What is serial casting and how can it help my child?
- Remco Hoppezak
- 1 day ago
- 11 min read
If your child is having difficulty with certain movements due to spastic muscles or shortened tendons, you may be wondering what therapies can help. One such option is serial casting – a gradual plaster cast treatment administered over several weeks to improve mobility. In this blog post, you'll learn in clear and detailed terms what serial casting is, how it works, who it's suitable for, and how it's applied in ApexaQLA's Sensophysio concept . We'll also look at how long such treatment takes, what happens afterward, how parents can be involved – and, of course, when serial casting is useful and how you can get started.
What is serial casting?
Serial casting (sometimes called serial plaster treatment in German) is a proven, non-invasive method used in physiotherapy to gently stretch shortened muscles and improve joint mobility. Instead of applying a single cast, as with a broken bone, a new cast is applied repeatedly over a period of usually several weeks. Each cast moves the affected joint a little further in the desired direction. This way, muscle and tendon length is increased step by step, without surgery but with continuous progress. Some even compare serial casting to braces for the arms or legs, as it improves posture in a similarly gentle and gradual way – only for muscles and joints instead of teeth.
Through this gradual stretching, Serial Casting offers a number of benefits for your child:
Improved mobility: Continuous stretching gradually increases the range of motion of the joint. Your child can, for example, raise their foot more easily or extend their arm further.
Reduced muscle tension: In children with spasticity, prolonged, gentle stretching can reduce excessive muscle tension somewhat. This can help relax tense muscles.
Avoiding surgery: In many cases, serial casting can avoid or at least delay orthopedic surgery . Instead of surgically lengthening tendons, the gentle approach of serial casting is attempted first.
Better function in everyday life: When joints can move more easily, everyday activities such as walking, standing, or reaching become easier. Your child regains mobility and independence in daily life.
Combinable with other therapies: Serial casting can be effectively combined with other treatments, such as botulinum toxin (Botox) injections for muscle relaxation. Serial casting is often used alongside intensive physiotherapy programs to maximize the effect.
In summary, Serial Casting is an effective and gentle method to specifically improve joint mobility, counteract muscle shortening and thus noticeably improve your child's everyday life.
Serial Casting vs. Dynamic Flex Casting – what’s the difference?
You may have heard of Dynamic Flex Casting alongside Serial Casting . Both methods use serial plaster casts, but there are important differences in their goals and approach:
Objective: Serial casting primarily focuses on increasing the range of motion of a joint by gradually stretching a shortened muscle . Dynamic flex casting, on the other hand, focuses more on the correct alignment of the bones (especially in the foot). It is often used to correct foot deformities or deviations, such as clubfoot, excessive toe walking, or other alignment problems.
Technique: In classic serial casting, the joint is passively stretched and held in place with a rigid cast (plaster or fiberglass bandage) to slowly lengthen the shortened muscle. In dynamic flex casting, however, the child's foot is first manually manipulated, gently moving it into the optimal anatomical position before being cast. More flexible plaster materials (soft cast fiberglass) are often used, allowing for a certain amount of movement.
Suitability for everyday use: Thanks to these more flexible materials, Dynamic Flex Casting usually allows the child to largely continue with their normal routine , apart from water activities. This means that children with a Dynamic Flex Cast can usually stand and even walk carefully, which further strengthens the muscles in the correct position during the casting phase. With Serial Casting, children with a below-knee cast can often also stand and walk slowly (with appropriate shoe soles), but the focus is less on movement in the cast and more on constant stretching. In both cases, it is important to avoid romping, running or jumping in the cast to prevent injury or damage to the cast.
In short, Serial Casting primarily improves range of motion through stretching, while Dynamic Flex Casting increasingly corrects the alignment and posture of the limb by allowing the body to function in the correct position while in the cast. Which method is more appropriate depends on the individual case – Serial Casting is often used when shortened muscles (e.g., calf muscles during tiptoe walking) are concerned, while Dynamic Flex Casting is more likely to be used when the shape/alignment of the foot is the primary focus. Both approaches are not "opposing" but rather different tools in the repertoire of pediatric physiotherapy.
Who is Serial Casting suitable for?
Serial casting is used primarily for children (but also adolescents and adults) who are limited in their mobility due to muscle shortening, spasticity or neurological diseases. Children with spastic paralysis or muscle shortening in particular benefit from this method when classic stretching and usual physical training alone are not enough to achieve sufficient freedom of movement.
Typical cases in which serial casting is used include:
Cerebral palsy: Many children with cerebral palsy have spastic muscles, such as shortened calf muscles, which leads to tiptoe walking. Serial casting can help bring the heel back to the ground.
