Muscle Tone, Endurance, and Strength

www.TheMotorStory.com

Some people come into the world primed for action. They have a propensity to move and muscle tone develops as they grow that allows ease and accuracy of movement. It takes more energy for others to get moving. Some folks have big bursts of energy and corresponding movement but they tucker out quickly as endurance for motor activity is short.

Others may come into the world in any one of these states, but illness, trauma or fatigue takes a toll and they are left in a weakened state. This section addresses the following:

1. Increasing strength
2. Recalibrating muscle tone
3. Building endurance

We move by activating muscles. The muscles haul the skeletal structure (limbs, skull, rib cage, hips) in one direction or another; sometimes big movements, sometimes very small. Some muscles move themselves (heart, tongue--a collection of 16 muscles with a coating of nerve sensors) and some facilitate movement of other organs (eye balls, stomach).*

Muscular strength and endurance are determined by several factors.

1. Pre set readiness to move. This relates to muscle tone** and is regulated by the brain.
2. Amount of time the muscle moves and the type movement (quick twitch vs. slow twitch)*
3. Physiological factors such as the muscles’ efficiency in the consumption of oxygen.*
4. Emotional/cognitive factors such as the person’s determination to move.

Lance Armstrong is a perfect case study of someone who had all of the + side of movement working for him:

1. He was preprogrammed for movement (he reports in his first book that he always had to

be moving).

2. He was always moving so the muscles got quite a workout (in his youth he began

as a triathlete).

3. Physiologists tested his ability to consume oxygen efficiency and he was off the charts.

When he became sick with testicular cancer he embraced the following:

1. Continued to ride his bike with friends’ support whenever he could drag himself out of bed,

accepting that the most recreational, out of shape folks would pass him on their bikes.

2. The will and determination kicked in to keep moving, no matter how difficult.

Lance Armstrong was already a world class athlete at the time of his illness. The rest of us muddle along, but lessons learned from his life experience can be applied in a modified form.

1. Activate movement, no matter how limited.
2. Keep moving.
3. As you get stronger, ramp it up a notch, then another, etc.
4. When you reach a state of health, keep moving: it will make you feel better and provide a sense of accomplishment.

STRENGTHENING

The following outlines how to begin movement in a very limited way. This applies to individual’s who have been sick or experienced trauma of some kind, as well as those who are born with low muscle tone and strength.

1. Positioning

-Variations in position (side lying, back and on stomach, sitting, standing) provide

sensory input to the body and brain that help keep the child active in a passive way.

-Certain positions require work against gravity.

-Prone or stomach: activates back and neck muscles

Photo: Eileen Counihan

When the arm lifts off the floor while lying on the tummy the child is

“working against gravity.” This requires muscle strength.

-Side lying: Stretches the muscles on the side making contact with the flat surface.

With reaching activities, side, stomach and back muscles become engaged.

Passive

Active

Activities for both side lying and prone positions:

Watching T.V./Videos

Looking at a book (turning pages activates muscles in the arm)

Playing a board game

Lifting the head while in this position is a lot of work for Bobby’s neck muscles. His arms

bear the weight of his upper trunk, which activates arm and shoulder muscles as well.

For the very weak child, consider this gradation from fairly passive to active work against gravity:

Comfortably positioned on pillows to look at books or play a game

As the child gets stronger, swings and balls will add new challenges

Scooters Wheelbarrow walking Crab walking

2. Flexibility

Becoming familiar with the way all body parts move (called range of motion) and gently

moving in the various directions, helps keep joints from becoming stiff and also activates

muscles in a passive but important way.

Examples:

Moving the arms over the head, behind the back, touch back of the head,

back and forth in front of the body.*

Gently lifting the leg up with the knee straight as high as it will go without

forcing it. With the knee bent, move the leg away from the body and over

the other knee. Move the ankle up and down and around.*

Carefully move the head up and down and side to side.

*Make sure the shoulder and hip are well supported while doing these. Direction from a physical or occupational therapist might be helpful in understanding how to proceed.

3. Reaching

Photo: Eileen Counihan

Reaching is a slightly more demanding activity. It requires work, not only of the arms

but the trunk as well. How far the reach determines how much work is entailed. The

position of the body while reaching dictates how much work occurs against gravity.

SITTING POSITION (supported or not):

-Encourage reaching slightly above resting position and eventually to over the head.

-Encourage reaching to the sides, eventually far enough away that the opposite hand

has to support the body to prevent falling over

Slight reach to the side Big reach leads to support from the other hand

Photos: Eileen Counihan More ways to reach

Simply place toys to the side of the body to facilitate lateral reaching

STOMACH (prone lying): Maximizes work against gravity. Initially have the child reach

with one hand and build to reaching with both hands.

One handed reach should lead to two handed reach-much harder!

Examples:

Playing a board game- the intermittent reaching requires muscle work

Turning pages of a book

Puzzles-more consistent reaching

Building blocks-reaching higher up

“Ball” games (use balloons, bubbles, kooshes, bean bags, foam/fabric balls

-tossing into basket

-catching or rolling with one then two hands

Add batting with a wrapping paper cardboard roll or foam bat

More challenging reaching occurs by incorporating positions with equipment.

Rolling forward and bearing weight in hands Side reaching strengthens side muscles

4. REPETITION

As the child becomes stronger, these activities can be played for a longer time.

The pacing of the activity can increase (e.g. rolling a ball back and forth quickly)

Depending on the child: sometimes having measurable goals motivates the child

For example: record how many ball pushes before both arms touch the floor

how many blocks stacked

how many minutes of puzzle work

“Wow, yesterday you worked on the puzzle for three minutes then needed to rest. Today you worked for six whole minutes!”

Children frequently respond positively to an egg timer (fascinated watching the sand

move down to the other side). It also gives a sense of finality and completion.

