Rehabilitation in Duchenne Muscular Dystrophy: The Evidence Base
Dr. Uladzislau Tsvirko
23 avril 2026
Meta-analyses of randomised trials show that regular rehabilitation in Duchenne muscular dystrophy preserves range of motion, reduces contracture risk by 29% and improves quality of life. The critical factors are early initiation and family involvement.
Objectives of Rehabilitation in DMD
Duchenne muscular dystrophy (DMD) is a severe X-linked inherited disease characterised by progressive muscle weakness, loss of motor function and declining quality of life from early childhood. No disease-modifying cure is available, yet rehabilitation remains a cornerstone of care in muscular dystrophy — aimed at slowing functional decline, preventing contractures and maintaining the highest attainable independence. Unlike occupational therapy, which focuses on self-care and fine motor skills, physiotherapy targets gross motor function, mobility and the musculoskeletal system.
Range of Motion and Contracture Prevention
Joint mobility restriction in DMD leads to worsening function, pain and higher risk of deformities and pressure ulcers. Regular range-of-motion assessment with a goniometer and structured stretching are core components of therapy. Stretching with warmed tissues (about 43 °C) is considered most effective — reducing discomfort and improving muscle elasticity. Programmes combine active exercises (where strength is preserved), active-assisted exercises (where weakness is present) and passive movements (when active motion is no longer possible).
Muscle Strength and General Physical Condition
Because DMD is progressive, resistance exercise is carefully dosed by disease stage. In severe weakness, gravity alone provides adequate resistance; in better functional states, light manual or mechanical resistance can be added. The overall programme targets deconditioning from reduced activity, maintenance of cardiovascular and respiratory endurance, and preservation of muscle strength and joint mobility.
Balance and Gait Training
Before gait training, patients must be able to maintain standing balance safely. Work proceeds at parallel bars, with multidirectional weight-shifting exercises, then a gradual transition to assisted walking (walker, crutches, canes). Orthoses and support belts are used where needed. Stair climbing and curb negotiation are introduced only after gait on level ground is stable.
Evidence from RCTs and Meta-Analyses
A 1-year RCT of 27 children with DMD showed that combining standard physiotherapy with a home programme involving the family better preserved distal and overall motor function on the Motor Function Measure scale (p < 0.05). A systematic review of 13 RCTs (617 patients) found a modest but significant gain in walking endurance (+17.36 m on average) — underlining that the aim of physiotherapy in dystrophies is functional preservation, not strength gain. A meta-analysis of 22 studies (1,487 patients) reported a 3.2-point improvement on the NSAA scale, a 29% reduction in lower-limb contracture risk and a 6.4-point rise on PedsQL quality-of-life scores. The most effective approaches were daily stretching (≥5 times a week), moderate strengthening, aquatic therapy and combined water-plus-land programmes.
Clinical Takeaways
Rehabilitation in Duchenne muscular dystrophy is not a disease-modifying treatment, but the evidence for its functional value is solid: preservation of motor function, slowed contracture progression, maintained range of motion and improved endurance and quality of life. The best outcomes come from early initiation, consistency, individualised loading and active family involvement. Current evidence supports rehabilitation as an essential, lifelong element of multidisciplinary DMD care.