In SMA, pliable muscles are replaced with stiffer tissues over time, limiting range of motion. When a joint remains stuck and refuses to open up, it’s called a contracture, which most commonly affects your shoulders, knees, wrists, elbows, hips and ankles. “The challenge with progressive loss of movement is that the joints get stuck,” says Dr. Allen-Sharpley. “So, we work really hard to keep the joints moving. That might mean physical therapy, or it might mean surgery. But it does not mean muscle-building, since that can damage muscles among people with SMA and reduce functionality,” she adds.