Idiopathic tiptoe walking: Even children who constantly walk on tiptoes without a neurological cause can stretch their Achilles tendons through serial casting and learn a normal gait.
Brain injuries or spina bifida: Muscular imbalances or spasticity often occur after acquired brain injuries or in cases of congenital spinal cord injury (spina bifida). Series of casts can mobilize specific joints.
Muscular dystrophy and other neuromuscular diseases: Progressive muscle diseases lead to shortening (contractures); serial casting can temporarily restore mobility and reduce pain.
Orthopedic foot deformities: In some cases of clubfoot or similar foot deformities (in addition to the Ponseti method), serial casting is used to gently assist in the correction. Serial casting can also be part of the treatment for arthrogryposis (congenital joint stiffness).
Of course, the appropriateness of serial casting for a child should always be determined on an individual basis. As a general rule: If a shortened muscle or joint contracture significantly impairs your child's development or function and conservative exercises are insufficient, serial casting may be a viable option. If in doubt, consult a specialist – they can assess whether a cast would help.
Serial Casting in the Sensophysio concept
At ApexaQLA in Switzerland, serial casting is not viewed as an isolated measure, but rather as part of a holistic therapy concept called Sensophysio. Sensophysio combines sensory stimuli (e.g., balance and tactile stimulation) with active movement therapy to optimally promote the child's neurological and motor development. What sets it apart is its intensive and individually tailored approach: therapy plans are tailored, state-of-the-art methods are used, and high-frequency (intensive) training is provided.
At ApexaQLA, Serial Casting is seamlessly integrated into this intensive program. The cast is applied directly at the center by an experienced technician and is directly incorporated into the therapy plan. Serial Casting is often combined with other Sensophysio intensive therapies. This means that while the cast series is in progress, your child receives active physiotherapy and sensory stimulation in parallel to maximize their newly gained mobility. For example, strength, balance, and coordination can be worked on during therapy sessions while the cast stretches the muscle. This optimally complements passive stretching and active training.
Another important component of Sensophysio at ApexaQLA is the family-centered approach. Parents are involved in the therapy process from the very beginning and receive close guidance. We'll look at exactly how this works in the next section. Overall, you can remember: At ApexaQLA, Serial Casting is part of an overall concept that is individually tailored to your child – intensive, innovative, and always with a focus on playful learning and sustainable progress.
Process and duration of treatment
So, how exactly does a serial casting process work, and how long does it take? Here's a step-by-step overview:
Initial examination and planning: First, a specialized pediatric physiotherapist will conduct a thorough examination. This will measure the current mobility of the affected joint and the extent to which the muscles are shortened. The treatment goals will be discussed with you as a parent—for example, being able to move the foot a certain degree further upward. Based on this information, the team will plan the cast series (approximately how many casts might be needed and at what frequency).
Applying the first cast: Now the first cast is applied. The therapist carefully moves the joint into the maximum possible stretch position that your child can still tolerate and secures this position with the plaster cast. This first cast is the starting point, so to speak – it establishes the initial stretch. Important: Applying the cast should not be painful; your child may feel a stretching sensation, but severe pain is not normal. The cast then usually stays in place for about 5 to 10 days at a time. During this time, it continuously stretches the muscle. Once the cast is dry, your child can usually stand with it and even walk carefully with auxiliary shoes (the physiotherapists will show you how to do this). However, you should ensure that the cast does not get wet and that full weight is not placed on it for the first few hours after application until it has completely hardened.
Cast changes and gradual increase: After the wearing period, the cast is removed (parents can often remove it at home the day before the next appointment so that the child can be bathed). The therapist then checks the progress: How far can the joint now be moved? Usually, a small improvement can be seen. A new cast is then applied with slightly more stretch – i.e., the joint is moved a little further towards the target angle and then re-fixed. This process is repeated weekly or every 5-10 days. Each week, a few degrees of range of motion are gained. In total, such a serial casting series typically lasts between three and six weeks, depending on the initial findings. In some cases, it can be up to 8-12 weeks, but a total of about 4-6 cast changes is usual. During these weeks, you will come to the therapy center regularly for changes – a bit like you would regularly go for readjustment with braces.
