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Disability support

Down syndrome physiotherapy

Physiotherapy helps babies, children and adults with Down syndrome build strength, balance and movement skills and stay active safely. We check neck safety before activities that load the neck.

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Understanding the condition

Down syndrome is a genetic condition, and people with Down syndrome may have a higher chance of some health problems.1 Many have low muscle tone (hypotonia) and loose, stretchy ligaments (ligamentous laxity), which can affect strength, balance, posture and walking, and often lead to flat feet.2 Babies and children commonly reach motor milestones such as walking later than their peers.3 Loose ligaments in the upper neck can also make the top two vertebrae less stable (atlantoaxial instability), so neck safety is checked before some activities.2

Physiotherapy cannot reduce ligament laxity, but it can improve motor control, strength and balance.2 Task-specific practice, such as treadmill walking or learning to ride a bike, has been linked with better motor performance and more physical activity.3 For adults, guidelines advise regular exercise and a healthy diet as part of weight management, and a review for signs of neck problems at annual checks.4 If neck symptoms appear, a doctor assesses them before activity continues.5 Physiotherapy can be NDIS funded for eligible participants.6

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Down syndrome physiotherapy

What to look out for, and how we help

Symptoms are a guide, not a diagnosis. Your GP confirms the diagnosis; our team helps you manage it day to day.

What you might notice

  • Low muscle tone: a baby who feels floppy, or a child who tires quickly and finds sitting, crawling or walking harder
  • Later motor milestones, such as sitting, standing and walking
  • Very flexible joints, flat feet, or an unsteady walking pattern
  • Difficulty with balance, stairs, jumping or keeping up with friends in play and sport
  • Reduced stamina or fitness, and weight gain, in the teenage and adult years
  • Seek urgent medical review for new neck pain or stiffness, a head tilt, trouble moving the neck, a change in the way a person walks or in the use of the arms or hands, new weakness in the arms or legs, or a change in bladder or bowel function, as these can be signs of neck (atlantoaxial) instability, which the Down Syndrome Medical Interest Group describes as an emergency.

How our team helps

  • Assessment of strength, balance, joint stability, posture and motor milestones, with goals set together with you and your family
  • Individual exercise programs that practise real tasks such as walking, climbing stairs, jumping and riding
  • A neck safety check before activities such as trampolining or diving, including asking about symptoms and liaising with your GP or specialist
  • Group classes and hydrotherapy for fun, fitness and confidence
  • Coordination with podiatrists for flat feet and footwear, and with dietitians and exercise physiologists for healthy weight and fitness
  • Reports for GPs, NDIS planners and other funders

Your PDC care team

The teams and services that most often support people with this condition. They work from one shared plan, and one GP referral reaches all of them.

Allied health teams

Physiotherapy
Physiotherapy
Allied health team
Physiotherapy
Musculoskeletal treatment and rehabilitation to help you move better and manage pain.
Read more

Exercise Physiology
Exercise Physiology
Allied health team
Exercise Physiology
Safe, effective exercise programs designed by Accredited Exercise Physiologists for chronic condition management.
Read more

Related services

Related conditions

See all conditions

Sources and clinical review

Our care follows the 2020 Global Medical Care Guidelines for Adults with Down Syndrome, as published by Down Syndrome Australia, and current Australian physiotherapy practice.

  1. Healthdirect Australia. Down syndrome. Sydney: Healthdirect Australia; 2024.
  2. Children's Hospital of Philadelphia. Ligamentous laxity 101: how loose joints impact people with Down syndrome. Philadelphia: CHOP; 2020.
  3. Latash M, Wood L, Ulrich D. What is currently known about hypotonia, motor skill development, and physical activity in Down syndrome. Down Syndrome Research and Practice. 2008.
  4. Global Down Syndrome Foundation. Medical care guidelines for adults with Down syndrome. Denver: Global Down Syndrome Foundation; 2020. Published on the Down Syndrome Australia website.
  5. Special Olympics Ireland. Atlantoaxial instability (AAI) information. Special Olympics Ireland; undated (file uploaded October 2023).
  6. National Disability Insurance Agency. What are therapy supports. Canberra: NDIA; page last updated 17 July 2026.
  7. Down Syndrome Medical Interest Group. Cervical spine disorders: craniovertebral instability. DSMIG; page shows updated April 2024 [cited 2026 Oct 4].
  8. Royal Children's Hospital Melbourne. Screening for children with Down syndrome. Melbourne: Royal Children's Hospital, Department of General Medicine [cited 2026 Oct 4].
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Common questions

When should a baby with Down syndrome start physiotherapy?
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Many families start in the first year of life, and you do not need to wait for a delay to appear. Early physiotherapy focuses on strength, movement and play, and supports milestones such as sitting, standing and walking.

Is sport or trampolining safe for someone with Down syndrome?
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Most physical activity is encouraged, but some, such as trampolining, diving and certain contact sports, put load through the neck. We ask about neck symptoms and work with your GP or specialist to decide whether further assessment is needed first.

Why do people with Down syndrome have low muscle tone?
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Researchers think several factors contribute, including loose ligaments and how muscles work together. It is not a matter of effort. Strength and balance training can improve movement skills, even though it does not change how stretchy the ligaments are.

Do I need a referral, and how is Down syndrome physiotherapy funded?
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No referral is needed for private appointments. With a GP Chronic Condition Management Plan, Medicare rebates apply to up to five eligible allied health services a calendar year. Physiotherapy may also be funded through NDIS Capacity Building supports, depending on your plan, or by private health extras.

Can adults with Down syndrome see a physiotherapist?
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Yes. Regular exercise supports fitness, weight and mobility, and a physiotherapist can help with balance, pain or a change in walking. Any sudden or ongoing change in how a person moves or functions should also be raised with their GP.

Not sure where to start?

Tell us what is going on and we will point you to the right discipline, or to more than one. Most people start with a single appointment and leave with a plan the rest of the team can see.

Or go straight to a service

Phone (08) 6110 0570 · Medicare, NDIS, DVA and private options across our services

For GPs and health professionals

Referring a patient with this condition?

Send an online referral in under two minutes. One referral reaches every discipline at PDC Health Hub.