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Stretching Interventions in Children With Cerebral Palsy: Why Are They Ineffective in Improving Muscle Function and
Barbara M Kalkman1, Lynn Bar-On2, Thomas D O'Brien1
1School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.
Insights
Stretching is often ineffective for children with cerebral palsy (CP) due to poorly understood spastic muscle behavior. This review explores why stretching limitations exist and suggests strategies to improve physical therapy outcomes for CP.
Area of Science:
- Biomedical Engineering
- Pediatric Physical Therapy
- Rehabilitation Medicine
Background:
- Hyper-resistance and joint stiffness are common in children with cerebral palsy (CP).
- Current physiotherapy, including stretching, has limited effectiveness in improving function.
- The mechanical behavior of spastic muscles during stretching is not well understood.
Purpose of the Study:
- To explain the limited effectiveness of stretching interventions in children with CP.
- To review muscle and tendon plasticity in response to stretching in CP.
- To identify strategies for enhancing stretching therapy outcomes.
Main Methods:
- Literature review of muscle and tendon properties in children with CP.
- Analysis of musculoskeletal interactions and mechanical properties.
- Examination of the effects of traditional stretching exercises.
Main Results:
- Stretching effectiveness is limited by the complex mechanical behavior of spastic muscles.
- Understanding muscle and tendon plasticity is crucial for effective interventions.
- Current stretching protocols may not adequately address the underlying pathophysiology.
Conclusions:
- Mechanistic insights into spastic muscle behavior are needed to improve stretching efficacy.
- Novel strategies are required to optimize non-invasive interventions for children with CP.
- Further research into muscle-tendon plasticity can enhance functional outcomes.
Abstract:
Hyper-resistance at the joint is one of the most common symptoms in children with cerebral palsy (CP). Alterations to the structure and mechanical properties of the musculoskeletal system, such as a decreased muscle length and an increased joint stiffness are typically managed conservatively, by means of physiotherapy involving stretching exercises. However, the effectiveness of stretching-based interventions for improving function is poor. This may be due to the behavior of a spastic muscle during stretch, which is poorly understood. The main aim of this paper is to provide a mechanistic explanation as to why the effectiveness of stretching is limited in children with CP and consider clinically relevant means by which this shortcoming can be tackled. To do this, we review the current literature regarding muscle and tendon plasticity in response to stretching in children with CP. First, we discuss how muscle and tendon interact based on their morphology and mechanical properties to provide a certain range of motion at the joint. We then consider the effect of traditional stretching exercises on these muscle and tendon properties. Finally, we examine possible strategies to increase the effectiveness of stretching therapies and we highlight areas of further research that have the potential to improve the outcome of non-invasive interventions in children with cerebral palsy.