After the cast series – stabilizing the results: When the desired mobility has been achieved or no further significant improvement is noticeable, the cast series is ended. Now it's time to maintain and utilize the newly gained freedom of movement! Immediately afterward, your child will usually be fitted with an orthosis, usually a so-called AFO (ankle-foot orthosis) for the daytime. This splint holds the foot at a 90° angle during the day, allowing the child to walk flat. For the night, there is often a soft positioning splint that even holds the foot slightly above 90° to ensure that the stretch is not lost overnight. How long such splints need to be worn depends on how well the muscles are strengthened and how the new range of motion can be maintained in everyday life. Physiotherapy continues in parallel: Now the program focuses primarily on strength training and movement training. For example, your child will practice rolling correctly and using the newly gained range of motion functionally. The biggest challenge is often breaking old habits like tiptoeing – this takes time, patience, and consistency. But with practice and the right tools, your child can learn to permanently embed the improvements.
Throughout the entire process, the therapists will, of course, ensure your child's comfort and safety. Parents will be instructed to check the cast daily to ensure it's in place, pay attention to pressure points or skin problems, and report any abnormalities immediately. Fortunately, serious side effects are rare—some skin redness or temporary discomfort on the first day of the new cast may occur, but these are easily manageable. Close collaboration between the family and the therapy team during these weeks is important.
Parent Training and Family Approach (FCC)
As a parent, you play a central role in serial casting therapy. ApexaQLA—and modern therapy concepts in general—follows a family-centered approach. This means parents are actively involved in the therapy process. After all, you spend the most time with your child and know them best. Furthermore, the progress made in therapy should be maintained and expanded in everyday life—and as a parent, you are your child's most important coach.
In concrete terms, this means that with serial casting, the therapists will show you from the very beginning how you can support your child. Even during the plaster cast phase, you will be given simple exercises to practice regularly at home. These could include heel taps while standing against a wall (this teaches your child to touch the floor with their heel, which is especially important after serial calf casting) or playful up-and-down leg movements while lying on their back. Such exercises, ideally performed several times a day, help to specifically strengthen muscles – such as the hip flexors and thighs – and to “teach” the brain the newly acquired mobility . Therapy therefore does not stop at the practice door, but continues at home.
The therapists will also train you on how to care for and monitor the cast (what do you need to pay attention to? When does the cast need to be removed? etc.). Through this parent training, you become, in a sense, part of the therapy team. Many parents feel more secure and empowered because they can actively contribute to improvements. And studies and practical experience show that when the family is actively involved, the results are more sustainable.
The entire process is geared toward providing your child with the best possible support in their familiar environment. Let's put it this way: Parents are equipped with the knowledge they need to optimally support their child's long-term development . And don't worry—you'll only be given as many tasks as you can handle. The team is always there to help you if questions arise. Together, you'll work toward ensuring that the improvements achieved through Serial Casting are lasting.
Conclusion: When does serial casting make sense – and how can you get started?
Serial casting is a gentle but effective treatment method when a child suffers from significant movement restrictions due to shortened muscles. Serial casting can be particularly useful for spastic children (e.g. with cerebral palsy) or who walk on their tiptoes, allowing them to achieve greater freedom of movement without surgery . The method is useful when conservative measures (stretching exercises, splints, normal physiotherapy) have not led to the desired result, or when the child is going through a developmental spurt and you want to gain mobility quickly. Serial casting can also be very helpful as a preparatory measure before botulinum toxin treatment or as complementary therapy in an intensive program. It is important to have realistic goals and to be willing to undergo the somewhat more complex procedure (with cast changes, splints, etc.) for a few weeks - however, the benefit to your child can be considerable when measured in terms of the improved quality of life.
How can you get started if you think serial casting could help your child? It's best to contact a facility or practice that specializes in child rehabilitation and has experience with serial casting. Because applying serial casts requires a certain level of expertise (e.g., you shouldn't stretch too much or too little, and complications must be recognized), only trained therapists should perform serial casting. At ApexaQLA, for example, you can schedule a no-obligation consultation at any time to find out if serial casting is right for your child (and if so, how therapy could be planned). During such a consultation, your child's needs will be examined, and you will be given all the details of the process explained to you.
In conclusion, serial casting is useful when the aim is to gently achieve more mobility and quality of life for your child . It does not replace other therapy, but can serve as a turbo to enable a developmental leap. The close involvement of physiotherapy and parents ensures that the results are maintained in the long term. A bit of patience and consistency are important - both from the therapist and from you as a family. But the effort is worth it, because the earlier you start with such measures, the greater the chance of lasting success for your child. If you are curious, do not be afraid to speak to specialists. Your child deserves the best possible support on their journey - and serial casting could be a valuable building block in helping them gradually achieve more freedom of movement and joy in life.
We look forward to getting to know you and your child. As part of our pediatric assessment, we will examine, among other things, whether serial casting is a viable option – individually tailored and always in the context of the best possible support.
As always, if you have any questions, just ask. We're here!
ความคิดเห็น