Low Muscle Tone or Hypotonia: Causes, Symptoms, Treatment, Exercises

Low Muscle Tone also known by the name of Hypotonia as the names suggests means having reduced muscle tone.¹ This is usually found in children but adults can also get it. When a child is born with Low Muscle Tone or Hypotonia then it is called as Benign Congenital Hypotonia.

Low Muscle Tone or Hypotonia can also occur as a result of certain medical conditions as well like cerebral palsy or muscular dystrophy which is a progressive neuromuscular disorder.¹ Low Muscle Tone or Hypotonia is usually detected in early infancy in children and in adults it is usually a symptom of a medical condition.

Children born with Low Muscle Tone or Hypotonia will be slow in achieving normal milestones, they will be floppy when they are held, they will also have a delay in holding their head held up, they will not be able to remain seated for some time when they are placed in a seated position, they will have frequent dislocations of the jaw, neck and hips. They may also have a slow chewing response and have difficulty feeding as a result of Low Muscle Tone or Hypotonia.

Treating a patient with Low Muscle Tone or Hypotonia is quite a challenge and involves a multispecialty approach depending on the cause and extent of the condition. The treatment will entail consultations right from a pediatrist to a neurologist, physical therapist, occupational therapist to a psychologist as some children when they grow older may find themselves lagging behind their peers in terms of fine and gross motor skills due to Low Muscle Tone or Hypotonia.

Low Muscle Tone or Hypotonia can be caused as a result of a variety of medical conditions. Sometimes, Low Muscle Tone or Hypotonia can also be genetic meaning that a child is born with Low Muscle Tone or Hypotonia. Usually, central nervous system disorders and progressive neuromuscular disorders are the main cause of Low Muscle Tone or Hypotonia. Some of the medical conditions that may cause Low Muscle Tone or Hypotonia are:

• Down syndrome
• Muscular Dystrophy
• Cerebral palsy ²
• Prader-Willi syndrome
• Myotonic dystrophy
• Tay-Sachs disease

Apart from Low Muscle Tone or Hypotonia, there are certain other symptoms which are associated with Low Muscle Tone or Hypotonia. These symptoms are variable and depend on the cause of the disease condition. Some of the symptoms associated with Low Muscle Tone or Hypotonia are:

• Muscle feeling extremely soft is a symptom of low muscle tone or hypotonia.
• Difficulty extending the limb beyond what is normal.
• In cases of children with low muscle tone or hypotonia, there will be symptoms of delay in achieving gross motor skills and problems with feeding.
• Shallow breathing is yet another symptom seen in children with Low Muscle Tone or Hypotonia.
• Children with Low Muscle Tone or Hypotonia also have symptoms of an underactive gag reflex.

Depending on the symptoms that are shown by the patient if Low Muscle Tone or Hypotonia is suspected either in a child or an adult the following tests will be done to confirm the diagnosis of Low Muscle Tone or Hypotonia and the cause of it.

• Radiological studies in the form of an MRI scan of the muscles affected can be done to see if there is any abnormality within the muscle which may be causing Low Muscle Tone or Hypotonia. An MRI of the spinal cord may also be done to look for any abnormalities in the spinal cord and nerves resulting in Low Muscle Tone or Hypotonia. Blood tests may be done to rule out any infections that may be responsible for causing Low Muscle Tone or Hypotonia
• EMG of Electromyography is done of the extremities to look for any abnormalities in the muscle function which may be caused due to Low Muscle Tone or Hypotonia.³
• A lumbar puncture may also be done to look for any abnormalities and rule out other medical conditions that may be causing Low Muscle Tone or Hypotonia
• Muscle Biopsy may be performed in which a sample of muscle tissue of a weak muscle is taken and sent for analysis. This will the physician an idea as to any abnormalities within the muscle itself that may be causing Low Muscle Tone or Hypotonia.

The treatment for Low Muscle Tone or Hypotonia depends on the age and overall health of the patient. It also depends on to which extent the disease condition has advanced. Certain medications may also be used depending on the cause of Low Muscle Tone or Hypotonia. In case if it is caused by an infection like meningitis or encephalitis then antibiotics may be prescribed to treat the infection first followed by intense physical therapy to strengthen the muscles and increase the tone of the muscle.

In case if Low Muscle Tone or Hypotonia is caused due to a neuromuscular disorder like muscular dystrophy or myasthenia gravis then it can be treated with medications like physostigmine. Steroids may also be used to increase the muscle tone of the patient. In cases of congenital form of Low Muscle Tone or Hypotonia there is no treatment in particular suggested except for aggressive exercising to increase muscle tone and strength.

Joint dislocations which are very frequent in children with Low Muscle Tone or Hypotonia may require treatment. Once a cause of the patient’s Low Muscle Tone or Hypotonia is established then a treatment plan is formulated by the physician usually involving aggressive physical therapy along with gross and fine motor skill training to make the patient more independent.

Exercises play an important role in treatment for Low Muscle Tone or Hypotonia. The aim of the exercise is to increase blood flow to the affected area so that the muscle is strengthened and the tone of the muscle is increased. The aim of the exercises is also to increase the fine and gross motor skills of the patient. Some of the exercises that are recommended in cases of Low Muscle Tone or Hypotonia are:

This is an extremely important exercise for patients with Low Muscle Tone or Hypotonia. A pressure massage to the affected area increases the blood flow to this area and stimulates development of musculature. This massage needs to be done judiciously everyday until there is a significant improvement in the strength and tone of the patient suffering from Low Muscle Tone or Hypotonia.

In some cases, joint compression wraps can also be utilized which need to be worn for a few hours everyday to increase blood flow to the affected area leading to increased development of muscle tissue and helping treat Low Muscle Tone or Hypotonia.

Certain simple weight training exercises at home can also be done to increase tone in patients suffering from Low Muscle Tone or Hypotonia. This can be done especially for children by utilizing beanbags which the child is asked to pick up. Gradually as the strength increases more weight can be added to the beanbag in the form of books or other articles. This exercise goes a long way in improving muscle tone and strength of a patient with Low Muscle Tone or Hypotonia.

The muscle areas which are identified to be underdeveloped or have Low Muscle Tone or Hypotonia can be stimulated through pressure massage, utilizing ice and heat. Muscle stimulation exercise can be used in both children and adults with Low Muscle Tone or Hypotonia. These measures increase the blood flow to the affected muscle thus not only strengthening the muscle but also improving the tone of the muscle.

This is also an important aspect of developing muscle tone in patients with Low Muscle Tone or Hypotonia. They are simple exercises, especially for children with Low Muscle Tone or Hypotonia where the child is asked to pick up an item placed at some distance on a table.

The effort that the child makes to pick the item up increases the strength of the affected muscle and helps in improving fine motor skills of the child. To improve coordination the child can be asked to rub the left hand and foot together and then the right hand and foot. This not only helps in muscle coordination but also helps improve muscle tone and strength in patients with Low Muscle Tone or Hypotonia.

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