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Does your child have low muscle tone? Get them swimming!

You just got home from a doctor’s appointment and you were told that your child has low tone and needs physical therapy services. At your initial appointment the physical therapist tells you that in addition to traditional therapy, the pool would also be beneficial. Really? The pool? Swimming typically doesn’t seem like the biggest priority when a child is in need of physical therapy, but hear us out, the water is a great place for a child with low muscle tone!

First, being in water gives more buoyancy, or lift, to the body than on land. So, many activities that a child with low tone can’t do on land can first be learned in the pool. The pool gives them an opportunity to learn an action without needing all of the strength to complete the action. This is also referred to as motor planning. Let’s look at crawling as an example. Independent crawling can often be achieved earlier in the pool than in the clinic because a child learns how to crawl without needing as much strength. With repetition in the pool, this motor plan of how to crawl is reinforced, and results in fewer errors when transferring the skill to the clinic or home. This in turn results in learning to crawl independently quicker at home! Ta Da! You’ve got a crawler, in part due to swimming!


The water is also a great place to work on strengthening muscles. Just moving your body through water requires more muscle strength than moving through air. So, any movement a child is doing in the pool means they are strengthening every muscle they are using! Therapists will use specific activities, with or without equipment, to target muscle groups that each child needs to strengthen in order to achieve their motor milestones. This might look like just walking around in the pool, but walking in waist or chest deep water can be quite a challenge! Some patients will be asked to ride a noodle like a bicycle, which helps strengthen their tummy and leg muscles. Some patients will be asked to walk like a crocodile in shallow water which works on upper extremity strengthening. So, as you can see, there are so many ways that the water can be used for strengthening!

Kids with low tone often have difficulties with balance. Guess what? The water can help with this too! I know, I know, broken record! But, it’s true. The water can act as a support, and the deeper the water, the more supportive it can be. A child learning to stand independently can learn first in waist deep water, then progress to knee deep water, then ankle deep water, and finally on the side of the pool (or at home!). The water also allows for slower and safer falls, which give children time to practice their reactions to being off balance and regaining it. Once a child is stable in the water, you might see your therapist making waves around them; these waves make it harder to stay upright, giving the child more of a challenge. It’s similar to going from standing on a flat surface to a wobbly one.


Motor planning, that part of moving where the brain is figuring out how to move the body, can be a challenge for older kids with low tone because they don’t experience as much variety of movement as other kids their age. Movement happens so differently in the water that it’s a great way for kids to practice moving their bodies in new ways. Therapists can use many different swimming activities such as riding pool noodles, climbing on to float mats and paddling to work on motor planning. Although these activities might not look like the exact goal your child is working to meet (eg: jumping jacks, jumping jills), experimenting with new movements is a great way to work on motor planning in general.


Overall, the pool is a great place for kids with low tone to progress their gross motor skills, increase their overall strength and balance, and improve their motor planning in a fun environment. These are just a few of the many things aquatic therapy has to offer. Please speak with your PTC therapists for more information on how aquatic physical therapy could benefit your child.

Cerian Bearl, PT, DPT
Physical Therapist

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