The Importance of Consistency

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by Sara Erling, NACD

NACD The Importance of ConsistencyAfter being gone several weeks this summer, I had not maintained my normal fitness routine. You see, I am one of those crazy people who likes to run marathons and work out at 5 a.m. I also like food. I figure the more I work out, the less restrictive I have to be with what food I eat. Anyway, while I am home I am used to doing classes daily that consist of strength training, Pilates, etc. However, when I am on the road, I mostly just have time for a quick run on the treadmill. It is exercise, but it is different exercise. This week since I have been home, I am EXTRA sore. Why? Because I am back to my strength training and muscle building activities that I haven’t done for three weeks. I am sure many of you have been there. You get good with working out or doing weights, then you stop, then you go back to it and you feel like you are going to die. That has been me this week!

So what does this have to do with your NACD program? I would like to specifically talk about gross and fine motor function and development. The cliché “if you don’t use it you lose it” comes to mind. While I have been working out this week, I have been thinking about some of the kids that I have worked with over the past several weeks – specifically, kids who have muscle balance issues and tone issues (high or low), which are impacting their ability to walk well or run. Due to summer schedules, it has been difficult for many of the families to stay on track with their programs. Believe me, I know. However, these kids haven’t improved in their mobility, and in some cases, they have regressed due to lack of input.

So I put the two different scenarios together and started to do some research. In a study in the Journal of Rehabilitation Medicine, researchers from the University of Copenhagen took 32 young and older men and had them stop exercising, using immobilization devices on one of their legs. In as little as 2 weeks, the younger men lost up to a 3rd of their muscle mass and strength in the immobilized leg. Two weeks! The older men in the study lost 25%. What is more interesting is that even after 6 weeks of retraining the muscle, the muscle strength for the men was still 5-10% lower than when they started. This was for a neurotypical adult. So if you think of your child with developmental issues, imagine what not working on muscle balance can do to their muscles. While the brain has plasticity and stores the muscle memory, muscle fibers grow but then can atrophy – really quickly. Whether we are doing sit-stands, or standers, or leg extensions, or crawling on a floor, the more the child is able to do that specific muscle building activity CORRECTLY, the more rapid the muscle fibers will grow, therefore not only increasing the strength and mass, but the muscle balance and tone. If we do the activities for a bit, then take time off and don’t exercise them, the less likely those muscles will stay developed, and they actually lose their ability to function. We see this with ourselves when we stop a workout plan; the same is true, and even more so, for a child with developmental issues.

Something to remember while on the subject of developing good muscle tone and strength is that function determines structure. The more a child (or adult for that matter) sits a certain way, sleeps a certain way, or even walks a certain way, the more likely they will continue to develop the muscle memory for that type of movement or position. For example, for a child who tends to always be in flexion – think back rounded, legs bent and curled up — the more likely their mobility will be like that – knees in flexion instead of straight, posture slumped instead of straight. That child needs extension. If the child is in that position too much of the time, so that their tone is then high (or tight), then they need even more extension. The flexor and extensor muscles essentially need to be equally strong to have good muscle balance. It is the same with abductor and adductor muscles or abdominals and back: they all work together to create a strong movement.  If we are to look at neurotypical development, especially with the younger kids, our goal is to build the proprioception/tactility and muscle balance to develop good tone. So if your child is like I am describing, and you see on your program that a high frequency of those mobility exercises has been recommended, that is why. We want to create an opportunity for each child, regardless of their diagnosis, to move well. The reality with this is that the more involved the child is, the more INPUT their brain and muscles need to make it happen. Tactility work is important for this also, as it provides the sensory input necessary for the brain to register the output. Finally, working the muscle in the correct way with frequency, intensity, and duration builds the mass and strength, therefore allowing the movements to occur.

The next time you are working out and your hamstrings and abs are sore in the morning, remember how important it is to stay the course. Stay consistent, not just with your own workout regimen, but your kids’. Happy programming!