140 chapter 16
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.
The muscles that
straighten the
elbow will not
be used—and
will get weaker.
EXERCISES WITHOUT MOTION
Even if the child herself tries to straighten
her elbow, the pain will cause the stronger
bending muscles to tighten.
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!
So it is important that the child learn to do exercises that strengthen the muscles that
pull against contractures, not those that make them worse. This will be easiest and
least painful if she does exercises without motion.
First help her to learn which muscles move
parts of her body in different directions.
Then help her find interesting ways to strengthen the muscles
that need it without moving them. For example, she can lean
on a fence like this.
Everyday she can step
a little farther back
from the fence, to
take more weight
on her arms.
Have her exercise these muscles by relaxing
and tightening them, without moving her arm.
Notice that this
exercise also
strengthens
her knee-
straightening
muscles and
helps stretch
her heel cords,
wrists, hips, back,
and neck, in order to
look the llama in the eye.
Note: We have shown these exercises in a girl who already has
contractures. But it is best to start them before contractures begin.
You can figure out similar exercises without motion for all the weak muscles that
need strengthening to help prevent or correct contractures.
For example, to strengthen the
knee-straightening muscles, the
child can lie on her back with
her leg as straight as possible.
Have her tighten the muscles
on top of her thigh (without
tightening those underneath)
and count to 25. Then relax
and repeat 10 times. She
should do this 3 or 4 times a
day. Again, look for ways to
make it more fun.
Tightening this muscle pulls
the kneecap and rings the bell.
You can strap a small
bell or flag to the leg,
so that it will ring or
move when the knee
bone moves.
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