Although it's not part of the official diagnostic criteria for Aspergers, low muscle tone is nevertheless an condition strongly associated with Aspergers.
Why is it so Confusing?
When most people hear about "low muscle tone" they assume that it has something to do with bodybuilding - I certainly did at first. This is particularly confusing since many newly diagnosed aspies are children and it's quite uncommon to see any child with a well-developed set of muscles. Most parents will either simply ignore the condition or assume that a bit of outdoor activity, eg: playing soccer, is required.
The other confusing thing is that there are adult aspies out there who regularly attend the gym and who have "better" muscles than many NT people. How do they fit the criteria?
I saw a great line on a web site discussing Hypotonia. "Your kid seems perfectly good with their muscles - they are strong, they run round with boundless energy, but they have trouble doing things. You have likely been given the standard explanation about your kid's muscles being floppy and you just cannot see it in your kid."
Defining Low Muscle Tone
Low muscle tone refers mainly to the distribution of muscles on the body, their initial state, speed and stamina. The affected muscles can be "trained" but that training won't come from sport or from and normal gym/weight training. It comes from some very specialized training - and it won't be 100% effective. In young children, the problems of low muscle tone will reduce in severity as they get older - up to about the age of 10, though aspies will likely continue to adjust and compensate for the rest of their lives.
Hypermobility/HyperFlexibility
Low muscle tone is often described as "floppiness". This is because the muscles are supposed to help support the skeleton and are supposed to prevent certain types of movement. Since the muscles aren't particularly tight, people with low muscle tone often experience "hypermobility", the ability to move limbs into awkward positions.
As children, aspies often find that they are able to easily perform feats which require flexibility but not strength or balance, such as splits, backbending and shoulder rotation. They may display unusual flexibility in other joints such as fingers.
The Bad News about Low Muscle Tone
Such flexibility comes with a price and aspies are usually quite uncoordinated and clumsy. In running, this contributes to the famed "unusual gait". It's easy to imagine that low muscle tone only affects the big muscles but this isn't the case, it affects all activities requiring muscles including most notably, speech, pencil grip and writing.
When sitting or standing for long periods, aspies tend to slump quite a bit. Sometimes, they will stand with their legs crossed in what appears to be an uncomfortable fashion. My mother was constantly trying to correct this stance and while I'm reasonably aware of it at work, I still find myself standing that way regularly. I'll point out now that although this looks uncomfortable, this is actually a very comfortable stance for aspies.
Aspies often sit with their head and shoulders rolled forward and will frequently lean on walls, furniture, door frames and desks. Parents of aspie children will probably be very familiar with being "leant on".
Low muscle tone does not prevent aspie children from enjoying themselves, they can run and play with other children without feeling any ill effects. The problem is that, they're a bit slower and they tire easily. This means that team sports, like soccer are often not well suited to aspies. In the case of my son, we turned to scouting as an alternative to soccer.
Dangers inherent in Low Muscle Tone
While the slumping and leaning behaviours aren't necessarily great posture, they're not particularly dangerous to the aspie unless the position is adopted for very long periods without proper breaks.
I have first-hand experience with this problem as I've had episodes of "overuse syndrome", a kind of RSI, with my hands, arms and shoulders from sitting at my computer for too long. It took quite a while for OH&S to work out that the issue wasn't with my hands, or even with my workspace. It was simply due to excessive time spent in an unsupported position.
Fixing the Problem
As I said earlier, the fix isn't normal weight training, it's physiotherapy and specialized muscle training. There is also a need for awareness and constant correction of one's position. In my case, the muscles most needing training were small ones high on my back. Correcting my keyboard "slump"moved my arms and shoulders back into less damaging positions. I have to be constantly aware of my position and correct it thoughout the day. I also do a bit of stretching and strengthening work on them at the gym.
Why is it so Confusing?
When most people hear about "low muscle tone" they assume that it has something to do with bodybuilding - I certainly did at first. This is particularly confusing since many newly diagnosed aspies are children and it's quite uncommon to see any child with a well-developed set of muscles. Most parents will either simply ignore the condition or assume that a bit of outdoor activity, eg: playing soccer, is required.
The other confusing thing is that there are adult aspies out there who regularly attend the gym and who have "better" muscles than many NT people. How do they fit the criteria?
