Physical Therapy for Friedreich’s ataxia

Physical therapy is important in managing the symptoms of Friedreich’s ataxia (FA) and has been shown to have a positive effect on patients by improving overall fitness.

Aim of physical therapy for Friedreich’s ataxia

Physical therapy for Friedreich’s ataxia (FA) aims to prolong motor function (the ability to walk) and achieve a higher quality of life as long as possible while minimizing pain, deformity, and disability.

Preliminary evaluation

Before starting a treatment plan, the physical therapist performs a thorough evaluation of the patient including an assessment of the complaints, functional abilities, posture, balance, range of motion, spinal alignment, foot alignment, muscle flexibility and strength, coordination, mobility, gait, endurance, and cardiovascular response to activity.

The physical therapist can then establish an appropriate plan to address the patient’s specific needs. An individualized home exercise program may also contribute to the patient’s sense of well-being. The physical therapist provides a reasonable, comprehensive, and safe home exercise program that is revised regularly (once a year on average) according to the patient’s needs.

Types of physical exercise for Friedreich’s ataxia

Strengthening exercises

Physical therapy for Friedreich’s ataxia includes low-intensity strengthening exercises that aim to prevent immobility and preserve the functionality of upper and lower extremities. Care should be taken to avoid fatigue during these exercises; they should be repeated less frequently with low weights and separated by sufficient rest periods.

The strengthening exercises for the hip and shoulder muscles help to maintain posture and function of the arms and legs. Lower back and trunk strengthening exercises help to reduce pain caused by scoliosis (curvature of the spine) and maintain trunk control.

Stretching exercises

Stretching the leg muscles and foot arch are important for patients with FA due to the typical presence of foot deformities called pes cavus. Stretching the spine helps relax tightened muscles that result from scoliosis. If the patient is in a wheelchair, it may also help to stretch hamstrings and hip muscles to prevent contractures (permanent shortening of a muscle).

Coordination exercises (gait training)

Coordination exercises are recommended for patients with ataxia to facilitate proprioception (sense of motion, position, and balance), which is lost in FA. In coordination exercises, the patient is advised to “watch” their movement because this will give feedback to the brain and provide gait training. It may help if patients watch their feet while walking to improve foot placement and be able to see where their feet are. A mirror may be helpful during these exercises to get visual feedback.

Coordination activities may be incorporated into daily functional tasks such as cooking, doing crafts, writing, or dancing, with instruction to the patient to watch their movement whenever possible.

The therapist often uses an appropriate device to ensure safety during gait training. Rollators are helpful because they glide smoothly and most of them have a seat for resting. It is important to maintain household locomotion and weight bearing on the legs even if the patient has to rely on a wheelchair for mobility.

Balance exercises

Balance exercises may assist with improving or maintaining balance and stability during sitting, standing, walking, and moving. The patient should be trained to avoid the risk of falling and instructed to do these exercises in front of a mirror or to focus eyes on a still object while doing them. It may also help if the patient concentrates, or thinks about being steady, while also thinking positive thoughts about the performance of the task or exercise.


Cardiovascular exercises should also be emphasized for patients with FA. Moderate exercise is usually not contraindicated for patients with FA since heart abnormalities are not occlusive or sclerotic in nature. A stationary bicycle can be helpful since the patient can sit on a stable base while exercising. Swimming or other water exercises are also beneficial and easy to perform as balance and coordination deficits tend to be less obvious and limiting in the water.


Note: Friedreich’s Ataxia News 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.