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Stretching Interventions in Children With Cerebral Palsy: Why Are They Ineffective in Improving Muscle Function and How Can We Better Their Outcome?

Kalkman, BM, Bar-On, L, O'Brien, TD and Maganaris, CN (2020) Stretching Interventions in Children With Cerebral Palsy: Why Are They Ineffective in Improving Muscle Function and How Can We Better Their Outcome? Frontiers in Physiology, 11. ISSN 1664-042X

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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.

Item Type: Article
Uncontrolled Keywords: 0606 Physiology, 1116 Medical Physiology
Subjects: R Medicine > RC Internal medicine > RC1200 Sports Medicine
R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Divisions: Sports & Exercise Sciences
Publisher: Frontiers Media
Related URLs:
Date Deposited: 16 Mar 2020 12:34
Last Modified: 16 Mar 2020 12:45
DOI or Identification number: 10.3389/fphys.2020.00131
URI: http://researchonline.ljmu.ac.uk/id/eprint/12502

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