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Introduction
 
Across the wide, uncharted country of Duchenne Muscular Dystrophy (DMD), where muscles weaken under the slow, relentless tide of a genetic inheritance, physical therapy stands as a kind of homestead—a steady outpost against the encroaching wild. It’s not a cure, no, but a way to hold the line, to keep the sinews limber, the strength clinging like thin roots in rocky soil, and the spirit free to move a little longer. These exercises, simple as they seem, are a quiet rebellion against surrender, a means to cradle a child’s independence and shore up the fragile banks of their daily joy. We’ve laid them out here like a map—stretching to keep the body from stiffening into silence, and other efforts to bolster what remains—each step deliberate, each movement a small defiance. Still, this is no solitary trail; a physical therapist or doctor must be your compass, shaping the path to fit the particular bends and hollows of your child’s frame.
 
Stretching Exercises
 
These exercises focus on maintaining muscle flexibility and range of motion, crucial for preventing contractures in DMD.

1. Side Twist Wrist Stretch
Purpose: Loosens wrist muscles to maintain flexibility.
Steps:
Have your child sit upright on a bed or bench.
Ask them to place one hand flat on the surface, fingers pointing outward at a 90-degree angle from their body.
Gently press their fingers down to keep them flat.
Support their elbow to keep it steady (it doesn’t need to be stiff or locked).
Hold the stretch for 30–60 seconds, repeat three times, then switch to the other hand.

2. Seated Finger Extension
Purpose: Keeps finger and hand muscles flexible and relaxed.
Steps:
Have your child sit comfortably in a chair or on a bed.
Help them extend one arm, bending the elbow to about 90 degrees.
Stand beside or behind them, holding their palm with both of your hands.
Gently open their palm.
Slowly slide your hands down to their fingers, extending them toward the floor.
Hold for 60 seconds, release, repeat once more, then switch to the other hand.

3. Moving Hand and Wrist Stretch
Purpose: Maintains range of motion in the arms through gentle movement.
Steps:
Have your child lie flat on their back.
Sit beside the arm you’ll stretch.
Ask them to extend their arm; support their elbow with one hand.
With your other hand, hold their arm near the wrist, gently keeping their fingers open if possible.
Slowly bend their elbow to at least 90 degrees, then straighten it back out (avoid forcing any movement).
Repeat this motion 10 times, rest, then do 1–2 more sets. Switch to the other arm.

4. Forearm Stretch
Purpose: Stretches forearm muscles to reduce tightness.
Steps:
Have your child lie on their back.
Use one hand to hold their elbow against their side throughout the stretch.
With your other hand, grasp their arm just above the wrist.
Bend their elbow to 90 degrees, palm facing up.
Hold for 60 seconds, release, repeat once more, then switch to the other hand.

5. Hip Flexor Stretch
Purpose: Loosens the hip flexor muscles (front of the pelvis and thighs)
Steps:
Have your child lie face down on a flat surface.
Stand on the side you’ll stretch, resting one knee on the surface for stability.
Place one hand on their lower back (on the stretching side).
Place your other hand under their knee on the same side.
Gently lift their leg while lightly pressing their lower back down.
Hold for 30–60 seconds, repeat 1–2 more times, then switch to the other leg.

6. Hamstring Stretch
Purpose: Lengthens the muscles at the back of the thighs.
Steps:
Have your child lie on their back.
Place one hand under their knee to support it.
With your other hand, lift their heel off the surface until they feel a gentle stretch behind their leg.
Keep their knee straight but relaxed (not locked).
They may feel the stretch in the upper thigh or along the whole leg.
Hold for 60 seconds, release, repeat 1–2 times, then switch to the other leg.

7. Iliotibial Band Stretch
Purpose: Maintains flexibility in the iliotibial (IT) band (outer thigh tissue).
Steps:
Have your child lie face down.
Stand on the side you’ll stretch.
Gently press one hand on their lower back.
Use your other hand to lift their knee on the same side.
Swing their leg gently across their body’s midline and hold it there.
Hold for 60 seconds, release, repeat once more, then switch to the other leg.

8. Supine Calf Stretch
Purpose: Keeps calf muscles flexible.
Steps:
Have your child lie face down.
Bend one of their knees to 90 degrees.
Use one hand to stabilize their lower leg.
With your other hand, hold the bottom of their foot and heel.
Gently flex their foot toward their shin as far as comfortable.
Hold for 60 seconds, release, repeat once more, then switch to the other leg.

