Stretching exercise study for children with Cerebral Palsy

Our 5 year old was asked to participate in a study looking into the effectiveness of stretching exercises that are carried out on children with cerebral palsy.   Children with cerebral palsy commonly suffer from stiffness of the muscles, the stiffness is caused because they can not walk normally using their muscles correctly and continuously.  Often children with CP walk on their tip-toes, and the heal of the foot doesn’t make contact with the ground.  This pattern of walking causes what is called, muscle shortening, the muscle is not used fully extended and in its short movement becomes very strong, causing problems for later when a child may have to have a tenotomy, which is the cutting of the tendon around the heal of the foot.

When a toddler (who doesn’t suffer from CP) starts to walk, this very act of repetitive frequent movement helps with muscle growth.  This is very important because the muscles need to keep in line with the bones as they extend.  This is why parents of cerebral palsy children are taught the stretching exercises, to be carried out on a daily basis when the child is young.

Physiotherapists use stretching as a way to treat stiff muscles and this stretch over a period of time is thought to help and stimulate muscle growth but this has never been proven before.

stretching exp 3

The study was to prove or not if the muscle and not just the tendon is being stretched, “The point of disagreement is whether stretching affects the muscle as well as the tendon in children with CP.  When an ankle joint is moved through its range of motion (ROM) by rotating the toes towards the shin bone, some, or all components (muscles and tendons) of the lower leg must stretch.  The posterior lower leg is made up of 2 major muscles, which come together to join the tendon, and connect to the heel of the foot.  In children who do not have CP, moving the ankle joint through a range of motion causes both the muscles and tendon to be stretched.  However, in a spastic muscle with an increased stiffness, moving the ankle joint may result in only the tendon being stretched and not the muscle…

Therefore the first purpose of the study was to investigate whether the muscle does indeed stretch when the ankle joint is moved through a range of motion, and second, whether any change is dependent on the stretch technique which is used.”

stretching exp 2

They used cameras detecting motion to see what was happening inside the 5 year old’s ankle movement.  Analysis was made of her lower leg before and after stretching.

stretching exp 1

Does stretching affect muscle?

Yes.  This study of children with CP showed that stretching had caused a change in movement, on average 12%.  It caused for the muscle to be increased by 0.8cm in length as well as the tendon by 1cm.  It did not matter which of the two common stretching technique was used.

The 5 year old was the youngest in the group of children to be studied.  I’m glad I said yes and volunteered to participate in this study, she loved the attention she received and was in good humour throughout.