Knees
Usually only minor contractures develop at the knees before the child has to start using a wheelchair but it is essential to prevent these because it is difficult to stand or walk with bent knees. To stretch the knees the child lies on his/her back while the parent stands at the level of the feet, slightly to one side. Grasp the heel of the right foot with your left hand, your palm cupped and your fingers bent. With the other hand counter pressure is given on the thigh just above the knee–cap and the lower leg is brought up until the knee is straight. Be careful not to cause discomfort by over–straightening the knee. Repeat with the other leg.

Feet and ankles
The infant lies on his/her back while the parent stands at the level of the feet, slightly to one side. Grasp the heel of the left foot with your left hand, your palm cupped and your fingers bent. Extend your thumb up the side of the child’s lower leg. With the right hand grasp the foot and move it to a right angle. When doing this, check that the foot is straight i.e. that it is not turning in or out. The foot should be directly in line with the knee and the knee should be kept straight. Repeat with the other leg.

Elbows, forearms and wrists
Most children with muscular dystrophy have floppy elbows and wrists but some can develop tightness as they get older. The main stretch is to straighten the elbows while turning the palm of the hand up. Stand beside the child on the side of the arm to be stretched. For the left arm, cup the elbow in your right palm and put your left hand on the palm surface of the wrist. Turn the forearm as far round as possible so that his/her hand faces upwards and pull the hand down to straighten the arm as much as you can (without overstretching), holding this position for a count of five. Repeat for the other arm.

Active & Active Assisted Exercises
Active muscle work is where the child does the ‘Work’ himself/herself. This type of exercise helps strengthen muscles and may or may not be against resistance. Active assisted exercises are where the child and the helper work together to achieve a particular movement.

No matter how much exercise your child does, you cannot expect the muscles to become as strong as the ‘Normal’ muscle. However, most of the muscles in the body have the potential for increased strength with exercises and this will lead to some improvement in function and ability. In the weakest children, it may be difficult to notice much increase in power with exercise. The exercises are directed at the weaker of the muscle pairs in the arms and legs. The opposite pairs of muscles in the neck and trunk are almost equally weak but it is thought more important to exercise the ‘Extensors’, those that lift the head up and pull the trunk up straight, rather than the ‘Flexors’ which are the muscles which bend them forward.

The child lies over a roll resting on the forearms with the head down. The object of the exercise is to try to lift the head and push the arms straight.

Head & Trunk Extension
The child rests on the tummy and attempts to raise the head and shoulders to look up. The arms may be supported by the helper. Games such as pushing a ball can be incorporated into this exercise.