Hesperian Health Guides

Exercises and Movement

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HealthWiki > Disabled Village Children > Chapter 16: Juvenile Arthritis: Chronic Arthritis in Children > Exercises and Movement


Our goal is to prevent contractures and dislocations, and to maintain the fullest possible range of motion for the body. So exercises are needed to strengthen the muscles that straighten the joints.

HOW PAIN CAUSES CONTRACTURES

When these muscles are tightened, they straighten the knee, Because it hurts to straighten the knee, the child with arthritis does not use these muscles much. So they become very weak.
arrows point to the muscles on top and below the thigh
arrows point to the muscles on top and below the thigh
and these muscles bend it. But these muscles stay tightened to keep the knee bent and guard against pain. So they stay stronger.
Since the muscles on top are weaker than those below, the uneven muscle strength keeps bending the leg more and more, even during sleep.
DVC Ch16 Page 138-7.png

Note: This kind of uneven muscle strength is called muscle imbalance


.

Because contractures from arthritis result mainly from unequal muscle strength, it is important that the child do all exercises and activities in ways that will strengthen the weak muscles that straighten the joints, not the muscles that bend them. For example:

Do exercises that work this muscle. But do not do exercises that work this muscle.
child exercises the muscle on top of the thigh
YES
This is the muscle that straightens the knee and prevents contracture.
crossed out image of the child exercising the muscle below the thigh
NO
This is the muscle that bends the knee and causes a contracture.
STRENGTHEN MUSCLES THAT STRAIGHTEN THE JOINT. DO NOT STRENGTHEN MUSCLES THAT BEND THE JOINT.

Follow this same logic with all exercises and activities. And look for ways to make the exercises useful and fun.

For example, Alicia has arthritis and can no longer walk by herself or straighten her arms and legs completely. As a way of moving herself about and getting some exercise, she can sit on a chair with casters, as shown here. But she should be careful to move in a way that helps prevent contractures.

crossed out image of a child pulling herself forward

NO
Pulling herself forward with her arms and legs exercises mostly the muscles that bend the joints.

child pushes herself backwards

YES
Pushing herself backward, with her arms and legs, does more to strengthen the muscles that straighten the joints.
This can make contractures worse. This helps prevent contractures.

Helping the child to strengthen the right muscles

One problem with exercises is that, when either you or the child try to straighten a joint, pain—or the fear of pain—can cause her to tighten the muscles that bend it. For example:

If you pull like this, the muscles that bend the elbow will pull against you—and get stronger. Even if the child herself tries to straighten her elbow, the pain will cause the stronger bending muscles to tighten.
child talks while straightening arm
OW!
DVC Ch16 Page 140-2.png
The muscles that straighten the elbow will not be used — and will get weaker. As a result, these exercises may strengthen the bending muscles instead of the weaker straightening muscles. This means that these exercises can actually make contractures get worse!




This page was updated:19 Jan 2018