How do I strengthen a muscle when it can’t move at all?

In an exam there may be situations where you want to try to strengthen a muscle that currently has no movement. An example could be where a patient has decreased foot clearance during gait due to having no active movement of their dorsiflexors.

In this specific case it would be appropriate to refer to an orthotist for an AFO, but you can also do some strengthening.

When a muscle cannot move at all there are 2 main options

• mental practice

• Functional Electrical Stimulation (FES)

I would suggest you do not consider FES in an exam, and, in any case, there is no FES machine listed on the sim lab equipment list

Mental Practice essentially relies on our knowledge that imagining or visualising a movement occurring activates the same or very similar areas of the brain as actually doing the movement.

This helps promote neuroplasticity through activating adjacent or linked areas of the brain and “encouraging” these areas to take on the function that is being visualised.

How do we implement Mental Practice?

Essentially our role is to educate patient’s that:

• trying to move an unresponsive part of the body can sometimes help that part of the body to regain some movement, even if they can’t see any result or feel anything happening during the mental practice

• the more mental practice is done, the more it has the potential to help

• it is often better to do it for reasonably frequent short periods with good concentration

There are a few considerations for mental practice:

• it requires the patient to have sufficient concentration

• it can be incredibly frustrating for some people or cause them to focus on what they can’t do (eg. move their ankle) rather than what they can (eg. walk)