Multiple Sclerosis


Introduction to Multiple Sclerosis (ms)

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system that causes demyelination and neuronal damage visible on an MRI. There are four types of MS; the most common is Relapsing-Remitting (RRMS) which accounts for ~80% of patients and most commonly presents between ages 20 to 30. RRMS is characterized by recurrent episodes of symptoms with stable manifestations between episodes; most commonly, patients notice visual symptoms at onset. RRMS typically progresses into Secondary Progressive (SPMS) 10-15 years after initial diagnosis. SPMS is characterized by gradual neurologic deterioration with our without relapses. Primary Progressive (PPMS) accounts for about 20% of patients and is progressive from the onset with no significant relapses; symptoms typically are more mobility-related at diagnosis than RRMS. Progressive Relapsing (PRMS) is much rarer but is progressive from the onset with relapses present.


Symptoms of MS a physical therapist can help manage

Fatigue

  • Education on energy conservation techniques and how to implement them in daily life

  • Prescribe exercise with recommendations on how to consolidate exercises to maximize the benefits/effectiveness and reduce the overall number performed

  • Allow for rest periods during exercise and monitor the duration and intensity of the exercise

Heat Sensitivity

  • Your physical therapist will take heat sensitivity into account in the therapy clinic, including clinic temperature, cool towels available, watching for early signs of heat-related problems or fatigue

  • Increase fluid intake

  • Provide exercise recommendations that you can incorporate into your daily life or fitness routine

Muscle Weakness 

  • Your physical therapist will develop a specific strength program for you to maintain and progress your strength based on the impairments found in the physical therapy evaluation

  • Muscles that are typically most affected with MS include: the core and gluts, hip flexors, and tibialis anterior

Numbness

  • Unfortunately, there is not much physical therapy can do to reduce or prevent numbness; however, balance and strength training can help to minimize gait and balance issues that arise due to sensory deficits

Balance/Gait Issues

  • Your physical therapist will provide you with strategies to prevent falls as well as teach fall recovery

  • Your therapist will always recommend exercise with surrounding support to prevent falls while still challenging your balance

  • Address vestibular deficits and treat vertigo (BPPV) if present

  • Recommend and educate on assistive devices or bracing for foot drop when necessary

Vision/Vertigo

  • Benign Paroxysmal Proximal Vertigo (BPPV) is very common with MS, which is a condition that can be treated and resolved in one to two visits with a physical therapist

  • Gaze Stabilization and habituation exercises to improve balance and reduce motion sensitivity or lightheadedness

Spasticity

  • Create a daily stretching program! The muscle groups that most commonly present with spasticity or increased tone in MS include: hamstrings, quadriceps, hip adductors, and gastrocnemius

  • Encourage dynamic flexibility exercises before static stretching

Exercise Recommendations for Patients with Mild/Moderate Disability

  • Cardiovascular exercise is recommended two times per week (at least one day of rest between)

    • Gradually increasing to 30+ minutes each session

    • Moderate intensity (5–6/10 on a scale of intensity, can talk but not sing a song during that activity)

    • Examples: arm or leg bike, walking, elliptical

  • Strength training exercise is recommended two times per week (at least one day of rest between)

    • Gradually increasing to two sets of 10–15 reps of each exercise

    • Pick a resistance (free weights, bands, pulleys) that are difficult enough to complete 10–15 reps of the second set barely

    • Rest 1–2 minutes between each set!

    • ENERGY CONSERVATION TIP: Group multiple muscle groups together to perform less overall repetitions, but still getting strength training in all areas (adding safe balance challenges to upper and lower body exercises or perform exercises in functional positions)

  • Other great types of exercise for people with MS

    • Aquatic exercise or swimming

    • Yoga

    • Tai Chi

  • Stretching

    • Daily!!

    • Key muscle groups: quadriceps/hip flexors, hamstrings, hip adductors, gastrocnemius