Stretching Exercises for Duchenne Muscular Dystrophy (DMD)

Importance of Stretching for DMD

Duchenne Muscular Dystrophy (DMD) is a progressive genetic disorder that leads to muscle weakness and atrophy. As the disease advances, muscle tightness, or contractures, can develop, severely limiting mobility and function. Stretching exercises are a critical part of managing DMD because they help:

• Maintain joint range of motion and flexibility
• Reduce muscle tightness and the development of contractures
• Enhance overall mobility and function
• Improve comfort and decrease pain due to muscle stiffness
• Support better posture and alignment

Stretching should be done regularly as part of a comprehensive rehabilitation program, tailored to the needs of each individual based on their level of muscle weakness and mobility.

Key Stretching Exercises for DMD

The following stretches are commonly recommended for children and individuals with DMD to help maintain muscle length, flexibility, and joint health:

• Hip Flexor Stretch: The hip flexors can become tight due to prolonged sitting or the weakness of other muscles. Tight hip flexors can lead to postural problems and contribute to a waddling gait.
  How to do it: To stretch the hip flexors, have the individual kneel on one knee with the other foot flat on the ground in front (forming a 90-degree angle). Gently push the hips forward while keeping the torso upright. Hold for 20-30 seconds, then switch sides.
• Hamstring Stretch: Tight hamstrings are common in individuals with DMD, which can limit their ability to walk or move freely.
  How to do it: To stretch the hamstrings, have the person sit on the floor with one leg extended straight in front. Keep the other leg bent with the foot near the inner thigh. Reach toward the toes of the extended leg, aiming to keep the back straight. Hold the stretch for 20-30 seconds, then switch sides.
• Calf Stretch: The calf muscles are often affected by muscle weakness in DMD, leading to tightness and contributing to walking difficulties.
  How to do it: To stretch the calves, stand facing a wall with one foot placed in front of the other. Keep the back heel on the ground and gently push the hips forward, feeling a stretch in the calf of the back leg. Hold for 20-30 seconds, then switch sides.
• Quadriceps Stretch: The quadriceps (front of the thigh) can tighten in response to muscle weakness, affecting posture and walking.
  How to do it: Stand holding onto a chair or wall for support. Bend one knee and bring the foot toward the buttock, holding the ankle with the hand. Gently pull the foot toward the body, keeping the knees aligned. Hold for 20-30 seconds, then switch sides.
• IT Band Stretch: The iliotibial (IT) band can become tight in children with DMD, contributing to discomfort and limited movement in the hips and legs.
  How to do it: To stretch the IT band, lie on your back and cross one leg over the other. Gently pull the top leg toward the opposite shoulder, keeping the lower leg flat on the floor. Hold for 20-30 seconds, then switch sides.

Guidelines for Stretching

It is important to perform stretches correctly to avoid injury or discomfort. Here are some general guidelines:

• Start slowly and never force a stretch beyond a comfortable point.
• Stretch at least 3-4 times a week, ideally daily, for optimal results.
• Hold each stretch for 20-30 seconds, and repeat 2-3 times per stretch.
• Focus on both sides of the body equally to maintain balance and symmetry.
• Combine stretching with other physical therapy techniques like strengthening exercises for maximum benefit.

Precautions and When to Consult a Professional

While stretching is beneficial for individuals with DMD, it is important to follow some precautions to avoid strain or injury:

• If pain or discomfort occurs during stretching, stop immediately and consult a healthcare professional.
• Work with a physiotherapist to develop a personalized stretching plan that suits the individual's abilities and needs.
• Be mindful of the child’s fatigue levels and overall health. If they are too tired or experiencing soreness, it’s okay to skip a session or reduce the intensity of the stretches.

Consulting with a healthcare provider or physiotherapist is essential before starting any new exercise routine, particularly for children with DMD. They can provide guidance on the appropriate stretching techniques and ensure the safety and effectiveness of the exercise program.