MS Symptom Management: Muscle weakness
As related to Multiple Sclerosis (MS), muscle weakness is somewhat like fatigue; there are primary and secondary causes. MS is a chronic inflammatory disease of the central nervous system. It causes demyelination and damage to the axons/neurons themselves, leading to lesions we see on MRIs. One way to think about your nerve is like an electrical cord. In MS, a portion of the insulation around the cord deteriorates, making the wire much less efficient, causing the appliance to short-circuit or stop working. So with MS, depending on where the damage was inflicted to the myelin sheath, it will cause decreased nerve function to a particular area of the body; this is primary weakness.
As we have previously discussed, many other symptoms present with MS, including fatigue, gait impairments, imbalance, spasticity, and falls. All of which can affect a person’s level of physical activity. We have all heard the phrase, “if you don’t use it, you lose it,” and it couldn’t be more accurate when it comes to MS. Not only has your activity level decreased, causing decreases in strength, but you also have the disease working against you. This is why individuals must get into an exercise routine early on after diagnosis. Even if you are not noticing any specific issues, it is good to get screened for them and determine a baseline for your physical activity. Then, your therapist can put together a program to prevent weakness or impaired flexibility before they arise.
The muscle groups that we know to be more often affected include the core muscles (abdominals and hip musculature) and the tibialis anterior. With this specific disease, muscles are typically affected proximally first (toward your core) and then work outward, except for the tibialis anterior causing foot drop. The research tells us that increased muscular strength and endurance can be shown following exercise interventions for people with MS. Strengthening the core and hip muscles is also beneficial for supporting the low back and improving hip mobility, decreasing the potential for low back or knee pain down the line.
I can’t emphasize enough the benefits of working with a physical therapist specializing in multiple sclerosis, or neurological disorders, early on after initial diagnosis. They can test strength, endurance, and balance and work with you to create an exercise program. I recommend regular check-ins (this could be every 1-3 months) to progress the program appropriately and retest to ensure there are no declines in strength, endurance, or balance before they become more significant issues.
As a physical therapist myself, I love working with patients in functional positions and group exercises together to maximize the benefits while still practicing energy conservation. Working in the functional positions allows all of the larger muscle groups to work together, focusing on stability and balance! I have listed a few of my favorite exercises below!
1: Tall Kneel Squats
This exercise can be performed on a firm bed or the floor. Get into a kneeling position (you can hold a weight for increased difficulty if needed).
Sit back onto your feet, keeping your core tight and activating your glutes. Then, push your hips forward again until you are into a full tall kneeling position.
2: Tall Kneel Chops and Lifts
This exercise can also be performed on a firm bed or the floor. Get into the tall kneeling position and clasp your hands in front of you (you can hold a weight or resistance band to increase difficulty).
Keep your core and glutes engaged, slowly raise your hands over your head, and then back to starting position. You can repeat this starting from 1 hip and going at a diagonal over the opposite shoulder. *It is essential to perform slowly and with control.
3: Half-Kneeling Chops and Lifts
This exercise can also be performed on a firm bed or the floor. Get into the tall kneeling position and then carefully bring one foot forward (you can do this on the floor, holding to a chair or table for support if needed). Clasp your hands together in front of your bottom leg (you can hold a weight for more difficulty)
Keeping your core tight, raise your hands up over the opposite shoulder. It may be hard to balance, focus on holding your core and glutes tight.
4. Quadruped Hip Flexion to Extension
This exercise can also be performed on a firm bed or the floor. Get into the quadruped position with your hands below your shoulders and knees below hips, keeping your back flat throughout the entire movement.
Slowly flex 1 knee forward toward your chest, really squeezing in your abdominals.
Extend the leg straight out behind you. Return it to the starting position and repeat with the other side. - If this is too difficult, you can also perform over a stability ball for support. Work to really push that knee into the ball when flexing the hip.
As you can see with these 4 exercises, you are working way more than 1 muscle group at a time. You always have your core and hips engaged, utilizing the lower extremity muscles for support and balance. You are using the shoulder muscles during the stabilizing phase or the chops and lifts. You can work your way up to 2 sets of 10.
In some cases, axonal damage has occurred that is not reversible, and we have to change our way of thinking to find compensatory strategies to allow people to be as functional and active as possible. Physical therapists can discuss different options for assistive devices ranging from just slight support or assist to devices that offer greater levels of stability. Remember, the goal here is always to function! At times people may be reluctant to use an assistive device, but I always focus on the function! For example, is it better to use a small brace to address foot drop or not? Using the brace will increase the length you can walk and avoid compensatory patterns like leaning or swinging your leg out to the side to clear your foot. If you do not use a brace, you may feel the need to significantly limit walking (especially in public, due to fear of falling) or have increased levels of fatigue from having to compensate for clearing your toe when walking. We always work to use the most minimal option necessary to function at your highest level and continue to enjoy your favorite daily activities or hobbies.
Over the coming weeks, we will continue to discuss different symptoms commonly associated with MS. We will provide specific stretches, exercises, and guidance for maintenance from a physical therapy perspective. Next up will be spasticity.
I have more information on my website at:
https://movementmatters-pt.com/multiple-sclerosis
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Disclaimer
This blog is provided for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
