As a parent of a child with spastic cerebral palsy or other neurological conditions and diseases, you want to prevent muscle, tendon, ligament shortenings and contractures or to reduce their negative impact if they have already developed. Basic ideas are to increase the range of motion in the joints where mobility is reduced and to reduce general stiffness and increase the child’s comfort.
Experience shows that natural and almost instinctive reasoning is to use passive stretching to counter the shortening of all mentioned structures. Logically, if bodily structures have become shortened, we should elongate them through stretching, right?
Well, what if I would tell you that they are not actually getting shorter, but that they are collapsing or structurally imploding?
For sure, I will explain:
- What structural implosion is;
- What the difference between the shortening and implosion of the body structure is;
- How it changes our understanding of what we should do to achieve results.
To be able to achieve long-term results and prevent or reduce the shortening or contracture of muscle, tendons, and ligaments there is a need to change the way how they are observed in the classical rehabilitation in the first place.
In the classical approach to the rehabilitation, the body is often observed and analysed two-dimensionally, but in reality, the body is three-dimensional. It is a wrong observation because the human body has volume. What does that mean?
Two-dimensional objects have just two spatial dimensions (length and width, for example) whilst three-dimensional objects have three spatial dimensions or in other words volume (length, width, and depth/height). A circle and a square are two dimensional and they are called geometric shapes. On the other hand, a sphere and a cube are three dimensional and they are called geometric bodies.
In the same way, when a physiotherapist talks about the alignment of the bodily parts, he or she explains the asymmetry between the sides of the body of the child, refers to the asymmetry of left and right side or front and back side. It is a two-dimensional view.
Further, in the cases of scoliosis, they point out which muscles are shortened and which are elongated on the left and right side of the spine. This is, also, a two-dimensional view. Finally, when therapists explain the contracture or muscle, tendon or ligament shortening, they are referring to the reduction of the length of those structures. It is a one-dimensional view. Does this sound familiar to you?
Even if it sounds familiar, from the standpoint of rehabilitation what difference does it make if we observe the body one, two or three-dimensionally? Well, when the body is observed two-dimensionally it is the wrong observation which brings us to the wrong conclusions and false information. Further, the therapeutic procedures built on those false conclusions are false too. The human body in two dimensions is artificial. It is made up with a reason to simplify such extremely complex systems and to help us navigate through its complexity, but it does not reflect the true nature of it!
- Structural implosion.
Everyone can imagine what an explosion is. You saw many times how things explode in the action movies. The explosion force pushes outwards. An implosion is the opposite of that. The force pushes inwards. The structural implosion means that the body structure collapses inwards and loses its volume in the process.
Already, we said that shortening or contracture of a muscle, tendon or ligament is presented to you as a loss of the length (one dimension). I must say that is a wrong and superficial observation. It is never just a matter of the loss of the length. It doesn’t matter how small a tendon or ligament is or whether you consider it insignificant. It always loses all three dimensions. What appears to you from the outside as the shortening of the tendon, in reality, is not shortening, but the structural implosion (the loss of length, width and depth — the volume). I am wondering how we can observe a living three-dimensional structure and then treat it as a two-dimensional one?
- What is the difference between the shortening and implosion of the body structure?
The difference between those two is that the shortening is happening in one dimension and the implosion in all three. Basically, with an implosion, the structure is shrinking, but from all sides, not just one.
Please, try to imagine how a normal plum looks like and then imagine next to it a dry plum (or a normal and a dry fig).
You will easily observe that a dry plum/fig in comparison to normal one is shrunk. A shrunk plum/fig lost its volume and is smaller than normal plum/fig, but in the process of drying out, it lost all three dimensions, not just one. A normal and a dry plum/fig have the same content of dry matter but the only critical difference is that a dry plum/fig loses its water content. This is why it shrunk in the first place. That is exactly what happens with the body structure which implodes. With muscle, tendon, ligament too! I would like to be precise and explain that I am not saying that we don’t observe the shortening of the mentioned body structures — we do. But, it is critical to understand that with the reduction of the length there is also a width and depth reduction. The stiffness which parents usually can notice in children with cerebral palsy is partially the consequence of the loss of water content in the connective tissues. The extracellular matrix is becoming harder because there is less water in the tissues, and that is also the reason why they shrunk.
This is also the reason why the children with contractures look skinny – their tissues dried out, they are not shortened!
- How does this change our understanding of what we should do to achieve result?
First, let us think about what conclusion we can make from the observations we talked about. Well, the first conclusion is that muscle, ligaments, and tendons are not shortened but shrunk. We know they haven’t lost only the length, but also the width and depth by losing fluids.
Now that we know this, we can see passive stretching from the other perspective.
Passive stretching will work only on the elongation of bodily structures. In other words, it will work only on the length. In that case, how can we expect that we will regain full volume and functionality of the muscle, tendon or ligament by means of stretching? If we know now that the body structure lost all three dimensions (volume), how can we expect to achieve long-lasting results if we address only the length of the body structures?
Logically, to achieve long-term results, we need to rebuild all three dimensions of the tissues — the volume. Only volume building will bring steady improvements. The regain of the original length is possible only through the rebuilding of the initial width and depth. This is a reason why stretching will never bring long-term results. The length of the body structure cannot replace the other two spatial dimensions.
After all this being said, are you going to perform passive stretching to gain length or you are going to build volume to regain length, width, and depth of the imploded structure?
When tissues start to regain fluids which they lost, the body structure slowly goes toward relaxation, regain the improved range of motion and general mobility.
Same as when a dry plum or fig loses their fluids, they become stiff. It is the same with children with the imploded body structure. We need to reverse the process, to fill up the tissues with fluids. What we should do is to stimulate the tissues through the connective tissue remodelling process to achieve that.
Please, pay attention to differences between the imploded body structure and structure which regained some of the original volume. On the photo on the left, the body structure is shrunk, not shortened!
That is why we didn’t stretch his skinny arms, but instead, we stimulated tissues to gain internal fluids which they lack. As a result, the body structure gets a healthier look and metabolism; it starts to regain volume which brings relaxation. We actually achieved the result which parents strive to achieve with stretching, but instead, we achieved it without stretching.
Further on, we show the loss of the volume (structural implosion) on the left photo in comparison to a healthy structure. You will notice again how skinny and shrunk the structure is because of the lack of fluids.
