Should rehabilitation aim to preserve lower-extremity flexibility as much as possible in children with Duchenne muscular dystrophy?

• A. Yes, we should
• B. No, not necessary
• C. LE flexibility should be avoided
• D. Only ankle ROM matters

Answer: (A)

In Duchenne muscular dystrophy, joints tend to develop contractures as muscles weaken and are progressively replaced by fat and fibrous tissue. Preserving lower-extremity flexibility helps maintain the length-tension relationships of the muscles and keeps the joints moving through a functional range, which in turn supports important activities like transfers, seating, and wheelchair propulsion. By maintaining ROM, you delay the onset of painful or limiting contractures and help the child stay in a more functional position for as long as possible, even as strength declines.

In practice, this means gentle, regular ROM for the hip, knee, and ankle, integrated into daily care. Avoid aggressive eccentric loading or excessive stretching that could cause tissue damage; use safe, low-load stretches and consider night splints or serial casting for tight ankle plantarflexors if needed. Keep interventions balanced with the child’s comfort and disease progression.

Choosing to focus only on one joint or to avoid flexibility altogether would undermine function and hasten limitations. Therefore, aiming to preserve lower-extremity flexibility as much as possible is the best approach.