#108 - Muscle Tone vs. Muscle Strength

by Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC July 08, 2020

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Muscle Tone vs. Muscle Strength

Do you know the difference between muscle STRENGTH and muscle TONE? If not, you are about to learn all about it! 

As Occupational Therapy Assistants, we often work with children who have low muscle TONE. While this is different from muscle STRENGTH, it can go hand in hand (but not always!). 

As always, we give you our fav. tips, tricks, and strategies to help your child (or client, or family member, or neighbor …) if they have low muscle TONE. 


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Muscle Tone vs Muscle Strength

We often hear the terms "muscle strength" and "muscle tone" used interchangeably, particularly when discussing children who have low muscle tone. However, it’s important to distinguish between these two concepts for better understanding of what is actually happening in their bodies.

We're going to talk about the difference between them, why there's a difference between them, and how low or high muscle tone can impact your child. Then, of course, our favorite tips, tricks and strategies to help work on this for you guys.

What Is The Difference?

According to shape.com, muscle strength can be evaluated by measuring the utmost force our muscles are able to exert in one effort - a concept that describes how hard our muscular system works when faced with resistance and generating power. To test your own levels of muscle strength, you can opt for the one-rep max challenge where you lift as much weight as possible only once.

Strengthening your muscles can provide noteworthy advantages, from lifting bulky items to carrying out everyday activities with ease. It also reduces the chances of injury and assists in keeping up a healthy weight, making muscle strength training essential for sustaining fitness and an improved quality of life.

In contrast, as Nutrition Realm details, muscle tone is a measure of the resistance that muscles have to both active and passive stretching. This results in overall stiffness when at rest. Muscle tone serves three main functions: it helps maintain posture, stores energy for use later (known as stamina), and allows for seamless movement of muscles.

To phrase it simply, muscle strength is what you observe when flexing your muscles and tone is how they appear when at rest. Our experience working with children has revealed that many of them are prone to diminished muscular strength and endurance which typically comes hand in hand with low toned muscles.

Types of Muscle Tone

Abnormal muscle tone can come in two varieties: hypertonia (high tensivity) and hypotonia (low tension). Hypertonia, as explained by Breakthroughptli.com, is an excessive state of activity or high rigidity wherein a child's muscles cannot be relaxed. Consequently, the range of motion within their limbs may decrease and orthopedic issues could manifest.

Conversely, hypotonia is a condition characterized by low muscle tone. Reacting more slowly and lacking the ability to maintain prolonged contraction of their muscles, those affected appear quite limp with soft or mushy-feeling muscles.

Hypertonia, which is common in children with cerebral palsy and those who toe walk, has a distinct treatment from hypotonia. This could include daily stretching exercises, orthotics, surgery or even drugs to assist the child. Therapeutic intervention can also be beneficial for long-term results.

Hypotonia, or low muscle tone, is commonly seen in children diagnosed with autism. However, the two are not necessarily linked - they don't always go together. Additionally, hypotonia may be present in kids with Down syndrome and sensory processing difficulties as well as any number of other medical conditions. It's important to note that a child needn't have a diagnosis for having either high or low muscle tone.

Signs of Low Muscle Tone

Hypotonia can manifest itself in infancy, childhood, and adulthood alike; thus it is crucial to be able to recognize its signs. By familiarizing yourself with this condition's common indicators, you may even discover that you possess the symptoms of hypotonia.

By the age of three months, babies should be strong enough to hold their head in a neutral position when being pulled up into a sitting position from lying on their back. If your baby experiences "head lag" while doing this exercise, it could indicate poor muscle tone.

You may see that your child's milestones appear to be delayed. While these are general and can vary from the typical timeline by a few months, if skills such as rolling, crawling, balancing on their feet, or standing occur much later than other kids of the same age then it could signify low muscle tone.

Other potential indications of hypotonia may include:

  • Low coordination, such as clumsiness or tripping over objects or oneself
  • Hyper-mobility of the joints can cause a child to W-sit or suffer joint injuries often
  • Open mouth postures and excessive drooling
  • Speech impairments
  • Feeding challenges

Children with low muscle tone are forced to expend more energy than their peers simply in order to carry out everyday tasks.  As a result, they may tire more easily or become easily frustrated.

Impact Of Low Muscle Tone

As children grow older, they become more aware of how difficult things can be which is why it's not unusual for them to resist activities that require too much effort. In addition, we can observe the ways in which children may strategize to take the simplest and most effortless route.

For instance:

  • A W-sit posture does not require any muscle contraction or support for balance
  • Even beyond the expected age, take one step at a time as you ascend or descend each stair
  • Ask to be carried more frequently

It is essential to recognize that hypotonia can be quite difficult to detect. During physical tasks, particularly those requiring weight-bearing on the arms such as crawling or lifting objects, telltale signs of hypotonia will surface including locked elbows and overextended limbs. Furthermore, scapular winging along with instability in the hip area and legs accompanied by an unusual gait are possibly indicative of inadequate muscle activation which may indicate a diagnosis of hypotonia.

When performing fine motor activities or handwriting, children will often demonstrate reduced muscle control and joint instability. Consequently, they struggle with small tasks such as stringing beads on a necklace or fastening buttons on their clothes. It is important to recognize this issue so that we can create strategies to help them overcome it.

