Last year, DMRF Canada surveyed people living with dystonia to better understand how they manage their symptoms. More than half of respondents reported participating in physiotherapy, making it the most commonly used complementary therapy. To learn more about how physiotherapy can help people with dystonia and how to find the right therapist, we spoke with physiotherapist Haseel Bhatt, founder of Neurology Rehab in Durham Region, Ontario.
Bhatt has spent his career treating people with movement disorders, including dystonia, Parkinson’s disease, and Functional Neurological Disorder. His experience in movement disorders clinics has given him extensive knowledge of the challenges people with dystonia face, the treatments available, and the role physiotherapy can play alongside medical care.
Why Consider Physiotherapy?
Although all people with dystonia are different, Bhatt has some general advice. “Anyone who hasn't tried physiotherapy for their dystonia could probably benefit,” he says. “If you’re a person living with a dystonia and trying to push through pain, or push through tightness, there’s likely a better way.”
Specifically, Bhatt suggests that those who are receiving botulinum toxin injections can especially benefit during a certain time in their treatment cycle. “There’s a therapeutic window after [botulinum toxin] injections in which patients can do a lot of work to retrain muscle patterns,” he says.
Dr. Jane Liao, a movement disorders neurologist, also shares this recommendation. “There have been good studies specifically looking at the role of physiotherapy in treating cervical dystonia,” she says. “The combination of botulinum toxin injections and physiotherapy had better outcomes than either alone.” Dr. Liao notes that adding physiotherapy to a treatment plan can be especially helpful in decreasing pain.
Finding the Right Therapist
If physiotherapy sounds like it might be worth exploring, the next step is finding a therapist with the right expertise.
“Ideally, you want to find somebody with at least a neurological rehab background,” Bhatt says.
He also advises that it’s okay to ask someone before working with them if they have ever worked with dystonia patients before. “I can technically treat a soccer player who gets injured at the World Cup, but that's not my expertise,” he says. If someone is not a good fit, Bhatt also suggests asking if they have any recommendations since they may know where to find someone.
How Does the Process Begin?
Bhatt treats therapy as a collaborative effort between himself and the patient. In order to understand a person’s needs, he first completes an assessment. He looks at how dystonia presents in terms of movement patterns, tension, range of motion and posture.
A thorough assessment, he emphasizes, also looks at the person as a whole. This includes getting an idea of how nonmotor symptoms like pain, anxiety and stress are impacting movement, as well as gaining an understanding of what the person does in their daily life and how dystonia affects these activities.
The assessment is also an opportunity for the person with dystonia to decide if they will move forward with physiotherapy. “By the end of the assessment session, you should know if this is a path or approach that would be helpful for you,” Bhatt advises.
How Treatment Works
Once the assessment is complete, treatment is tailored to the individual's symptoms, goals, and daily activities.
One of the first skills many dystonia patients gain in physiotherapy is awareness of movement. Bhatt notes that once certain postures and movements get patterned into the brain, many of his patients overestimate how pronounced they are. This in turn can exacerbate non-motor symptoms like anxiety, in a vicious cycle, leading to an increase in motor symptoms like tension.
Bhatt often uses video feedback to help patients notice and track their movement, giving them a more accurate baseline.
Once a patient has a better sense of what is happening in their body, Bhatt strives to explore different ways of moving that increase function and alleviate discomfort.
This involves strengthening and stretching certain muscles and using that increased body awareness to selectively activate muscles, achieving movement more efficiently.
He lists tools like vibration stimulation, breathing and relaxation, as well as sensorimotor exercises to achieve these different ways of moving. Bhatt will also explore sensory tricks that may alleviate symptoms.
There is no simple answer when it comes to timelines for treatment. This can vary based on a person’s type of dystonia, previous experience, personal goals and resources. Bhatt’s approach is focused on creating an exercise plan patients can do every day at home to build and maintain gains. Bhatt suggests being up front with your physiotherapist about limitations in the time or resources you have for physiotherapy and you can work towards a realistic plan together.
What Kinds of Improvements are Possible?
For Bhatt, physiotherapy isn't about perfect movement. It's about helping people do the things that matter most to them. He has many examples of functional goals his patients have been able to achieve through physiotherapy programs.
There was the teacher who wanted the ability to turn her head to address a group of students without a pronounced tremor interfering.
Bhatt recalls another person with dystonia who wanted to improve their balance to the point where they could navigate going to see a movie in a theatre. They worked together to build stamina and started with a short walk to the corner store. They introduced carrying, picking up a carton of milk to bring home. Eventually they worked their way up to carrying their popcorn up the steps to their seat in the movie theatre.
He recalls a woman who wanted to be able to write notes for her husband and continue signing her own cheques. They worked on modifying arm posture and relaxing the shoulder, giving her hand more freedom to hold a pen and write.
Recently, he had a patient remark that a year ago she could not have imagined being able to walk with her dog without pain. After working together on exercises to increase strength and strategies to manage pain, she was able to walk for longer distances and without pain.
It’s these functional gains that make therapy motivating and effective. “People can go to physiotherapy for as long as they want,” Bhatt explains, “But if there's no goal at the end of it, oftentimes they won't do the exercises and they don't understand how those exercises are going to help.”
Barriers to Access and How to Address Them
Access is a key barrier for many complementary treatments for dystonia. When it comes to physiotherapy, specialized knowledge in movement disorders can be hard to find.
Bhatt provides services in person and online for those who are too far geographically. Telehealth has increased within provinces, however there are regulations requiring physiotherapists to be licensed in the province where they provide care. Increasing flexibility in licensing could mean that more people can access professionals with specialized knowledge across provinces. Contacting your provincial physiotherapy regulator or professional association can help in terms of making the demand for these changes to licensing known.
There is also the issue of cost. While publicly funded, multidisciplinary programs for disorders like Parkinson’s disease exist, there isn’t the same access for those with dystonia. Dr. Liao acknowledges this is an issue.
“I hope we will see an increase in subsidized specialized physiotherapy and dystonia-specific group exercise programs in the future that can fill the unmet needs,” she says.
Raising awareness and advocating for these services where you live can be the first step in making physiotherapy a standard part of provincially funded movement disorders clinics.
While physiotherapy isn't a cure for dystonia, it can help many people move more comfortably, build confidence, and work toward meaningful everyday goals. Dr. Liao stresses that because dystonia can present differently in different people, specialists are learning more about it every day.
“For many patients, the medications we currently have often only work partially or carry too many side effects. Complementary therapies such as physiotherapy are beneficial and carry no side effects.”
As Bhatt puts it, “It's about learning, experimenting and trying new approaches to movement.”
Source: Adapted from “How Physiotherapy Can Help People Living with Dystonia,” Dystonia Canada Report, Fall/Winter 2026, Dystonia Medical Research Foundation Canada.