Low muscle tone seems to be increasingly common. Physiotherapists Pip Jackson, Marieta Erasmus and Fiona Morley explain what it is and what you can do to help.
Low muscle tone
You may have heard teachers and therapists talking about “low tone”, but what is it? We all maintain our muscles in a state of readiness that allows them to contract rapidly should the need arise. This would not be a conscious action. When a person chooses to stand up, they should just be able to stand up and not have to think about it. In short, our muscle tone is what allows us to stay upright against gravity and to move and carry out activities.
Low muscle tone is used to describe things such as postural instability, postural vestibular dysfunction, motor planning difficulties, hypotonia, spatial problems or proprioceptive difficulties, to name a few. These terms mean that people have more difficulty in “turning on” some muscles than other people do. Because these muscles are seldom used, they remain weak. A person with low muscle tone adopts movement patterns which avoid using the weak muscles but overuse other muscles. A muscle imbalance develops, the overused muscles become tight or shortened and the under- utilised muscles become too lengthened and weaker.
People with low muscle tone learn to move in ways that are less efficient than they could be, because they accommodate the “hard to activate muscles” by avoiding the need to use them. If a person has low muscle tone, the number of methods that they use can become limited or they may only be able to achieve a particular task in one way.
As we develop from babyhood into childhood, movement demands become more complex and there comes a time when these coping strategies can no longer keep up. Sometimes an infant or a toddler is slow or cannot progress to the next milestone without skilled assistance. Some people can progress through life without intervention or only needing assistance when they develop a sore back because of the patterns that they adopt. Low tone appears differently and in varying degrees in different people. Therefore, individual assessment is necessary.
Why the fuss?
Young children learn and develop through their interaction with their environment and they do this by moving. When children are moving, they involve their bodies completely in the activity, whether it is climbing a jungle gym or playing cops and robbers.
Each time a baby moves, he is learning about space, distance, speed, the amount of force needed to move an object, height, balance… The list is enormous, and it extrapolates into broad areas such as mathematical and language concepts. Low tone is only a problem if a child is struggling to achieve milestones or with everyday activities. Low muscle tone is much more of a problem today than it was in years gone by. Firstly, lifestyles are far more pressured, and children are expected to understand information an achieve and operate at higher levels than in years gone by. Secondly, with cars, television and computers, kids are far less physically active.
Children need to know about their bodies and to be encouraged to participate in appropriate sporting and exercise activities even if they will never come first. If your baby, toddler or child is not developing in the areas that are necessary for his physical, social and emotional development, then therapeutic intervention may indeed be indicated.
There are signs that, when they occur in combination, may indicate that an assessment is required. Watch out for a child who:
- Struggles to suck
- Fatigues quickly
- Seems floppy or limp
- Drools (once they are beyond the age when this is normal)
- Complains of frequent muscular or joint pain or writer’s cramp
- Is slow to complete work, or completes it quickly, but with little attention to detail
- Avoids equipment that allows him to climb
- Refuses to participate in particular activities
- Is clumsy
- Falls frequently
Remember to look for a combination of symptoms, not just one. It is important to be aware that the above symptoms may be the result of sensory, motor or sensory- motor problems, which is why a thorough assessment leading to the correct “plan of attack” is so important.
If you think that an assessment is necessary, it does not matter who sees your child first – psychologist, paediatrician, occupational, speech language, play or physiotherapist. Each of these professionals should be able to say, “I think that this is really an issue for this person to tackle”.
Physiotherapy does not cure low muscle tone and nor do any of the other therapies. Your genetic makeup is what you were born with and it is what you will die with. Physio addresses the muscle imbalance that arises secondary to the low tone. It therefore works at a muscular level to stretch the shortened muscles and strengthen the weak ones; this should support the child to feel good about himself and to achieve. Once the imbalance is corrected, children, babies and toddlers use their muscles in their play and will usually maintain the improvement themselves. In some instances, they need booster treatments and sometimes when they are doing more study and less active play or sport, issues can reoccur or present themselves differently, for example as recurrent writer’s cramp.
Milestones part four: Twelve months
- Starts rapidly crawling
- May be able to stand or walk on her own
- Points to what she wants
- Can recognise her own name
- Claps her hands and waves goodbye
- Likes to imitate
What you can do
- Read books together and get her to point at various objects
- Encourage her movement by putting Tiny Love’s musical Stack and Play just out of reach
Real life story
Gaynor Paynter’s two sons have been diagnosed with low tone. She tells us her story:
Our one son had an Apgar score of 9 and 10 respectively. He slept through the night from the age of 6 weeks, smiled at 6 weeks and could roll over and hold his head up by the age of 3 months. His progress seemed to stop there. By the time he was 8 months, we started to become concerned. By now, we thought that he would be starting to sit up and crawl.
My husband Damian took Andrew to the doctor, the paediatrician told him in no uncertain terms that she suspected that our son had Spinal Muscular Atrophy, a debilitating disease that leaves the sufferer wheelchair bound, with a life expectancy of approximately 20 years. The second paediatrician and the physiotherapist suspected a far milder condition, low muscle tone or hypotone. We took Andrew for weekly physiotherapy and within a month, he could sit. Soon he started to leopard crawl. With physiotherapy and follow up exercises done at home; he took his first steps at 18 months.
We had hoped that our second son Brandon, who is similar to his brother in many ways, would not be hypotonic, but now at 9 months, he can sit for 20 seconds, he cannot hold his head properly or roll over all the way. It was with reluctance that we recently returned to our excellent physiotherapist, this time with Andrew running up the garden path. This time around, we know the exercises and we know the routine.