Case ReportsImproved Function in a Runner With Hereditary Spastic Paraparesis With Use of Extracorporeal Shockwave Therapy Personal Clinical ExperienceRovito, Craig MD; Paganoni, Sabrina MD; Babu, Suma MD, MPH; Tenforde, Adam S. MDAuthor Information From the Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, Massachusetts (CR, SP, AST); and Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts (SB). All correspondence should be addressed to: Craig Rovito, MD, 300 First Ave, Charlestown, MA 02129. Craig Rovito is in training. Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.ajpmr.com). American Journal of Physical Medicine & Rehabilitation: May 2021 - Volume 100 - Issue 5 - p e66-e68 doi: 10.1097/PHM.0000000000001547 Buy SDC Metrics Abstract A 59-yr-old male marathon runner presented with recent diagnosis of hereditary spastic paraplegia in the setting of gait deviation and spasticity. He noted asymmetric wear pattern of his right shoe and toe drag, with recent development of left lower limb pain and cramping attributed to spasticity. He elected to proceed with radial extracorporeal shockwave treatment targeting the affected muscles. The night following initial treatment, he was able to run 2 mins per mile faster over a 4-mile run with resolution of toe drag. He completed six sessions of radial extracorporeal shockwave treatment along with maintaining regular cardiovascular exercise and strength training. He was seen 6 wks after a series of treatment with recent worsening and toe drag that recurred. He completed further sessions with return to improved function seen after his initial series of shockwave and ability to return to running up to 13 miles. His neurologic symptoms remained controlled without noted progression. This case illustrates the potential use of radial extracorporeal shockwave treatment in spasticity management of hereditary spastic paraplegia and that more frequent sessions may be required to maintain benefits of treatment. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.