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Common Sense Precautions When Doing Exercises

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HealthWiki > Disabled Village Children > Chapter 42: Range-of-Motion and Other Exercises > Common Sense Precautions When Doing Exercises

Every child’s needs are different. Please do not simply do, or recommend, the same exercises for each child. First THINK about the child’s problems and needs, what exercises might help her most, and what could possibly harm her. Adapt the exercises to the child’s needs, and to how she responds. Here are some important precautions:

1. Protect the joint. Weak joints can easily be damaged by stretching exercises, unless care is taken. Hold the limb both above and below the joint that you are exercising. And support as much of the limb as you can.

Hold the leg firmly just above the knee. A child lying down while the adult is holding her leg up Hold the leg just below the knee and support the whole leg with your arm.
an image of hands pushing on child's knee joint with an X through it
Do not push directly on the joint. Do not pull far from the knee.

WARNING! Pulling here can dislocate the knee (or break the bone).

2. Be gentle—and move the joints SLOWLY— especially when a child has spasticity, or when joints are stiff or painful.

WARNING! Moving spastic joints rapidly makes them stiffer. SLOW DOWN!

For example, Teresa has juvenile arthritis and her joints are very painful. She holds them in bent positions that are leading to contractures. Move the joints very slowly and gently, as far as you can without causing too much pain. Straighten them little by little, like this:

A child in pain and an adult holding her hand
I'm sorry! I'll just hold it still until it stops hurting.
Adult holding hand and child is not in pain
It's stopped hurting now.
I'll straighten it a bit more, little by little!

A common mistake is to move the limb back and forth rapidly like the handle of a pump. This does no good and can do harm. Go slow, with gentle, steady pressure.

3. Do no harm. In children who have recently broken their neck, back, or other bones, or who have serious injuries, exercises should be done with great caution. Be careful not to move the broken or injured part of the body. This may mean that some joints cannot be exercised until the bones have joined or wounds healed. (For broken bones, usually wait 4 to 6 weeks.)

4. Never force the motion. Stretching will often cause discomfort, but it should not be very painful. If the child cannot tell you, or does not feel, be extra careful. Feel how tight the cords are to be sure you do not tear them.
An adult pointing to a boy's hand while boy is watching
I can feel the tendons tighten here as I stretch your elbow.

5. Do not do exercises that will increase the range of motion of joints that are ‘floppy’ or that already bend or straighten more than they should.

A child with bent ankles walking with support
Foot curved inward.
One hand on lower leg, another hand moving foot outward.
Large X crossing off image of one hand on leg, another hand moving foot inward.
If a child has ankles that already bend up too much, do not do ROM or stretching exercises that pull the foot up. Or if a child’s foot bends in more than normal, but does not bend out, do exercises to bend the foot out, but do not do exercises that bend the foot in.
Do exercises in the opposite direction of the deformity or contracture, so that they help to put the joint into a more normal position.

6. Before doing exercises to increase the range of motion in certain joints, consider whether the increased motion will make it easier for the child to do things. Sometimes, certain contractures or joint stiffness may actually help a child to do things better.
Child with normal leg and leg that is thinner and shorter.
For example, a child with a short leg may walk better if a tight heel cord keeps his foot in a tiptoe position.
Similarly, a child with paralysis in the thigh muscles may actually walk better if a tight heel cord prevents his foot from bending up.
Thin leg with arrows pointing to top of foot and to back of thigh and ankle.
weak thigh
tight tendon
This foot does not bend up. The tight heel cord holds the leg back and keeps the knee from bending.
Bent, thin leg.
Stretching exercises to bend the foot up may cause the weak knee to bend when the child tries to walk.

A child with cerebral palsy or arthritis often needs exercises to maintain or improve the movement of the back. However, a child with spinal cord injury or muscular dystrophy may do better if the back is allowed to stay stiff—especially if it is in a fairly good position.

Because of their weak back muscles, these children often develop a slouched or hunchback position. Range-of-motion exercise to increase flexibility could make the posture worse!
Child sitting in chair with back curved forward.
with ROM back exercise
Allowing the child’s back to stiffen in a good position may help him to sit straighter.
boy sitting in a chair with a straight back
without ROM back exercise

In persons with quadriplegia or other paralysis that affects the fingers, avoid stretching open the fingers with the wrist bent back.

A quadriplegic person with no muscle power in his fingers can often pick things up by bending the wrist back. Tight cords make the fingers bend.
A hand trying to pick up a ball with wrist bent forward and a hand with ball with wrist bent back
straightening fingers of a hand with wrist bent down
WRONG a hand stretching fingers of a hand with wrist bent back
To keep this holding function, straighten fingers with wrist bent down. Do not stretch the fingers with the wrist bent back.
For the same reason, the quadriplegic child should also learn to support herself on her hands with her fingers bent, not straight.
Child sitting on box with arm supporting him behind, and flattened hand.
7. In doing range-of-motion exercises for a stiff neck, caution is needed to make sure the neck bones do not slip and cause damage to the spinal nerves. This damage can cause total paralysis or even death. The danger is especially great in persons with arthritis, Down syndrome, or neck injury. Do not use any force to help the person bend her neck. Let her do it herself, slowly, with many repetitions, and without forcing.

8. In children with cerebral palsy, sometimes the standard range-of-motion exercises will increase spasticity and make bending or straightening of a particular joint difficult or impossible. Often the spastic muscles can be relaxed by positioning the child in a certain way before trying to exercise the limb. For example:

When a child with spasticity lies straight his back, his head and shoulders may push back. His legs also stiffen and will be hard to bend. But if we position the child with his back, shoulders, and head bent forward, this helps to relax his stiff legs and will make motion easier. It may also help to rotate the leg outward before trying to bend the knee.
Bending the spastic leg of child with cerebral palsy lying on ground.
Bending the leg of a child with cerebral palsy in hammock.
It may be very hard to bend the spastic legs of a child in this position.
A hammock is good for positioning the child with cerebral palsy who stiffens backward.

REMEMBER: Fast movements increase spasticity. Do exercises VERY SLOWLY.

CAUTION! Range-of-motion exercises are very important for many children with spasticity, but special techniques are needed. More examples of how to relax spasticity are given in Chapter 9 on cerebral palsy. However, you can learn a lot by trying different positions until you find the ones that help relax the spasticity.

9. In joints where there is muscle imbalance, do exercises to strengthen the weaker muscles, not the stronger ones. This will help to prevent contractures by making the muscle balance more equal.

If the muscles that straighten the knee are weak, then do exercises that strengthen the weaker side. Do not do exercises that strengthen the stronger side.
Child lying on back with knees bent, two arrows pointing to upper leg and thigh.
Child lying on table, one leg bent, other extended beyond table with band tied to table.
Child lying belly down on board with logs below it, one leg bent at knee, other with band pulling leg downward.
This will make stronger the muscles that straighten the knee. It helps prevent contractures. This will make the muscles stronger that bend the knee—and make contractures more likely.
and the muscles that bend the knee are strong,

In daily activities, also, look for ways to give weak muscles more exercise than strong ones. This advice is discussed in more detail in Chapter 16 on juvenile arthritis.

This page was updated:19 Jan 2018