“We are going to pick up the cards until all the sand is down on the bottom.”

A number sets a goal to work towards and also give the reassurance that the

activity WILL be completed (i.e. the child doesn’t have to do this for an interminable

amount of time!).

“You only need to do ten of these...five-you are half way there...you only have TWO to go..!”

Retrieving a set number of bean bags Five “Blast-Offs”

5. ENGAGEMENT

Finding activities that the child enjoys is obviously key. An adult might get real excited about a pair of 5 pound dumb bells, but I assure you in my many years of practice, I have never seen a child gravitate to these. (At a certain macho age, these become the treatment of choice, of course).

Sharing the time enthusiastically with the child is the other half of the formula. Leaving a pile of books or puzzles in a room will hardly motivate the child. But come with a small 3 cent balloon and chase it around the room, and you have the child engaged. Seeing a grown up play childish games is always of interest to children. (Remember the movie Patch Adams)

Quietly blow bubbles while the child rests in the crook of your arm and eventually you might see that child make a tiny reach to touch a bubble as it slowly floats by.

Photo: Eilene Counihan

Tinkering with Muscle Tone:

Muscle Tone is the continuous and passive activation of muscles throughout the body.

There are unconscious nerve impulses that result in partial contraction of the muscles at all times. When sleeping, muscle tone decreases.** There is a broad range in “muscle tone.” Some people have muscles in a fairly active and “ready to go state.” Others have lower tone leading to the need for more exertion to “get going.”

Clinical states of dysfunctional muscle tone are classified as:

Hypertonia or high muscle tone: This includes excessive muscle contractions leading to muscle spasms and/or contractions with permanent tightening of the muscle fibers, thereby limiting range of motion and function.

Conditions that lead to hypertonia should be addressed by a skilled professional. Generally neurologists, orthopedist, physical and occupational therapists*** address these concerns. Families are then given very specific guidelines regarding stretching programs and other supports.

Hypotonia, or low muscle tone: This relates to muscles being in a state of very low activation.

Some people are so “floppy” that they have difficulty or cannot sit upright and have a difficult time balancing and walking. Frequently the “low tone child” manages to learn to walk and sit but the quality of movement is poor. The child fatigues easily and prefers to be in a reclined position.

This child may be excessively clumsy and appears to be careless. Frequently the child is accused of laziness and/or stubborn behavior. The child may be whiny when asked to do something. This is the child who frequently is chosen last in gym class.

When a child is unable to acquire basic motor skills such as sitting, crawling and walking, child development professionals*** should be consulted. Serious hypotonia needs specific treatment just as hypertonia does.

When the issues are mild (more of a couch potato profile) the following guidelines can be used to recalibrate the neuro motor system and help the child increase overall muscle tone.

Keep in mind, this does NOT relate to toning muscles as in strength training.

Heavy Work Activities send nerve impulses to the motor centers of the brain that regulate tone. Ongoing bombardment sort of “wakes up” this system.

Movement Activities send “excitation” stimuli to motor organizing neurological centers. This “primes” the system for movement.

Photos by Eileen Counihan

Example: After certain low tone children play on a swing that moves rapidly in a circle, their backs become visibly stronger and they sit in an erect position and can work more effectively against gravity.

Net swings provide passive rotation * Holding on required for tire swings*

*Care should be taken when spinning the child. Refer to Comfort With Movement before

using rotation with the child.

The Touch or Tactile System also has an alerting effect on the brain and muscles. When children touch something “gooey” you can actually see the tone increase in their hands as they explore the substance.

For more information and specific activities for influencing muscle tone through these channels refer to:

Building Trunk Strength

Tactile Exploration

Increasing Body Awareness

Organizing That Body

Comfort with Movement

Tolerating Touch

BUILDING ENDURANCE

Endurance is simply the ability to sustain for an extended period of time in an given activity.

Some people can spend hours working on a math problem and others give up after 30 seconds. (Guess where I fall on that spectrum).

Language oriented people may struggle with a cross word puzzle for hours.

With practice and training, the language challenged person can learn strategies to do cross word puzzles and with intermittent success, will keep at it for increasingly longer periods (when motivated to do so). Likewise, with a final examination looming in Calculus, the math challenged student will buckle down for hours (albeit unpleasant hours) to figure out those d--- problem sets.

Likewise with physical activities. I have participated in 200 mile bike-a-thons over two days (yes, that is a century a day) with cancer survivors leading the pack. Some are still undergoing active treatment at the time of the ride.

There are thousands of stories of incredibly brave people who overcome the limitations of their physical maladies. I will briefly share just one, because I think it is rather remarkable. Patrick Byrne, CEO of Overstock.com**** is a cancer survivor. He bicycles across the country, SOLO, in a recumbent bicycle every year. He ended last year’s trans continental journey by participating in the Pan Mass Challenge, the 200 mile bicycle ride I was referring to earlier.

How does this relate to children?

Figuring our what the child enjoys and helping the child to increase the repertoire of enjoyed activities is pivotal to the child buying into working hard on physical activities.

I have one little boy who HATES “Rocketships.” I make him do these as a warm up ten times at the beginning of his treatment sessions. This activity requires him to lie prone on a scooter board, kick off the wall and “fly” across the room. It takes a lot of “heavy work.”

One day I decided to give up the same old drill and introduced a new component, which actually made the activity more difficult. Now he had to pick up a bean bag along the way, reach a bucket and toss it in-all in one big kick off the wall. You’ve guessed already. With the added challenge, he picked up all ten bean bags, with ten kicks off the wall, without complaint. Motivation is key.

Review all the sections listed above for increasing strength and recalibrating muscle tone. Make sure the child feels safe and enjoys movement. There are ample activities and strategies to help engage the child and get motivated to “work.”