Joint care for Duchenne muscular dystrophy
Last updated May 21, 2025, by Lindsey Shapiro, PhD
Fact-checked by PatrÃcia Silva, PhD
Duchenne muscular dystrophy (DMD) is a disease that mainly affects the muscles, but joint issues such as pain and stiffness are also common DMD symptoms. Understanding the causes of joint pain from DMD — and knowing how to best manage these symptoms — is essential for limiting their impact on your mobility, independence, and overall quality of life.
There are a number of strategies, including exercise, wearable devices, diet changes, and medications, that may be a useful addition to a comprehensive joint management plan.
But there is no one-size-fits-all approach — what works for one person might not work for another — and your needs might also change over time. So it’s important that you work closely with your healthcare team to come up with a safe and effective DMD joint care plan that is best for you at each stage of your DMD journey.
Joint pain and stiffness in DMD
People with DMD are deficient in dystrophin, which is a protein that helps protect muscles against use-related damage. This deficiency leads to progressive muscle weakness and wasting, as healthy muscle tissue is replaced by scar tissue and chronic inflammation.
Problems with the joints — the area where bones come together to allow for movement — are not considered a direct consequence of dystrophin protein loss, but often are a response to changes in the muscles that influence how the body moves.
Muscle imbalances and a loss of normal movement from DMD can cause the joints to tighten and feel stiff, interfering with their natural range of motion. The resulting buildup of inflexible scar tissue and inflammation also makes it harder to move joints naturally.
When muscles and joints aren’t regularly being used in the right way, it leads to joint problems such as:
- stiffness
- contractures, in which the muscles and tendons around a joint shorten and tighten, keeping the joint in one position and making it more difficult to fully move it
- pain, from strain, poor body positioning, or other bone-related complications.
Commonly affected joints in DMD are the ankles, knees, hips, elbows, and wrists. If not treated correctly, joint issues from DMD can become severe — making it harder to move and limiting your participation in daily activities. That is why management is a key part of a comprehensive DMD treatment plan.
Exercise and physiotherapy
The right exercise regimen can help improve muscle strength and keep the joints as mobile as possible. Still, it’s important not to overdo it, as this can cause further damage that makes DMD joint pain worse.
The goal of exercises for DMD is gentle activity that’s sustainable. A physical therapist will help you come up with an exercise plan that should be safe and effective for your particular needs. Your plan might include:
- stretching to maintain flexibility and minimize joint stiffness or discomfort
- low-impact aerobic activities, such as swimming or cycling, that limit strain on the joints.
Certain high-impact or straining activities, like jumping or lifting heavy weights, can cause additional muscle harm that further strains the joints in the long term.
It is important to speak with your physical therapist before trying stretching exercises for DMD or any other physical activities. They will help adjust the DMD physiotherapy plan to accommodate your evolving needs and maximize joint comfort at every stage.
Orthotics and positioning
External support devices — known as orthotics — such as braces and splints, can help with joint protection, delaying or preventing contractures, and making natural movement easier. An occupational therapist may play a key role in determining which, if any, devices or strategies are likely to help maximize your comfort and mobility in daily life.
Examples of orthotics for DMD include:
- ankle-foot orthoses or knee-ankle-foot orthoses, which help stretch the muscles to prevent contractures
- hand and wrist splints, to maintain hand flexibility and prevent contractures
- standing devices, to help stretch the body and allow standing when walking becomes difficult
- supportive chairs or wheelchairs, once walking abilities are lost.
Maintaining proper positioning and posture during daily activities minimizes strain on the joints and prevents them from stiffening. This includes staying upright and well-supported while sitting, and sleeping in positions that don’t worsen joint pain and stiffness.
It’s important that orthotics and assistive devices are used safely and don’t risk causing further joint harm. Pay attention to how your joints feel throughout the day, including during different activities and in various positions, and let your care team know what you notice.
Dietary considerations
While there isn’t a specific diet for managing joint problems from DMD, a well-balanced and nutritious approach to eating can support DMD joint health and improve your overall energy and mobility.
Excessive weight gain is a risk as DMD progresses and mobility is affected, as it can put strain on the joints. Eating a balanced diet can help you maintain a healthy weight, reducing joint stress. A DMD diet may include:
- eating whole grains
- sticking with low-fat proteins, such as lean meats and fish
- keeping to healthy fats, like olive oil, avocado, or nuts
- eating fruits and vegetables
- avoiding foods with excess calories, fat, and sugar
- staying hydrated.
Maintaining healthy joints also requires getting enough nutrients, especially calcium and vitamin D, to support bone health. A doctor can suggest which foods are highest in these nutrients. Clinicians may also prescribe supplements to make sure you get enough of what you need to stay healthy.
It’s been suggested that certain other dietary components or supplements — such as omega-3 fatty acids — could reduce inflammation and help protect muscles and joints. However, more research is needed, so always talk with a doctor before trying them.
What your joints and the rest of your body need will change over time. In general, it’s recommended that people with DMD work with a dietitian who can monitor them and help in determining what dietary plan is best.
Treatment and medication
If you have joint pain, your doctor will first want to assess its source and severity. Your doctor may first try DMD pain management strategies that don’t involve medication, such as exercise and positioning. Heating pads or ice packs may also be able to help ease inflammation and reduce pain.
Should your pain persist, your doctor might recommend medications such as:
- over-the-counter pain relievers, including acetaminophen or nonsteroidal anti-inflammatory drugs like ibuprofen or naproxen
- prescription pain medications, if pain is more severe or persistent
- muscle relaxants, which can help reduce muscle tightness, in turn easing joint pain.
Corticosteroids are often a standard part of the DMD treatment regimen to try to slow muscle weakness and ease inflammation. By helping to preserve muscle strength and functionality, these medications can also have indirect benefits on the joints. But they can also cause weakened bones and weight gain, so their use should always be carefully considered.
Make sure to talk with your doctor and other healthcare providers before starting any medications to manage joint issues, as your team will need to determine the safest and most effective approach. In rare cases in which contractures are severe and can’t be managed with other approaches, a doctor may consider surgery.
Daily habits to reduce pain
It may not be possible to completely avoid developing joint pain from DMD, but there are daily habits that can help you manage joint-related discomfort and minimize the impact these symptoms have on mobility and daily activities. DMD pain relief strategies may include:
- performing gentle, mindful movements throughout the day to keep the joints mobile
- avoiding putting excess pressure on the joints or doing demanding activities that will strain them
- maintaining good posture and paying attention to positions that aren’t comfortable
- relaxing, avoiding excessive stress, and getting enough sleep
- using aids, devices, or home adaptations as recommended by your care team to make it easier and safer to move around.
Importantly, always listen to your body. Pain and discomfort are its way of telling you that something isn’t right. If you notice any joint discomfort with certain movements or activities, let your healthcare team know so they can suggest strategies to address it.
Joint pain and discomfort can be hard to deal with, but a proactive and well-rounded care approach can help keep them from significantly interfering with your life.
Muscular Dystrophy 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.