I saw a great line on a web site discussing Hypotonia. "Your kid seems perfectly good with their muscles - they are strong, they run round with boundless energy, but they have trouble doing things. You have likely been given the standard explanation about your kid's muscles being floppy and you just cannot see it in your kid."
Defining Low Muscle Tone
Low muscle tone refers mainly to the distribution of muscles on the body, their initial state, speed and stamina. The affected muscles can be "trained" but that training won't come from sport or from and normal gym/weight training. It comes from some very specialized training - and it won't be 100% effective. In young children, the problems of low muscle tone will reduce in severity as they get older - up to about the age of 10, though aspies will likely continue to adjust and compensate for the rest of their lives.
Hypermobility/HyperFlexibility
Low muscle tone is often described as "floppiness". This is because the muscles are supposed to help support the skeleton and are supposed to prevent certain types of movement. Since the muscles aren't particularly tight, people with low muscle tone often experience "hypermobility", the ability to move limbs into awkward positions.
As children, aspies often find that they are able to easily perform feats which require flexibility but not strength or balance, such as splits, backbending and shoulder rotation. They may display unusual flexibility in other joints such as fingers.
The Bad News about Low Muscle Tone
Such flexibility comes with a price and aspies are usually quite uncoordinated and clumsy. In running, this contributes to the famed "unusual gait". It's easy to imagine that low muscle tone only affects the big muscles but this isn't the case, it affects all activities requiring muscles including most notably, speech, pencil grip and writing.
When sitting or standing for long periods, aspies tend to slump quite a bit. Sometimes, they will stand with their legs crossed in what appears to be an uncomfortable fashion. My mother was constantly trying to correct this stance and while I'm reasonably aware of it at work, I still find myself standing that way regularly. I'll point out now that although this looks uncomfortable, this is actually a very comfortable stance for aspies.
Aspies often sit with their head and shoulders rolled forward and will frequently lean on walls, furniture, door frames and desks. Parents of aspie children will probably be very familiar with being "leant on".
Low muscle tone does not prevent aspie children from enjoying themselves, they can run and play with other children without feeling any ill effects. The problem is that, they're a bit slower and they tire easily. This means that team sports, like soccer are often not well suited to aspies. In the case of my son, we turned to scouting as an alternative to soccer.
Dangers inherent in Low Muscle Tone
While the slumping and leaning behaviours aren't necessarily great posture, they're not particularly dangerous to the aspie unless the position is adopted for very long periods without proper breaks.
I have first-hand experience with this problem as I've had episodes of "overuse syndrome", a kind of RSI, with my hands, arms and shoulders from sitting at my computer for too long. It took quite a while for OH&S to work out that the issue wasn't with my hands, or even with my workspace. It was simply due to excessive time spent in an unsupported position.
Fixing the Problem
As I said earlier, the fix isn't normal weight training, it's physiotherapy and specialized muscle training. There is also a need for awareness and constant correction of one's position. In my case, the muscles most needing training were small ones high on my back. Correcting my keyboard "slump"moved my arms and shoulders back into less damaging positions. I have to be constantly aware of my position and correct it thoughout the day. I also do a bit of stretching and strengthening work on them at the gym.
Comments
The more important part is start of movement is always very hard, e.g. when we have to do sit-ups in P.E. class, I tremble hard at the first 4-5, then the trembling gradually fades. It's like my muscles have to "learn" making continuous tension from the repeated small activation impulses first (as the nervous system sends little sparks instead of one long signal, of which it's not capable of [I remember this from bio 101 but surprisingly many people don't]). Also, I tire quite quickly when running, and I have been told many times that I sit, stand or walk "carelessly" or too loosely. I was told it's not "polite" - but I, being an Aspie, don't really get what exactly politeness means, anyway, so I thought it was not that important. And I always found handwriting very strenuous and thus my writing was always messy and hrd to read. But the really peculiar thing is that when I'm excited/happy, I don't have any of the "constantly tired" feeling what I usually do. Maybe the manic excitement creates a state that would be hyperactive in a person with a higher muscle tone, but in me it's just "normal" as perceived. (Though the bad balance and coordination stay there in this state as well, which can cause many "silly" accidents.)
So, do I fit the hypotonia dx? It would explain quite a few things.
Your comments on this site are always very enlightening.
I don't think it is common for an aspie to not have hyptonia. It's not directly part of the diagnostic criteria but it is certainly indirectly there.