9. Lying Achilles Stretch
Purpose: Stretches the Achilles tendon (calf to heel connection).
Steps:
Have your child lie on their back with a small rolled towel under their knees.
Hold their heel with one hand, pulling gently to straighten the leg.
Help them flex their foot toward their shin as much as they can without discomfort.
Hold for 60 seconds, release, repeat once more, then switch to the other leg.
 
Additional Exercises
 
These exercises focus on strength, respiratory function, and functional independence, complementing the stretching routine.
 
10. Isometric Quadriceps Contraction
Purpose: Strengthens quadriceps without excessive strain.
Steps:
Have your child sit on a chair edge, leg hanging down.
Straighten leg, hold for 5-10 seconds.
Repeat 5-10 times per leg.
Note: Ensure normal breathing during contraction.
 
11. Deep Breathing Exercises
Purpose: Improves respiratory function, strengthens diaphragm.
Steps:
Lie on back, hands on chest and abdomen.
Inhale deeply through nose, abdomen rises.
Exhale slowly through mouth, abdomen falls.
Repeat for 5-10 minutes.
Note: Helps expand lungs, crucial for DMD progression.
 
12. Water Walking
Purpose: Low-impact exercise, reduces muscle strain.
Steps:
Enter pool, water at waist level.
Walk forward, backward, sideways; include leg kicks, arm movements.
Supervise for safety.
Note: Buoyancy makes movement easier, less painful.
 
13. Standing from Sitting Practice
Purpose: Maintains ability to stand, enhances independence.
Steps:
Sit in chair with arms, use arms to push up, stand, minimize leg effort.
Practice regularly.
Note: Supports daily activities, preserves strength.
 
14. Isometric Bicep Contraction
Purpose: Strengthens biceps without movement.
Steps:
Sit, arm extended on table, push against resistance (e.g., hand) without moving, hold 5-10 seconds.
Repeat 5-10 times per arm.
Note: Avoids muscle lengthening, safe for DMD.
 
Comprehensive Analysis of Physical Therapy Exercises for Duchenne Muscular Dystrophy (DMD)
 
This section provides a detailed exploration of physical therapy exercises for children with Duchenne Muscular Dystrophy (DMD), combining both stretching and additional strengthening/functional exercises to support muscle function and quality of life. The analysis is grounded in a review of medical and physical therapy resources, ensuring a professional and evidence-based approach.
 
Background and Rationale
 
DMD is a genetic disorder caused by mutations in the DMD gene, leading to progressive muscle degeneration and weakness, particularly affecting males due to its X-linked inheritance. Physical therapy is a cornerstone of management, aiming to maintain flexibility, range of motion, muscle strength, and functional independence. The initial request included nine stretching exercises, focusing on passive stretches for various muscle groups. These are essential for preventing contractures and maintaining mobility. However, to address other aspects of physical therapy, additional exercises focusing on strength, respiratory function, and functional activities are necessary, especially given the disease’s impact on respiratory muscles and overall mobility over time.
 
Methodology
 
The process involved identifying exercises not covered in the initial list, focusing on those commonly recommended in DMD care guidelines and supported by clinical evidence. The exercises were categorized into stretching (nine exercises) and additional exercises (five exercises), ensuring they align with the needs of DMD patients at various stages. Each exercise was described with detailed steps, purposes, and precautions, drawing from the sources reviewed.
 
Detailed Exercise Descriptions
 
The following tables summarize the stretching and additional exercises, their purposes, and step-by-step instructions, ensuring clarity for caregivers and alignment with professional recommendations:

Safety and Customization: All exercises must be tailored to the child’s current abilities and stage of DMD, as emphasized across sources. Muscular Dystrophy News (Duchenne muscular dystrophy: Exercise and physical therapy) stresses consulting neuromuscular specialists every six months to assess muscle strength and function, ensuring exercises are safe and effective. The need for professional supervision is critical, given the risk of muscle damage from inappropriate exercises, as noted in the MDA Quest article.
 
Surprising Benefit: Water-Based Exercises
 
A notable finding is the significant potential of water-based exercises like Water Walking, which not only reduce muscle strain but also improve respiratory and muscle function. This approach offers an inclusive activity for both ambulatory and non-ambulatory children, enhancing quality of life in ways not typically emphasized in standard stretch routines.
 
Conclusion
This comprehensive list of 14 exercises, divided into 9 stretching and 5 additional exercises, provides a holistic approach to physical therapy for DMD. The stretching exercises maintain flexibility, while the additional exercises support strength, respiratory function, and functional independence.

Caregivers should consult a physical therapist to personalize these exercises, ensuring safety and efficacy for their child’s specific condition.