Low Muscle Tone
A common question parents ask is “what is low muscle tone?”. As a pediatric therapist, I forget that most parents don’t understand health care professional terminology. It’s important for families to understand our terminology when speaking to them.
As therapists, we work with children that have low muscle tone and explaining this to parents can be quite confusing. Let’s first understand the concept of low muscle tone and how we as therapists can help explain this better for families. Then we can go into different treatment ideas for children with low muscle tone.
What the research is defining muscle tone as:
Muscle tone is defined as “resistance to passive stretch while the patient is attempting to maintain a relaxed state of muscle activity.” It can also be described as the amount of tension or stiffness in the resting muscle that is typically assessed by performing passive movement of the muscle being tested.
According to Ratliffe et al., low muscle tone (Hypotonia) is characterized by lack of resistance to passive movement, poor definition of muscles, hypermobility of joints and sometimes decreased strength and endurance.
According to Martin et al., children with low muscle tone display the following characteristics: decreased strength, hypermobile joints, increased flexibility, rounded shoulder posture, poor attention and motivation, leaning on supports, decreased activity tolerance, and delayed motor skill development.
Interpreting the research into parent friendly terminology:
Muscle tone is described as the readiness of your muscles for action; where as strength is how much power is in your muscle. Normal muscle tone means that the tension in the resting muscle is even throughout and you can easily control your muscles when crawling/walking, reaching for items on a desk, picking up objects from the floor. Low muscle tone means there is less tension in the resting muscle and it may be difficult to control your muscles. A child with low muscle tone has to use more energy and work a bit harder to perform a task/skill.
For example, a child with normal muscle tone can sit at their desk and reach for items on their desk with no problem, whereas the child with low muscle may be slouching in their chair and has to use more energy to sit upright to reach items on their desk. The child with low muscle tone may have difficulties with performing age appropriate tasks and have difficulty with postural control, core strength, as well as poor endurance.
Signs/symptoms of low muscle tone:
Delayed motor milestones (rolling/sitting/crawling/walking)
Poor head control
Difficulty sitting without support
Slouched posture when sitting in a chair
Has a hard time sitting on the floor with legs crossed and prefers to sit with legs straight out in front of them with hands behind their back on the floor for extra support
Difficulty with handwriting
Doesn’t like climbing on the jungle gym
Hypermobile (flexible) joints
Muscle tone cannot be altered however you can help strengthen the muscles, improve postural control, motor planning, balance, coordination, and body awareness.
Here are some exercises/activities to help your child with low muscle tone. Just remember that your child may need frequent breaks and this is ok, as they have to use more energy to do things when compared to a child with normal muscle tone. Early intervention is the most important for a child with low muscle tone.
1) Light massage at arms, back, legs, & feet to stimulate the muscles and provide proprioceptive input/body awareness.
2) Tummy time throughout the day when the baby is awake, alert, and supervised. By the end of 4 months, your baby should tolerate up to 90 minutes of tummy time a day. For more information on tummy time ideas, check out our tummy time post.
3) Lie on belly over therapy ball and have a good grip on your baby as you slowly rock the ball forward/back for a few minutes at a time and perform throughout the day when your baby is awake and alert.
4) Have a good grip on your baby's waist and place them sitting on the therapy ball as you slowly move the therapy ball backwards, to the right side, and then to the left side for a few minutes to work on righting reactions, head/neck control and core balance.
For older children:
1) Sit-ups: Have the child lie on their back with knees bent, feet flat on the floor and about shoulder width apart. Secure the feet in place by keeping your knees around them. Have the child hold onto your fingers as they come up into a sitting position.
a. # of sit-ups: 10-15
b. Frequency: 3 sets
2) Therapy Ball: This is a great core strengthening exercise. Lie on belly, roll therapy ball forward and back as the child weight bears on forearms/arms. You can also have the child pick up a puzzle piece from the floor, working against gravity while strengthening the upper body/core.
Frequency: Perform until puzzle is complete
3) Belly activities: Perform activities on belly can help with overall balance and strength. Let the child lie down on blue balance disc while playing games, reading a book, or coloring.
4) Squats: Great activity for balance, lower leg strengthening and motor planning. Have your child stand in front of the couch, place puzzle on top of couch and pieces on the floor. Have the child squat down to pick up one puzzle piece at a time and stand back up to place in puzzle. To challenge your child, have them stand on blue balance disc while squatting as shown below.
a. Frequency: 10-12 pieces
5) Tall Kneel Play: Place toys on top of a high support surface or couch and have your child maintain this tall kneel position while playing. This is a great position for balance, core strength, and transitioning to standing.
6) Balance disc: This is a great exercise to strengthen the core and legs while improving balance skills as well. Once your child is balanced, practice catching/throwing a soft ball to challenge your child even more.
a. Time: 30 seconds
b. Frequency: 3 times
8) Slide Pulls: This exercise requires the use of a slide. A playground slide or backyard playground slide is perfect. The child lies belly down at the bottom of the slide and pulls themselves up the slide using their arms and feet. This works upper body muscles like biceps and triceps. It also aids in the toning of back and shoulder muscles. Children can pull themselves up the slide, and have fun sliding back down.
9) Weighted backpack: Have your child carry a weighted backpack that you can fill with books or other items and go for a walk around the house.
10) Stairs: Practice walking up/down the stairs while wearing 1/2-1lb ankle weights. Check out our tips & tricks for stair climbing.
In addition to the above exercises/activities, here are some other suggestions an Orthotist can help with:
1) Surestep: These orthotics provide stability to children who pronate (flat feet) when standing and walking. They allow children to gain stability, while still allowing normal movement and function (e.g. walk, run, jump without instability). Surestep orthotics will also help improve alignment throughout the lower extremity, allow for a more stable gait, and decrease energy expenditure.
2) Dynamic Movement Orthosis (DMO): This is a lycra compression product that is specifically designed for children with abnormal muscle tone. The Lycra provides gentle compression, supports the muscle systems and corrects developing deformities of the spine. It is designed to target scoliosis and kyphosis, as well as low tone and spasticity. Other products include gloves, shorts, and leggings.
1) Martin K, Kaltenmark T, Lewallen A, Smith C & Yoshida A. Clinical Characteristics Of Hypotonia: A Survey Of Pediatric Physical And Occupational Therapists. Pediatric Physical Therapy, 2007;19:217-226.
2) Jacobson RD. Approach to the child with weakness or clumsiness. Pediatr Clin North Am 1998;45:145–168.
3) Ratliffe KT. Clinical Pediatric Physical Therapy: A Guide for the Physical Therapy Team. St. Louis, MO: Mosby; 1998
4) Martin K, Inman J, Kirschner A, Deming K, Gumbel R, Voelker L. Operational definition of hypotonia in children: a consensus opinion of pediatric physical and occupational therapists. Pediatr Phys Ther. 2005;17:275–282
The content in this blog should not be used in place of medical advice/treatment and is solely for informational purposes. All activities/exercises posted in this blog should be performed with adult supervision, caution, and at your own risk. Big Leaps, LLC is not responsible for any injury while performing an activity/exercise that has been posted on this blog. If you have any information on the content of our blog, feel free to contact us at firstname.lastname@example.org.