Hi Phunphysio

Thank you for your response. I have some difficulty following your argument. I think it is useful to stick to what little evidence we have, as well as the tangible things that can be measures such as muscle strength and changes in functional performance.

The other point is that any resistance to passive elongation one may pick up in a muscle, in the absence of neurological disorder, is related the the connective tissue elements associated with joints and muscles, as well as the titin within the muscle. Both of these structures change in response to muscle loading ie strengthening activities.

There is always a functional reason for child receiving a "diagnosis" of low muscle tone. There will be some functional task the child has difficulty performing.

The purpose of assessment is to identify the tasks a child cannot do and then identify the possible underlying reason for performance, as well as the factors, including impairments that are limiting performance.

In my experience children with so called "low muscle tone' always have a mixture of weakness, some two joint muscle shortening, hypermobility and avoidance of activities that require physical and mental effort.

Training task performance, strengthening muscles, releasing tight structures, training endurance improves everyday function. But most important perhaps is that the child learns to put effort into tasks and becomes more active, and the parents start to expect more or the child.

If an adult presents with low muscle tone it is always associated with weakness of joint hypermobility, which is associated with pain.