The comment about standing with crossed legs hit home, and I've joked about having inherited lousy joints because of various instances of RSI.
Please keep this great site up.
Another aspect of this is a kind of delay in getting muscles to fire. I used to notice it while riding a ski lift--after sitting for a few minutes it was very hard to get off of the chair, and once I missed the ramp completely! Even getting out of the car takes a mental effort. This is not from being unfit or overweight, just a weird kind of neurological delay.
I would be very intererested to know if anyone has done some actual research on this.
Thanks much, Fred in Utah, USA
Megan
Really interested in your article and would especially like to know more detail re: appropriate physiotherapy and specialized muscle training. How does one go about getting this?
Have a look at this article: From a Cerebal Palsy Web Site.
Note the following in particular;
"There is currently no known treatment or cure for most (or perhaps all) causes of hypotonia, and objective manifestations can be life long. The outcome in any particular case of hypotonia depends largely on the nature of the underlying disease."
You may be able to change the size and strength of muscles but you can't change their position.
Still, you can visit a local physiotherapist and ask about hyptonia and you will be given some exercises which can reduce issues.
Just be careful. Weight training a person with Hyptonia can cause more damage because our arms can move into bad positions due to floppiness.
i was very flexible. ok i can still put my palm hand fully on the ground with my legs straight so im still quite flexible i guess (with no gym since 15 years)
funny that i was reading your comment about crossed legs while i had my legs confortably crossed :p
horrible handwriting which is more a support for above average long term memory than a real writing. but maybe it s related to left handedness since i write with right hand.
when im tired i can pronounce words with difficulty.
unusual way of walking,sandals in winter, toe walking when possible
i happen to have unusual burst strenghth for my body size. i have well developped upper body muscles with very little training.i also have very low physical activity and im very lazy.
2 days ago i moved a laundry machine, no problem to carry but my joints hurted after this.
on some occasions (maniac enthusiasm as meredith says) i displayed amazing strength, which i can not reach when in normal state.
also , despite lack of training and no taste for sports, i used to be above average in endurance running.
maybe hypotonia have also good side effects on performance while bad effect on normal daily muscle use?
like something that runs better than normal at full power but runs poorly at low power? (2 stroke engines for instance)
i have some idea that there are different muscle fibers.
a specialist of muscles physiology could probably answer to this.
Any Aspie around with a special interest in muscle physiology? :p
aduroyon@yahoo.ca
And lo and behold, it ticks SO many boxes, from his awkward gait as a child, difficulty handwriting and drawing, sleeping folded in half over crossed legs, to his hand tremor, and fatigue when just brushing his hair.
He's really been enjoying your blog, and keeps coming in to show me more posts, and saying "Yes, yes, I do that!" (stimming, memory problems, etc etc). Thank you again!!
I am not sure if I have it, though. I have never tired easily, and have always enjoyed (and been fairly good at) sports. In high school and college, I did a lot of weightlifting, and am thus very strong, but inflexible. I was never hypermobile. But I do have poor handwriting, poor fine motor control, a hand tremor and general clumsiness. I also have awful balance, which I had previously attributed to inner-ear damage from childhood ear infections.
Also, your description of hypotonia as "floppiness" does not sound like me; I'm more rigid than floppy.
Essentially what you are describing is a loose joint with hypermobility.
When I was little I used to suck my big toe. (I know its gross but I saw nothing wrong wth that.) Now that I have spent 16 years in the gym irony has set in. I can do 90% full front splits but as for sides I can only achieve 86 degrees at best. Ahhh the price you pay for doing too many squats. I tightened my hips sooo much that I now have to restretch them again.
And to validate Gavin, muscle strength and joint mobility are two completely different animals. My tool for this was the execution of slow controlled exercises in a fixed plane of motion using mainly bodyweight as opposed to normal reps with big weights. Tighten the bolts first and the crane doesn't fall over. The bolts are the joints. Good luck guys.
I also have balance problems if I stand straight up with my legs together. I usually stand on my right leg with my left leg off to the side and I cannot stand for more than a few seconds without something to lean on, and even that is just a few minutes. Most of the time I am out I always try to sit somewhere because my legs start to shake and my feet get hot and hurt. When I was little I thought I was just being lazy. Also, I will sometimes lean against something and stand on just one leg, or I will stand with my left leg crossing behind my right leg.
