Stretching Interventions in Children With Cerebral Palsy: Why Are They Ineffective in Improving Muscle Function and How Can We Better Their Outcome?
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 mea...
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doaj-14bb386a3eb34577b067c67edac8ddb72020-11-25T01:36:20ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2020-02-011110.3389/fphys.2020.00131517986Stretching Interventions in Children With Cerebral Palsy: Why Are They Ineffective in Improving Muscle Function and How Can We Better Their Outcome?Barbara M. Kalkman0Lynn Bar-On1Thomas D. O’Brien2Constantinos N. Maganaris3School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United KingdomDepartment of Rehabilitation Medicine, VC University Medical Center Amsterdam, Amsterdam, NetherlandsSchool of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United KingdomSchool of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United KingdomHyper-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.https://www.frontiersin.org/article/10.3389/fphys.2020.00131/fullmuscletendonin vivosarcomere additionstiffness |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Barbara M. Kalkman Lynn Bar-On Thomas D. O’Brien Constantinos N. Maganaris |
spellingShingle |
Barbara M. Kalkman Lynn Bar-On Thomas D. O’Brien Constantinos N. Maganaris 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 muscle tendon in vivo sarcomere addition stiffness |
author_facet |
Barbara M. Kalkman Lynn Bar-On Thomas D. O’Brien Constantinos N. Maganaris |
author_sort |
Barbara M. Kalkman |
title |
Stretching Interventions in Children With Cerebral Palsy: Why Are They Ineffective in Improving Muscle Function and How Can We Better Their Outcome? |
title_short |
Stretching Interventions in Children With Cerebral Palsy: Why Are They Ineffective in Improving Muscle Function and How Can We Better Their Outcome? |
title_full |
Stretching Interventions in Children With Cerebral Palsy: Why Are They Ineffective in Improving Muscle Function and How Can We Better Their Outcome? |
title_fullStr |
Stretching Interventions in Children With Cerebral Palsy: Why Are They Ineffective in Improving Muscle Function and How Can We Better Their Outcome? |
title_full_unstemmed |
Stretching Interventions in Children With Cerebral Palsy: Why Are They Ineffective in Improving Muscle Function and How Can We Better Their Outcome? |
title_sort |
stretching interventions in children with cerebral palsy: why are they ineffective in improving muscle function and how can we better their outcome? |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Physiology |
issn |
1664-042X |
publishDate |
2020-02-01 |
description |
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. |
topic |
muscle tendon in vivo sarcomere addition stiffness |
url |
https://www.frontiersin.org/article/10.3389/fphys.2020.00131/full |
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