Living with HSP? How Physiotherapy Can Make a Difference

A pseudonym has been used in the following article to maintain patient confidentiality.

Hereditary Spastic Paraplegia (HSP) is a condition caused by mutations in the SPAST gene, causing stiffness (spasticity) and weakness in the legs. Physiotherapy for Hereditary Spastic Paraplegia can help manage these symptoms to reduce its impact on mobility and daily activities. While there’s no cure, physiotherapy plays a big role in helping people stay active, safe, and independent.

For more information about this condition. Please visit this link.

Exploring The Benefits Of Physio For Spastic Paraplegia: John’s Experience 

John is 60-year-old man who was diagnosed with HSP type 4, the most common form of the condition, in 2021. He uses a walking stick to move around at home and crutches when outdoors. He reported that walking and stair climbing had become more difficult due to tightness and weakness in his legs, and he was occasionally off-balance. His cognition and upper limb ability remained intact. His goals are simple but important: to improve his strength and flexibility, walk better, and stay independent for as long as possible.

What Physio For HSP Looks Like For John

Bodyweight-Supported Treadmill Training (BWSTT)

Using special equipment (our Lite-Gait treadmill) which supports part of his body weight via a harness, we are able to help John practice walking with less load on his legs. This makes walking easier and allows him to focus on taking smoother, more natural steps without getting too tired or feeling unstable. This type of training helps reinforce rhythmic, reciprocal stepping, which is often disrupted by spasticity.

Gait (walking) Retraining

Gait retraining focuses on correcting abnormal walking patterns such as toe walking; reduced movement at the hip when stepping; or scissoring, where the legs cross over with each step. BWSTT is one way to achieve this, but other methods include walking over-ground with support and breaking up the walking cycle to focus on a specific phase that John has difficulty with. Supplemental strategies include cueing, verbal feedback, visual markers, and mirror use. Repetitive walking practice under supervision enhances the way the brain communicates with muscles to coordinate movement, and may slow down functional decline.

Lower Limb Strengthening

Strengthening the muscles of the hips, knees and ankles not only makes it easier to walk, but also helps counterbalance the effects of spasticity. Resistance exercises are customised to ensure safety while building strength, endurance and power, which are essential for tasks such as transfers, walking, and stair climbing. For example, John has weak quadriceps and tight hamstrings, making it difficult to lift his leg when walking. We are focusing on strengthening his quadriceps with isolated and functional exercises to make walking and daily activities easier for him.

Stretching Tight Muscles

Routine passive stretching helps manage spasticity by improving muscle length and joint mobility. The most commonly affected muscle groups are the hamstrings, inner thigh muscles, and calves. John has increased tightness of his hamstrings, so physio has included gentle passive stretching to loosen these muscles, reduce spasms, and improve flexibility. He has also been provided with stretches to do at home to help with comfort and ease of movement.

Balance Training

Staying steady on your feet is a big challenge with HSP. John has a history of falls and near-falls, so our goal is to improve his confidence, stability, and postural control to lower his risk of falls. This involves practicing standing and moving in ways that challenge balance through reactive balance drills, stepping exercises, and single-leg tasks. For some people, gait aids may be necessary to ensure safety as the condition progresses.

What You Can Expect From Physio For Spastic Paraplegia

As HSP is a progressive condition, physiotherapy can help manage symptoms and maintain function for as long as possible. With consistent effort and the right support, we hope to see several key improvements over time:

• Better walking ability and efficiency
• Maintained or improved strength and endurance
• Reduced muscle tightness and spasms
• Enhanced balance and a lower rate of falls

While we can’t stop its progression or cure the condition, physio for HSP can offer exercises and strategies to help you stay active, reduce the risk of complications, and improve your quality of life. Treatment plans are always tailored to you, especially as each person’s journey with HSP is different.

With the right support, living well with HSP Type 4 is not only possible – it’s achievable.

If you or someone you know is living with HSP or similar mobility challenges, reach out to our clinic. Our physiotherapists are here to help you move and live better.