Physiotherapy for HSP is highly individualized, adapting to the specific symptoms, severity, and progression of the condition in each person. Common interventions include:

• Stretching and Flexibility Exercises:
  • Passive stretching: A therapist or caregiver moves the limb through its range of motion.
  • Active stretching: The individual performs stretches independently.
  • Prolonged stretches: Holding stretches for a longer duration to reduce muscle tightness and prevent contractures, particularly in the calf muscles (Achilles tendon).
  • Regular stretching is crucial to combat the effects of spasticity.
• Strengthening Exercises:
  • Targeted exercises for muscles that are weak or underutilized, especially in the hip flexors, quadriceps, and core.
  • Using bodyweight, resistance bands, or light weights, focusing on controlled movements.
  • Strengthening can help improve stability and compensatory movements.
• Gait Training:
  • Focus on improving walking patterns, efficiency, and safety.
  • Exercises to improve foot clearance, stride length, and balance during walking.
  • Practicing walking on different surfaces and with varying challenges.
  • May involve using a treadmill, often with body-weight support for safety and to practice normal gait patterns.
• Balance and Coordination Exercises:
  • Static balance exercises (e.g., standing still on one or two legs).
  • Dynamic balance exercises (e.g., reaching, stepping over obstacles, tandem walking).
  • Activities to improve proprioception and coordination, crucial for reducing falls.
• Functional Task Training:
  • Practicing daily activities that are becoming challenging, such as standing up from a chair, climbing stairs, or reaching for objects.
  • Breaking down complex tasks into smaller steps.
• Assistive Devices and Orthotics:
  • Assessment and recommendation for assistive devices like canes, walkers, or crutches to improve stability and reduce energy expenditure during walking.
  • Prescription and fitting of Ankle-Foot Orthoses (AFOs): These are often highly beneficial in HSP to control ankle spasticity, prevent foot drop, and improve the gait pattern. Physiotherapists provide training on how to use them effectively.
• Postural Training:
  • Exercises to improve core strength and maintain good spinal alignment, which can be affected by altered gait and muscle imbalances.
  • Advice on appropriate seating and positioning to maximize comfort and function.
• Aerobic Conditioning:
  • Low-impact aerobic exercises (e.g., cycling, swimming, arm ergometry) to improve cardiovascular fitness, reduce fatigue, and maintain overall health without exacerbating spasticity.
• Aquatic Therapy (Hydrotherapy):
  • Exercising in water provides buoyancy, reducing the impact of gravity, which can make movements easier and less painful. The warmth of the water can also help relax spastic muscles.
  • This allows for greater freedom of movement and strengthening without excessive load.
• Pain Management Techniques:
  • Manual therapy techniques, therapeutic exercises, and modalities to alleviate muscle and joint pain.