Serial Casting

For Management of Muscle Length and Spasticity

Serial casting is a method used to stretch and lengthen muscles. It is a very common treatment especially in children with neurological conditions like Cerebral Palsy. In neurological conditions, the muscles often shorten due to limited movement, muscle tightness or muscle stiffness called spasticity. Muscle shortening can often worsen after a growth spurt as the muscle is unable keep up with the change in bone length.


Serial casting is often recommended after Botulinum Toxin injections. This is to take advantage of a reduction in muscle spasticity to enable serial casting to be more comfortable and maximise its effectiveness. 

How does it work?

The leg or arm is placed in a stretched position and casting material is applied to lock the joint into position.

The cast stays on for 3-5 days, after which it will be removed and a new cast applied with the joint placed into

a deeper stretch. Whilst the cast is on walking and use of the upper limb is encouraged to maximise results

and minimise weakness. In some cases it is ideal to allow for time out of the cast to minimise weakness. 


Up to 3 casts may be required to reach the goal range of movement. 

Your physiotherapist or occupational therapist will work with you to establish a sensible goal and

casting plan prior to casting. 

The prolonged stretch provided by the cast may:

  • increase the length of the muscle

  • reduce the spasticity in the muscle

  • improve your child’s walking pattern

  • improve tolerance of ankle foot orthoses




Good to Know

  • Botulinum is known to reach peak effect 3 weeks following injection. We recommend that you inform us of timing of toxin injection so we can plan a casting series at the optimal time

  • The weather! We encourage you to consider casting in winter for comfort. We understand of course that this is not always possible.

  • Are new ankle foot orthoses (AFOs) required? After serial casting, ankle range may be much improved. Consult with your rehabilitation doctor or physiotherapist to see if the current AFOs will ensure that the improved range is maintained. Sometimes it is easier for the orthotist to cast for AFOs after serial casting. 

  • Have you told school or work about serial casting? Walking is encouraged following casting and there is no need to stop going to school or work. It would be a good idea to let them know in advance though!

  • Stretch Vs Pain. Often children are unable to distinguish between stretch and pain. Speak to your child about the feeling of stretch and the benefits casting will provide

  • Discomfort and pain is usually worse at night as our brain and the world quietens down for sleep. The first night or two with casting can be restless, mild pain relief medication can help with this. Rest assured that it will pass! It usually is a sign that a good stretch has been achieved by the cast.

  • 2 people are required in the serial casting process. One person to hold the limb in a stretched position whilst the other applies padding and casting. We usually engage our parents and carers to assist us in this process. If you've never had serial casting before or if you require another staff member to attend, please let us know.

  • If you are a NDIA participant, therapist time can be claimed under CB improved daily living as usual. Casting materials and products can be claimed under Core Supports "consumables" funding. 

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