Tone can be described as the amount of tension a muscle has at rest. All muscles have a normal resting tone, which helps the body move freely against gravity and is needed for overall posture. In the case of muscular hypertonicity (hypertonia or high muscle tone), even at rest, there is an increased state of active muscle contraction.
To assess whether high tone is present, a muscle is taken through passive movements. Let’s take your leg for example, if someone tries to bend your knee, without you helping at all, there would be more rigidity trying to get your knee to bend because of this increased resistance from your muscles.
Hypertonia is commonly seen in Cerebral Palsy but may also affect those affected by other pathological disorders such as a stroke or simply be a response to pain. High muscle tone will often present as appearing rigid, it’s generally difficult to move and often involve muscles responsible for flexion, more than extension. In the leg, the knee may have a slight bend, the same will go for the elbow, while wrist and fingers are often fisted. In contrast, hypotonia is the term for low muscle tone.
Hypertonia can affect both arms and legs (quadriplegia), affect only the legs (diplegia), just one side of the body (hemiplegia) or can even affect only one extremity or one muscle group in a single limb. If gone untreated, hypertonicity can have the potential to lead to contractures or a permanent shortening in the muscles of the affected limb or limbs. It can present in babies as early as one year, sometimes earlier, all dependent on how severe the condition.
So, what can we do at home to combat hypertonia?
Position your child where they are most comfortable and move the affected body part slowly and safely through their available range of motion. Typically, your kiddos body will have a natural stop, which is why it’s important to move slowly. Stop just before this point, hold them to sustain that range for a few seconds, gently bring them back to the starting position and repeat. Hopefully as you continue this motion, their range increases further and their body is able to relax.
Going into a half kneel or a captain’s pose is the perfect example of what this may look like.
If your child typically postures in a global extension pattern, a child’s pose position – sitting on their heels and bringing their trunk to their thighs, may prevent increases in tone if in a heightened state. Initially these positions may be hard to maintain but more exposure can build tolerance.
Providing increased input to each major joint – ankle, knee, hip, wrist, elbow and shoulder, with short, gentle compressions. Placing one hand right above the joint, the other just below, gently bring both hands together while making sure not to pull your hands too far apart when returning to the starting position. If you feel like you are pulling too much soft tissue apart and/or together or their whole body is moving and grooving, that is far too much motion. Keep both hands as close to the joint as possible, the movement is extremely minimal.
Kristen Maranan is a pediatric physiotherapist at NAPA Center. She is an LA native who couldn’t imagine not being able to drive to the beach, mountains, Disneyland or grab some good grub, all in the same day.