We often advise stretching as an essential part of our client’s therapy. Because, stretching muscles that have restricted range of movement is important for everyone however it can have a significant benefit for individuals with movement disorders.
As a child ages their bones grow with them and the muscles grow longer by being stretched as the bones grow. This is the reason that daily stretching may be essential for some individuals. An example would be; a child with cerebral palsy who has spasticity may be affected in their hamstring (back of the upper leg muscle). As a result they can’t straighten the leg fully due to the spasticity which affects their control of the muscle, their strength or sometimes reflexes. Another person could straighten the leg for the child and this is known as passive movement.
If a child can’t actively achieve a full range of motion the muscle won’t be stimulated to stretch as the bone grows. So in this example the Hamstring muscle would remain shortened but, at the same time the opposing muscle the quadriceps (front of the upper leg) would be lengthened and weaker as they have been stretched by the bent knee position. The range of motion (ROM) at the affected joint will reduce if there is no intervention. Range of Motion (ROM) can be improved or maintained in many cases through daily stretches conducted by a professional, parent or carer.
Benefits of Daily Stretching?
- to prevent muscle shortening
- to improve range of motion
- helps with the child’s comfort and daily care activities
- helps when learning new skills such as sitting or walking
- helps prevent contractures (see below)
- helps prevent subluxation or dislocation, caused by tight muscles (see below)
During an assessment by a professional they can identify the specific stretches to focus on as each person is affected differently therefore the advice will be specific to your needs.
When a joint is NOT straightened for weeks or months it causes the ligaments (fibrous tissue) around the joint are also affected. Some are stretched and some are shortened, this combined with the short muscles prevent the full joint motion and this is called a contracture. A joint contracture that persists will bring about changes to the bones at the joint and ultimately become irreversible, this would occur over a long period of time.
Subluxation or Dislocation
The constant pull of tight muscles will affect how joints grow. Subluxation means that the joint has moved partially out of its socket and a dislocation means it has moved completely out of its socket. The hip joint is affected by short hamstrings and inner thigh muscles and this is why your child’s consultant will take regular hip X-rays to monitor for any changes.
How to do stretches
Technique is important when doing stretching exercises, therefore should be demonstrated by your therapist. As each child is different the stretches they require will differ. If a child can achieve a full range of motion at a joint independently they likely don’t require a stretch for that area. If you are unsure or have concerns ask your therapist for advice and support as this is a key part of your child’s therapy and you need to be confident in the techniques moving forward.
General guidelines for stretching a child with cerebral palsy include;
- Position the child correctly. As shown by your therapist it is possible to use different positions to do the same stretch but your therapist will help identify the best one for you and your child.
- Talk to your child. The more relaxed the child is, the more effective the stretches will be, a calm environment created by talking, singing, listening to music may help.
- Move slowly. If you do the stretch too quickly the resistance increases and stops the movement before the muscle has reached its full length.
- No twisting or turning. It’s important that you don’t twist or turn the limb when doing a stretch as this can put stress on the joint and cause damage.
- Know when to stop and hold the stretch. It is important to carefully watch your child’s face for signs of discomfort when stretching. Stop as soon as it becomes slightly uncomfortable and reduce your pressure and hold the stretch there. There is no benefit to over stretching or causing pain.
- Do not overstretch a muscle. Once you achieve a normal muscle length the goal is then to maintain this range as the child grows. Do not over stretch the muscle.
Do all children need to incorporate stretching?
No, not all children will need stretching it will depend on their medical condition, movement patterns, posture and other factors. For example a child with low tone or hypermobility may have increased range in some areas and therefore stretching could over lengthen the muscle. However, they may have tight muscles in other areas. The key is to seek advice from your child’s therapist and ask questions if you need more information and guidance.