Which activity is not recommended for Duchenne muscular dystrophy rehabilitation?

• A. Serial casting
• B. ROM exercises
• C. Stretching
• D. High-load resistance training with eccentric emphasis

Answer: (D)

In Duchenne muscular dystrophy, muscles are highly vulnerable to injury because dystrophin is missing, so rehabilitation focuses on preserving range of motion and function without stressing the muscles too much. High-load resistance training that emphasizes eccentric contractions applies large, rapid forces to already fragile muscle fibers. This can cause muscle membrane damage, calcium influx, inflammation, and necrosis, leading to accelerated weakness and contractures. Therefore, this type of training is not recommended.

In contrast, maintaining joint mobility with gentle range-of-motion exercises and stretching helps prevent contractures and preserve flexibility. Serial casting can be used to manage or slow the development of contractures in a controlled way, with careful monitoring. The overall approach aims to protect the muscles while sustaining function and daily abilities.