Advanced physiotherapy for LGMD goes beyond basic exercises and involves a comprehensive, individualized, and progressive approach that adapts to the changing needs of the patient. It focuses on slowing functional decline, managing symptoms, and optimizing independence.

Techniques-

• Comprehensive Assessment and Monitoring:
  • Detailed Functional Assessment: Beyond muscle strength testing, this includes evaluating gait patterns, balance, ability to perform ADLs, and endurance using standardized scales.
  • Regular Reassessment: Crucial for tracking disease progression, identifying new challenges, and adjusting the treatment plan.
  • Respiratory Function Assessment: Spirometry and other tests to monitor lung capacity and identify early signs of respiratory muscle weakness.
  • Cardiac Monitoring: For LGMD types known to have cardiac involvement, ensuring exercise programs are safe.
• Maintaining Range of Motion and Preventing Contractures:-
  • Gentle Stretching Programs: Active, active-assisted, and passive stretching exercises are critical to prevent or delay contractures, particularly in the hips, knees, ankles, and elbows.
  • Serial Casting or Splinting: In cases of developing contractures, these interventions can help gradually lengthen tissues and restore joint mobility.
  • Positioning and Postural Management: Advising on optimal sleeping and sitting positions to prevent prolonged shortening of muscles.
• Strengthening (Low to Moderate Intensity):
  • Avoiding Overexertion: This is paramount. High-intensity or eccentric (muscle lengthening while contracting) exercises are generally avoided, especially in rapidly progressive types, as they can cause muscle damage.
  • Low to Moderate Intensity Resistance Training: Focus on strengthening remaining functional muscles without causing fatigue or muscle breakdown. This may involve bodyweight exercises, resistance bands, or light weights.
  • Aquatic Therapy: The buoyancy of water reduces the impact of gravity, allowing for easier movement and exercise, making it an excellent medium for strengthening and cardiovascular fitness without excessive joint stress.
  • Electrical Stimulation (e-stim): May be used to prevent muscle atrophy and maintain or improve muscle strength, particularly in weakened muscles.
• Balance and Proprioception Training:
  • Balance Boards and Unstable Surfaces: To improve stability and reduce fall risk, starting with stable surfaces and progressing cautiously.
  • Dynamic Balance Exercises: Incorporating movements that challenge balance, such as reaching, turning, and stepping.
• Gait Training and Mobility Aids:
  • Gait Re-education: Addressing specific gait deviations (e.g., waddling gait, foot drop) through targeted exercises.
  • Assistive Devices: Recommending and training in the use of mobility aids (canes, walkers, orthotics, wheelchairs/scooters) to maintain independence, reduce fatigue, and prevent falls as weakness progresses. Orthotics can help manage foot drop or provide ankle support.