Novel treatment of spasticity in HSP

Helping recently diagnosed marathon runner

Radial extracorporeal shockwave treatment (R-SWT) is helping a recently HSP diagnosed 59 year old marathon runner with toe dragging, spasticity, pain and cramping.

It is also helping his athletic performance, recording significantly faster times following treatment. It is thought that more frequent treatment sessions may be required to maintain the benefits achieved.

R-SWT is a relatively new form of SWT that is more affordable and easier to administer. Read more …


A 59 year-old male marathon runner presented with recent diagnosis of hereditary spastic paraplegia in a setting of gait deviation and spasticity. He noted asymmetric wear pattern of his right shoe and toe drag, with recent development of left lower extremity pain and cramping attributed to spasticity.

He elected to proceed with radial extracorporeal shockwave treatment (R-SWT) targeting affected muscles. The night following initial treatment, he was able to run 2 minutes per mile faster over a 4 mile run with resolution of toe drag. He completed 6 sessions of R-SWT along with maintaining regular cardiovascular exercise and strength training. He was seen 6 weeks after series of treatment with recent worsening and toe drag that recurred. He completed further sessions with return to improved function seen following his initial series of shockwave and ability to return to running up to 13 miles.

His neurological symptoms remained controlled without noted progression. This case illustrates the potential use of R-SWT in spasticity management of hereditary spastic paraplegia and that more frequent sessions may be required to maintain benefits of treatment.

SOURCE: Am J Phys Med Rehabil. 2020 Jul 22.  doi: 10.1097/PHM.0000000000001547. Online ahead of print. PMID: 32732747

Improved function in a runner with hereditary spastic paraparesis with use of extracorporeal shockwave therapy: personal clinical experience

Craig Rovito 1Sabrina Paganoni 1Suma Babu 2Adam S Tenforde 1

  1. Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School.
  2. Department of Neurology, Massachusetts General Hospital/Harvard Medical School.


  1. This is very encouraging. I have HSP, SPG4. I am 72 and am managing well enough. I walk outdoors with a cane. My son, 48 years old, is failing faster than I did at his age. What can we share with his neurologist (and mine) that might lead to immediate treatment?

    1. Editors Note: This is more for your physiotherapist / physical therapist than neurologist. Suggest sharing the link to the article with them if they are not already aware of this treatment.

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