Physical Therapy to Regain Muscle Length and Joint Range of Motion

Many special needs children experience muscular tightness/stiffness every time they grow. This is especially seen in children with cerebral palsy because their bones grow at a normal rate, but their muscles fight to keep up. Toe walking occurs frequently due to muscular tightness and increased muscle tone. Habitual toe walking can also be due to sensory issues. Children who demonstrate prolonged walking up on their toes whether due to increased muscle tone or sensory issues, can develop tight calf muscles. This tightness prevents the child from walking with the heel in contact with the floor.

Serial casting is a treatment option that offers a relatively safe, non-surgical method of regaining muscle length and joint range of motion. Serial casting involves the application of several casts over a 3-4 week period. Casting is usually performed at the ankle. The goal of each cast is to gradually increase soft tissue extensibility and joint range of motion, thereby, reducing the foot and ankle deformity. Serial casting is often used along with the administration of Botox-A. Casting does not reduce the muscle tone that is present within the muscles, only the muscular stiffness associated with growth and limited motion.