PURPOSE: To review research regarding mechanisms of muscle contracture in cerebral palsy (CP) and the effectiveness of stretching, and to discuss current physical therapy stretching practices. Community-based recreation opportunities that encourage flexibility and fitness are explored as alternatives to traditional therapy stretching approaches. SUMMARY OF KEY POINTS: Mechanisms of muscle contracture in children with CP are unclear and clinical research evaluating the effects of stretching is inconclusive. Recent shifts in thinking about the management of children with CP suggest an increased emphasis on flexibility, fitness, and participation in activities that are meaningful to children and families. STATEMENT OF CONCLUSIONS: Additional research is needed to explore the structural changes that occur in the shortened muscles of children with CP and the effects of stretching practices used in pediatric physical therapy. RECOMMENDATIONS FOR CLINICAL PRACTICE: Physical therapists can consider innovative alternatives that integrate flexibility and fitness goals with community-based recreation programs.
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