Another problem I have is with body awareness, though I don't know if this counts as part of hypotonia. The gymnastics I do requires a lot of body awareness, but when I am doing a move I don't always know what my limbs are doing unless I look. It's not like I'm not paying attention, but it is like I literally CAN'T FEEL THEM. Obviously I know my hands are still there, but I can't tell if my fingers are together and my hands are straight, which makes each move harder.
One last question: could hypotonia explain why I can't build up strength in my arms and core?
So I typed in 'aspergers and muscle tension' and I get this - I wasnt even sure there was a link!
i am probably an asperger person , with low muscle tone and energy, is there any way around this or is there any way to improve the condition marginally
I don't have any experience of Aspergers but we are considering adopting a child with a history of it and he suffers from low muscle tone. He is 2. He seems to have a really good emotional connection with people. Does it always affect your emotional connection with the world?
I'm yet to meet someone with Asperger's Sydnrome who doesn't have some kind of difficulty with the communication of their emotions to the outside world.
Aspergers doesn't affect your emotions themselves but it can make it harder for you to communicate them to others. This means that sometimes people can't read if your happy or sad in your face - and sometimes they can't read an expected response (empathy).
It doesn't mean that it isn't there.
HOWEVER, we recently took him to a Podiatrist for basic insoles, thinking that would help his stability. Instead, the podiatrist pointed out that our son clearly has an underlying connective tissue disorder. Because he has Aspergers, the "autism" doctors have always passed off the "floppiness" and "hypotonia" as just another symptom of Aspergers. After the appointment, I began researching online and found tons of info on Connective Tissue Disorders, info that would have helped us greatly had we gotten it when he was 4 and we initially saw the geneticist. Now we're just catching up.
What is scary is this: Connective Tissue Disorders appear as "loose" or "floppy" limbs, scoliosis, etc. because the connective tissue is affected by an underlying cause (genetic, bacterial, or viral depending on a whole range of possible disorders or diseases). But Connective Tissue does not just hold your limbs in their sockets. They hold your organs together. "Loose" or "Floppy" limbs could indicate "loose" or "floppy" colon, stomach, lungs, heart, brain... (I'm being simplistic here, but you can explore further by googling "connective tissue disorders" on your own.) In my son's case, they are seriously looking at him for Marfans which affects different organs including the heart and colon. (He has had IBS and reflux since infancy and has had great relief on the GF/CF diet.)
Amazingly, I found (just) one medical site that did list Connective Tissue Disorders as a comorbid condition associated with ASDs. It seems that statistically, people with Aspergers and ASDs are more likely to also have connective tissue disorders, tho no one disorder is particularly linked. Interestingly, people with many connective tissue disorders are often dxnd with Generalized Anxiety Disorder due to how connective tissue affects proprioception. (If you've been dxnd with Sensory Processing Disorder you know this term well.)
This is really disturbing to me. The more I search the various autism websites, the more I see these sypmtoms listed as benign "signs" of Aspergers. If you have a connective tissue disorder, you possibly might live a long life, but very possibly you will die of aortic problems or bowel perforations in your early to mid adulthood. You might also end up with severe arthritis due to joint "floppiness" and spend your golden years in severe pain. I didn't know this before the podiatrist began to talk to us about connective tissue disorders. I just assumed the "symptoms" were benign indications of his Aspergers. I've always tried to decide between treating or accepting my sons Asperger "symptoms" on a basis of whether the symptom is hurting him in some way. Since "floppy" limbs didn't seem to hurt him, I assumed wrong. Now we are going through a series of tests to find out just how much our child has been affected.
Just wanted to let you know. This is really something that should be explored further.
I have always described certain behaviors of his as "noodlely" flopping around. We have seen improvements of the noodlely behavior with biomedical treatments (gfcf diet and supplements), listening therapy and sensory integration with an OT, and martial arts training. My son also needs the orthopedic inserts in his shoes, so I'll have to ask our wonderful doctor about connective tissue disorders. Thanks for that information.
Strongly associated (as in very frequently a condition).
It doesn't say always.
Don't forget, if you've met one person with Asperger's Syndrome, you've met ONE person with Asperger's Syndrome.
