Child & Family Development Child & Family Development

March 14, 2023

Physical Therapy and Down Syndrome

How Physical Therapy Can Help Children With Down Syndrome

Pediatric physical therapists work with children of all ages and all medical conditions. In PT one of our main goals is to help progress a child’s motor development, so they can improve participation with their peers in age-appropriate physical activities. To learn how physical therapy can help children with Down Syndrome to improve their quality of life, independence, and participation, then read along!

Children with Down syndrome have several musculoskeletal differences that contribute to a delay in motor development. The most significant difference is due to hypotonia (low muscle tone) and ligament laxity (looseness) which are characteristic of Down Syndrome. Hypotonia is distributed to all major muscle groups, including the neck, trunk, and all four extremities.

The following lists some common neuromuscular impairments in Down Syndrome, and how each impairment can limit a child functionally:

  • Hypotonia and low force production: Low muscle tone has been highly correlated with a delay of gross and fine motor skills, and delays in other areas such as speech acquisition and cognitive development. Low muscle tone can lead to a lack of interest in movement activities and decreased overall fitness.
  • Joint hypermobility: Can cause some anxiety with movement and feeling unstable while holding static positions, like standing on one leg. Ligament laxity can result in flat feet, knee instability, a curvature of the spine called scoliosis, and atlantoaxial (A-A) instability. A-A instability is caused by laxity of a ligament in the upper neck joints, and is present in 10 to 20% of children with Down Syndrome. The laxity results in excessive motion of the first two cervical vertebrae. Only 1 to 2 % have symptomatic A-A instability and will need medical attention.
  • Slow automatic postural reactions: Can cause balance limitations, slow reaction time and decreased speed for completing tasks.

Children with Down Syndrome receive physical therapy intervention across the lifespan. Some of the common PT interventions can help:

  • an infant to achieve motor milestones such as sitting up and crawling.
  • a toddler to walk independently, and later on to safely go up and down the stairs.
  • older children and youth to work on specific motor skills and fitness needed for community or recreational activities.

For example, PTs can help a child improve their joint stability by strengthening the muscles around the joints, and practicing activities that improve proprioception, which is the awareness of joint position in space.

In addition, physical therapists can help a child with Down Syndrome by:

  • Teaching caregivers appropriate positioning and handling activities for their infant or child to promote postural control and weight bearing.
  • Designing activities to encourage the development of antigravity muscle strength in all positions.
  • Encouraging dynamic rather than static exploration of movement.
  • Collaborating with other members of the interdisciplinary team to enhance development in other areas such as cognition, language, and communication.

If you feel that physical therapy will benefit your child, or if you are unsure whether your child would benefit, then we highly recommend scheduling an evaluation with one of our PTs! Please call either of our office locations, or click “Request an Appointment” on our website to get started, and we would be happy to answer your questions.


Campbell, S. K., Palisano, M. N., Orlin, M. N., & Schreiber, J. (2017). Campbell’s physical therapy for children|physical therapy for children. Elsevier.