The natural history of muscular dystrophy is such that force imbalances, produced by muscle weakness and contracture, cause progressive postural decompensation. Ultimately, the patient loses the ability to position his center of gravity over the base of support, becoming wheelchair-bound by late puberty. After this, the disease follows a rapidly declining course, terminating in early death.In selected patients, properly timed surgery and bracing has enhanced standing balance and significantly extended the ability to ambulate. Because severe weakness can result from prolonged restraint, operative procedures must permit immediate mobilization without excessive pain or wound dehiscence. Conditions requiring surgical correction are lower extremity flexion contracture, metatarsus adductus, rigid forefoot equinovarus and calcaneocavus. Techniques designed to correct these deformities, and still permit early postoperative mobilization, include subcutaneous tenotomy and percutaneous tarsal medullostomy. Postoperative plastic bracing improves walking mechanics through mild knee flexion and ischial seating.Progressive disability in these diseases can be delayed by a variety of physiatric techniques, including the prescription of appropriate orthoses and aids to daily living. Where feasible, fractures are treated with minimal splintage and early ambulation. After patients are no longer ambulatory, they require suitable wheelchairs and a variety of special devices to facilitate ongoing care. Orthotic and operative treatment of scoliosis provides wheelchair-confined patients, with either myopathy or neuropathy, increased comfort and improved cardio-respiratory function, while freeing the upper extremities for functional tasks.Although most muscle diseases are incurable, this is not synonymous with untreatable Optimal therapy for the patient with muscle disease should be multidisciplinary, aggressive, and conducted in an atmosphere of intelligent concern. This approach minimizes the frustrating aspects of these conditions, while maximizing the benefits obtained through available care, enabling the patient to live as fully as possible for as long as possible.