As a kid, I had poor coordination and low strength, but a year of playing football at the age of 13 (Aussie Rules) started a lifelong transformation. I seemed to take particularly well to the training, and the more intense, the better I developed. A couple of years later, I accidentally found myself getting into gymnastics, which I ended up enjoying. This also brought a lot of coordination issues under control. Today, I use weight training, run and compete in some very intense team sports. At almost 45, I have the energy levels of someone much younger, and am still finding my peak potential, and I'm remarkably free of wear and tear type injuries (touch wood!).
One challenge and mystery that remains is despite having little natural endurance and extremely high power over a very wide range of speeds (which is a real asset in my sport, where I have to push heavy objects at speed), I hack the sprinting speed that I should have. I suspect this is a neuro-muscular issue, as on a bad day when I'm feeling particularly sluggish, any attempt to increase speed is likely to cause injury, and I'm wondering about ways to specifically train to consistently reach my full potential. I also have a slight delay in changing direction, and don't perform as well in agility test that one would otherwise expect, which definitely seems to be neurological in origin.
On, and I've always had lousy handwriting. :)
If I have the idea of low muscle tone right, then it means that there's not enough tension in the muscle as well as a lack of graded control right? Which means they have much more difficulty performing tasks that we have no problem with, as they require more energy to perform them, as well as the fact that they have difficulty remaining still independently (like without leaning on something) for long periods of time.
This was said to be curable but... How long would it take on average? And is it completely curable, or will they continue to have problems in the future? And for the hyperflexible joints, do they go away after (if) the low muscle tone "cures"?
Also, patients with low muscle tone can still form muscles, right? Like through exercise and such? Since its not really the muscle development itself that is affected... (or is it?)
Sorry if the questions are worded awkwardly or what not, I just wrote it as my brain thought and rewriting it just makes it sound more awkward. My brain's kinda dead, I guess.
No it's not "curable". You can increase your muscle strength but you can't change how it is layered.
People with Hyptonia always have excessive muscular movement, even when better toned. It has its upsides and downsides.
The most obvious downside is that it's much easier to injure oneself if the limbs and move into positions that they shouldn't.
seems every aspie has different symptoms...my handwriting was perfect and I was very coordinated
My body posture always made me feel awkward, and as a kid I remember the other kids often said I walked weirdly, but I didn't get what they meant-after all, everyone walks differently, right? Now though it's annoying for me as a pianist, I've tried to sort out my posture before in figure skating lessons(my coach did ice dancing and decided to focus on my posture) and Alexander technique. All I have now though is that when I notice my posture's bad I try to correct it but don't seem to be able to maintain it without serious concentration, and Meredith I get what you said about usually feeling sore all over until you feel "hyper", it's annoying because that feeling's so inconsistent! One day I have the energy to go figure skating and do a lot of practice, the next three I'm sore all over! It never seemed to make sense...
The "leaning" thing also makes so much sense. I always thought that I just I just got tired more easily because I tended to lean against things when I was standing up for a while. Up until recently, I worked at a job that required me to be on my feet all day, and my boss had to constantly remind me not to lean against the wall, chair, etc. because it looked bad in front of our clients. I feel like I want to slap myself in the face for not realizing this sooner!
Although I have overcome many challenges that I had when I was 9. I have bad knees, tendonitis in both elbows which has been a booger to treat and had it since winter last year, back issues and I am always leaning on something if I have to stand for long periods of time. I am very active and exercise regularly but its so difficult sometimes as I have no energy. In boot camp groups Im always lagging behind, and its so embarrassing when the old folks pass me. I feel like its gotten worse, and no matter how much I train and work on isolated muscle groups I cant seem to strengthen those muscles. I just keep plugging away the best that I can though. Maybe if I ever get formally diagnosed I can look into focus muscle training which will help me in the long run.
This is great information that needs to be in the hands of doctors (children and adult), therapists, counselors, etc. There is research concluding a deficit of motor coordination in ASD but even this study steers it back towards behavior and socialization. When will professionals learn to look deeper than outward behavior and instead focus on the neurological, cognitive, sensory, and biomechanical aspects?!
P.S. You misspelled hypotonia in the title, writing hyptonia forgetting the "o"
Tiredness could be lots of things including chemical imbalance and diet -- or it could be hypotonia which would indicate poorly layered muscles and hyper-flexible joints. If his joints are too flexible, this could cause his legs to collapse under him.
Doing Physio is the right answer but keep a watch on diet as well. If nothing is showing up in the blood work, it suggests, for the moment, that the problem is physical.