin
  • Casts are applied with patient either lying or sitting in a held position
  • One therapist will apply the cast while another will hold the joint in the specific position

How long does casting take?

  • If casting is appropriate, improvement should be seen with each week of casting, at least 3-5 degrees of improvement per cast is the goal (this may vary significantly)
  • When casts have achieved the desired range or motion or plateaued with progress for 2+ weeks in a row, casting is discontinued
  • This total casting takes between 4-6 weeks on average (but can vary based off of joint casted)


  • Patients being casted must be able to verbalized pain
  • Casts must remain dry the entire week (no bathing)
  • Never put anything in or on the cast during the week

Who will be serial casting?

Laurel Mogensen (Pineville Location)

  • Pediatric PT with more than 12 years of serial casting in Charlotte

Gail Fennimore (Midtown Location)

  • Pediatric PT who has been with CF&D since 1994