What is Muscle Tone?

By Nicole Crisan, PT, DPT

Muscle tone is the tension or resistance when muscles are at rest (not contracting or moving a body part). Muscle tone influences how well we hold up our bodies when sitting or standing as well as our reflexes, coordination, motor control, and endurance. In contrast, muscle strength refers to how we actively move our bodies against resistance, such as gravitational forces or lifting, pushing, pulling weighting objects. Muscle tone and muscle strength are different but work together. If the muscle is not in its optimal length/position at rest, it cannot properly contract and produce adequate force. Thus, in children you either have low or high muscle tone, you can still see muscle weakness.

Normal Tone: There is adequate tone to resist natural gravitational forces. Children with normal tone will need an average amount of force from their muscles to actively move their bodies.

Low Muscle Tone (Hypotonia): Low muscle tone, or hypotonia, refers to muscles that are too relaxed. In children with low tone, there is little resistance felt when passively moving their bodies. It will take them more effort and work to actively move and use their muscles. Often children with low muscle tone lack proximal stability meaning they lack core strength. This in turn makes it more difficult to move and control their head, arms, and legs.

Signs of Low Muscle Tone in Children: 

• May appear “floppy” or have difficulty holding their body up.
• May have difficulties sitting or standing upright without support. Will often attempt to lean on any support (wall, parent, furniture)
• Delayed motor skills
• Decreased endurance-may get tired faster as it takes more effort for them to move/use their muscles
• May see poor coordination, balance, and motor control
• Increased flexibility
• Decreased body awareness

Activity Ideas:

• Elevated surfaces: Doing tummy time on your chest, wedge, legs, or on any elevated surface. This reduces the effects of gravity and makes it easier for your baby to lift their head up and work on propping themselves up on their arms.
• Yoga/Therapy ball: Bouncing/rolling back and forth on the yoga/therapy ball provides additional proprioceptive input to help provide feedback to their bodies to help their brains understand where they are in space. You can have your child in various positions on the yoga/therapy ball to work on strengthening.
  • • Sitting: Holding your child at their trunk (the higher you hold your child; the more support you give them which makes the exercise easier for them: under the armpits-lots of support vs at their hips-less support). Then, slowly move their body to the left, right, forwards, and backwards to work on their sitting balance, core strength, righting reactions, and postural control. Be sure to provide adequate support that your child needs to be successful. If you see they are having a difficult time trying to right themselves (bring their head and body back to the middle), then adjust provide them a bit more support. Then as they get stronger you can decrease the support you provide them.
    • Tummy time: Place your child on their stomach while holding them at their hips and slowly move them forwards, backwards, right, and left. The further back you roll them (moving their feet closer to the floor), this places them in a less gravity-dependent position making this activity easier for them. The movement on the ball will also help them work on their weight shifts and can work on strengthening their neck muscles as they will try to lift their head up and bring it back to the center.
    • Transitioning to sitting: Start by having your child lying on their back and hold them at their trunk (the higher you hold your child; the more support you give them which makes the exercise easier for them: under the armpits-lots of support vs at their hips-less support). Then slowly roll them to their right or left side, once they are on their side, with your hand that is on hip that is facing up to the ceiling, gently push your hand down towards you as you also help bring their trunk forward. You should see your child try to use their hand to help themselves push up into sitting. If you do not, that is ok! They just need to learn how to coordinate this movement; so, you can add more repetitions into your daily routine by every time you pick them up while they are their back, you can practice this transition.
    • Standing facing the ball: Have your child stand facing the ball and place their arms in front of them so they will have to push against the ball to stand up. I like to put the ball in a corner or against stable objects/furniture so that the ball does not move. You can place toys on a ball or wall or face a mirror to encourage them to look up.
• Obstacle course: Putting together different activities in a row to move from one end of the room to the other to work on a variety of skills such as strength, balance, and coordination. Some activities that you can include are using a box/step stool to walk up and down a step, walk across pillows, roll up a towel/blanket or use tape as an obstacle to step over, or put tape on the floor and having your child walk across it like a balance beam.
• Heavy Work: These activities help to provide additional proprioceptive input to help improve body awareness. Some examples are pushing/pulling a weighted box or toy cart (placing cans or objects), jumping, climbing over pillows, or carrying heavy objects.

High Muscle Tone (Hypertonia): High muscle tone, or hypertonia, refers to increased resistance or tightness in the muscles. In children with high tone, there is more resistance felt when passively moving their bodies. It is important for children with high tone to work on strengthening specific muscles so they can learn how to isolate muscle movements and not rely on using muscle groups to complete a movement/activity. It is often thought that children with high muscle tone are strong as it is difficult to have them move out of specific movement patterns or positions. They do still display muscle weakness as they will need to exert more force than normal to overcome the high muscle tone they have to perform an active movement. For example, as babies they might prefer to stand (earlier than expected) because they can extend their whole body, keeping their head extended, trunk upright, hips and knees straight. It can be more difficult to maintain a sitting position as they will have to keep their head and trunk upright but need to bend/flex their hips; their muscles need to be used and engaged in different ways to sit.

Signs of High Muscle Tone in Children:

• Stiff or rigid muscles: You might notice this when changing their clothes or diapers as it can be difficult to move their arms, legs, and/or neck. This also impacts their muscle length and their range of motion
• Difficulty with movement-have a difficult time performing smooth, coordinated movements
• Maintaining a fixed posture at rest
• Delayed motor skills

Activity Ideas:

• Yoga/Therapy ball: Gentle rocking and bouncing can help relax your child’s body. You can place them in sitting on their back, on their stomach, and standing while their body/hands are support on the ball.
• Short/Tall kneeling: Putting your child in dissociated positions such that different body parts are activating muscles in a different way. One example is being in a short kneeling position. This is when your child’s trunk is upright (trunk extended) and their bottom is resting on their heels (hips and knees flexed). Another variation that is a bit harder is tall kneeling. This is when your child’s trunk is upright (trunk extended), their bottom is not resting on their heels (hips extended), and they are on their knees (knees flexed). This position takes more hip and core strength to maintain. You can keep your child in these position by placing a paper on the wall and having them put stickers, paint, or draw on the paper. Another activity you can do is while they are in front of the fridge, have them play with magnets.
• Ramp: Standing and/or walking up and down the ramp works on postural control, balance, coordination, and strength. This will also help to work on the strength of your child’s ankles. By having them stand/walk facing the incline and stand/walk facing the decline, it makes them use both the muscles that are in the anterior and posterior portions of the feet/ankles. You can make this activity more interesting by playing catch/throw, popping bubbles, or rolling a ball up and down the ramp and having them walk after it.
• Side stepping: This works on helping them understand how to shift their weight as well as work on motor planning, coordination, and strengthening. You can use a curb or beam at the park/out in the community for your child to walk along. First have your child stand sideways on the curb/beam place your hands holding them at their hips or trunk (depending on how much support they need for their balance) and gently rock them right to left and as they lift one foot tell them to take a step sideways. They might need you to help them take a step initially.

Early intervention is key to help provide individualized treatment and parent education/support to address any concerns and signs of developmental delays. If you have any questions regarding muscle tone or concerns about your child’s development, you can schedule a consultation call with one of our therapists.