We can also observe these compensatory positions in seated tasks. For example, if they are sitting at a table or chair, their posture may involve leaning against the furniture; moreover, their head is likely to rest on their arm while lying down on its stomach during activities. Additionally, it's typical for them to keep their legs wider than the hips.

Activities To Strengthen Low Muscle Tone

If you are a parent, therapist or educator searching for the best practices to aid your child in cultivating muscular development, look no further! Here we present five of our most powerful tactics that can help strengthen low muscle tone.

Complete warmup activities every single day

Before getting your child to sit down at the table or doing any activity that requires dexterity and strength, take a few moments to engage in a five-minute warm up session. This will help activate their muscles, so they can perform better in whatever task comes afterwards. Here are a few fun activities to explore:

  • Jumping on the trampoline
  • Playing hopscotch
  • Completing a sensory path
  • Play dough or clay activities

Incorporating a positive reward system for challenging tasks

We can aid in developing self-esteem and resilience by utilizing a positive reward system instead of shaming or coercing children into doing difficult tasks. Kids who struggle with muscle tone may already be displaying signs of low self-confidence, so it's important to provide them with the incentive to stay motivated and persevere.

When children try something and are rewarded with positive praise, this fosters a cycle of success. This is key to building their confidence and stimulating them to keep trying again in the future. By having that positive reward system as an incentive for attempting tasks, we can equip kids with valuable life skills which will serve them well into adulthood.

Obstacle courses

The incredible benefits of this simple three to five step obstacle course cannot be understated. It's designed with one goal in mind: get every muscle firing and activated! Give it a try - jump five times, bear walk for five feet, perform wall pushes for 15 seconds, and end off doing the bubble mountain exercise for 30 seconds. Then, repeat these steps three to five times.

If your child is struggling to complete an obstacle course, this positive reward system will be extremely beneficial. Through using encouraging words and creating a fun atmosphere, you can help them press forward even when fatigue sets in. Motivation plays a big role in helping kids stay committed to the task at hand.

Participate in a variety of activities and games

Get your child to partake in activities and games while situated or reclining on a therapy ball, as well as when they're leisurely stretched out on the floor. Not only will this activate the core muscles, dynamic balance, postural control, and stability—it can also engage neck-, shoulder- and hand-muscles!

Container play is an excellent way for young children to build both their physical and mental strength. Sitting on the ball, rolling around, or engaging in tummy time activities can be beneficial alternatives to traditional table-based learning methods. These actions help strengthen muscle tone while also sharpening cognitive skills.

Get outside

With so many ways of enjoying the outdoors, it's easy to forget that these activities are also great for strengthening our muscles. Whether you're hiking, biking, swimming, or go on a nature walk - every outdoor activity is an opportunity to increase muscle tone and reap numerous other rewards!

The playground can provide endless entertainment options for kids of all ages. From slides to monkey bars, children won't ever get bored. If you have a child who is older and one who is younger, give your child the responsibility of pushing or pulling their sibling in a wagon.

Modify your approach as a parent

It is essential that you are mindful of the manner in which you lift your child with low muscle tone. Are you lifting them and setting them down by their hands? Maybe pulling or dragging them around with just one arm?

For extra security, make sure to squat down and grasp your child firmly around the ribcage or under their armpits before lifting them onto your hip, back, or shoulders. This will provide a much more comfortable lift while also avoiding any potential injury caused by incorrect handling methods.

Improving Low Muscle Tone

It is important to understand that developing muscle strength and achieving toned muscles are two distinct processes. Performing exercises or lifting weights alone will not give you the desired results; more specific methods must be employed for this purpose.

Muscle tone relies heavily on the central nervous system, so there is no guarantee of it ever normalizing completely. To fuel long-term health advantages for your child, the most efficient approach is to promote persistent physical activity! Stimulate frequent movement, and change up the positions they take as well as their exercises.

Children with low muscle tone become tired more quickly than usual, so it's paramount that we provide them a chance to rest. By understanding the struggle of having low muscle tone, we can better relate to kids and strive to incorporate activities into our lives which give assistance for them. Allowing ourselves the time to consider what is like in their shoes is an essential stride towards ensuring these activities are successful!


Check out our video on 7 Activities to Improve Core Strength, Postural Control and Balance in Children



While we make every effort to share correct information, we are still learning. We will double check all of our facts but realize that medicine is a constantly changing science and art. One doctor / therapist may have a different way of doing things from another. We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties and what we have found to be beneficial that will be as evidenced based as possible. By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your children. Consult your child’s pediatrician/ therapist for any medical issues that he or she may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Under no circumstances shall Rachel Harrington, Harkla, Jessica Hill, or any guests or contributors to the podcast, as well as any employees, associates, or affiliates of Harkla, be responsible for damages arising from use of the podcast.

Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We try our best to keep things fair and balanced, in order to help you make the best choice for you.

This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast.

Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC
Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC

Rachel Harrington, COTA/l, AC, CPRCS, and Jessica Hill, COTA/L, CPRCS are Harkla's in-house Certified Occupational Therapy Assistants (COTA) and Certified Primitive Reflex Clinical Specialists. They have been working with children for over 6 years in outpatient settings. They specialize in creating easy-to-digest, actionable content that families can use to help their child's progress at home. Jessica and Rachel are the in-house experts, content creators, and podcast hosts at Harkla! To learn more about Jessica and Rachel, visit the Harkla About Us Page. Make sure to listen to their weekly podcast, All Things Sensory by Harkla for actionable, fun advice on child development.

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