Physical therapy for spinal muscular atrophy
Last updated Oct. 15, 2025, by Susie Strachan
Fact-checked by Joana Carvalho, PhD
Physical therapy (PT) can be especially helpful if you are living with spinal muscular atrophy (SMA) and are able to exercise.
The main goal of physical therapy for SMA — a rare genetic condition that causes progressive muscle weakness — is to improve or maintain muscle strength and mobility. The various techniques and devices used will depend on many factors, including your age and the type of SMA.
Trying PT for SMA can make daily activities like walking, standing, and breathing more comfortable, and increase your overall quality of life.
How physical therapy helps people with SMA
Regular physical therapy can be a proactive way to manage SMA progression.
Whether you have SMA or care for someone with the condition, a physical therapist can help create a plan that supports motor strength and improves posture, flexibility, and range of motion. It may also prevent complications like contractures (the shortening of muscles, tendons, skin, or other tissues around a joint).
A therapist can guide you through an exercise program that engages your muscles and joints to their full range of motion. PT can help minimize stiffness, maintain flexibility, and prevent pain from tight, inflexible joints.
For scoliosis or other bone-related issues, a physical therapist may also recommend braces or supportive seating to promote good posture and protect your bones and joints.
If you need surgery for scoliosis or joint problems, a physical therapist may work with you before and after the procedure.
Common physical therapy techniques for SMA
At your first appointment, a therapist will assess your abilities and limitations and adapt physical therapy exercises and techniques to help with mobility and managing SMA.
Some common physical therapy exercises for SMA can be used no matter what type you have:
- Stretching and range of motion exercises: These exercises can help to maintain flexibility and reduce stiffness in the muscles and joints, to help prevent complications like contractures.
- Strength training: Resistance training improves muscle strength, stability, and endurance.
- Respiratory exercises: These exercises, as well as chest-clearing methods and postural support, can help maintain lung capacity and strength. This is especially important for type 1 SMA, as early intervention can improve an infant’s breathing ability.
- Aquatic therapy: Also called water therapy, aquatic therapy can benefit people of all abilities, including those unable to sit, so long as there’s proper head and neck support and supervision. Water’s buoyancy reduces muscle strain and the risk of injury when doing strength, balance, and aerobic exercises.
Physical therapists can also give guidance on specialized equipment for SMA. This includes assistive devices, such as standing frames, which help maintain an upright position, and splints and braces to provide stability during movement.
Therapists can also help you explore other mobility tools, such as strollers, manual and power wheelchairs, customized seating systems, and walkers.
Adapting PT to different abilities
Physical therapy isn’t one size fits all.
Techniques and types of exercise may change depending on factors such as your age, ability, stage of life, SMA type, and disease progression.
Infants and toddlers
Early intervention is key for babies and toddlers with SMA. A physical therapist may focus on developing basic motor skills and preventing delays in movement, especially for children with type 1 SMA who can’t sit up on their own.
Stretching and range of motion exercises can help maintain flexibility, prevent contractures, and support children in reaching developmental milestones.
Children and teenagers
As children with SMA get older, physical therapy can help with growth-related challenges by strengthening muscles, improving posture, and supporting trunk stability.
For example, a child’s muscles may struggle to keep up with the demands of increasing body size. In some cases, their spine may develop curvatures such as scoliosis due to muscle weakness and insufficient trunk strength.
For those who can walk, PT can focus on maintaining balance, preventing falls and fatigue, and maintaining energy levels.
A physical therapist may also include games and engaging activities in therapy sessions to make them more enjoyable for children. Therapeutic methods like play, aquatics, and assisted horseback riding, known as hippotherapy, can help strengthen muscles while conserving energy.
Assistive technologies such as adapted toys and standing devices may be recommended to support mobility and posture.
Adults
For adults with SMA, the goal of PT may be to manage progressive symptoms and maintain independence. This can be done by focusing on preserving mobility and strength in the hands, arms, and legs, and reducing the risk of complications.
Postural support, assistive devices, and weight-bearing activities can also help adults preserve function.
Setting goals and monitoring progress
Physical therapists can help children and adults with SMA establish short-term and long-term treatment goals. They can also monitor progress and adjust goals as your condition or abilities change.
Short-term goals might include building endurance, improving posture, or strengthening respiratory function. Long-term goals may involve maintaining mobility for as long as possible and preventing complications such as scoliosis.
For infants and toddlers with SMA, a therapist might focus on developmental milestones such as head and torso control, rolling over, crawling, and sitting.
Challenges and limitations of physical therapy for SMA
While physical therapy has many benefits, it can also come with challenges, including managing fatigue and finding physical therapists who are familiar with SMA.
Fatigue
Fatigue and overexertion are common risks for individuals with SMA, as exercising too much can sometimes lead to exhaustion or muscle strain.
While the exact causes of fatigue in SMA aren’t completely understood, weakened muscles tire more easily, affecting daily activities.
A physical therapist can help create an exercise plan that fits your mobility, such as by including stretching, aerobics, and resistance training. The routine can be adjusted according to how you feel.
Lack of resources
Another limitation is access to specialized resources. Not every place has physical therapists familiar with SMA, so finding the right support can sometimes be challenging.
When searching for a physical therapist, look for one who specializes in neuromuscular disorders and is experienced with or open to learning about the SMA Standards of Care.
Organizations like the Muscular Dystrophy Association and Cure SMA can connect you to local resources. Similarly, the American Physical Therapy Association offers an online tool for physical therapists.
SMA News Today also has a healthcare provider finder tool to assist in locating physical therapists in your area.
Building a supportive team
Physical therapy is just one of many therapies available to people with SMA. Physical therapists often collaborate with occupational therapists, speech therapists, and other SMA medical specialists to ensure a well-rounded therapy routine.
Your SMA care team may also incorporate certain medications, such as disease-modifying therapies, to address the underlying cause of SMA and potentially slow or halt its progression.
And, of course, family members and caregivers can be great partners in helping you practice physical therapy at home, making a big difference in your progress.
SMA News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
