A Pilot Study of Shockwave Therapy in HSP

Inclusion Criteria: 1. Over the age of 18 2. Diagnosis of genetically-confirmed HSP 3. Score of 2, 3 or 4 on the PLSFRS walking question 4. 30 days stable dosages of oral spasticity medications prior to screening and throughout study participation 5. Able to come to site for treatment sessions 6. Able to understand all study procedures Exclusion Criteria: 1. Diagnosis of any other neurological disorder that may impact gait 2. Lower motor neuron (LMN) disease or combined UMN and LMN 3. Non-ambulatory or requiring two-person assistance for any functional ambulation on most days 4. Less than 3 months of symptoms 5. Have received SWT within the past 3 months 6. Prior botulinum toxin injection within 3 months or planning to receive botulinum toxin injections during the study participation for spasticity management 7. Presence of an intra-thecal baclofen pump 8. Women who are pregnant. This is due to the fact that pregnancy will reduce participants activity after the treatment and the safety concerns related to shockwave treatment. 9. Patients with neuropathy affecting sensation to pain 10. Patients with a known underlying cardiac disease that could be affected by shockwave therapy 11. Concomitant intake of another clinical trial or other off-label experimental treatments that might influence study outcomes 12. Presence of unstable psychiatric disease, cognitive impairments, or dementia impairing study participation 13. Presence of other chronic neurological diseases such as Alzheimer's Parkinson's, stroke, or multiple sclerosis 14. Personal history of narcotic overuse for chronic pain or substance abuse or dependence 15. Contraindications for ESWT, including local skin breakdown, infection, malignancy or other soft tissue pathology at sites of planned treatment.