How can physical therapy help in multiple sclerosis (MS)? What is physical therapy, exactly? Which symptoms of MS can it help with? These are questions that run through the minds of many people living with MS when they get a referral to a physical therapist as part of their treatment plan.
MS is an autoimmune disease that can attack any part of the central nervous system (CNS) — your brain and spinal cord — so it can affect any part of your body in a number of different ways. That’s why common symptoms can include numbness, tingling, and other sensory symptoms — as well as weakness and the inability to move your arms or legs. Limbs may also become overly stiff (a symptom called spasticity). These impairments can prevent you from doing everyday activities, greatly impacting your overall quality of life.
Physical therapy is one way to help you regain some of these functions. It can include exercise programs as well as assistive devices to help you get around and perform daily activities much more easily while you are having symptoms.
Across all stages of MS, a large part of treatment and recovery involves working with a well-rounded rehabilitation team of health care professionals centered around you and your unique symptoms. Physical therapists (PTs) specialize in addressing your body’s ability to move around and function, focusing particularly on:
Working with PTs can help you gradually regain your mobility, and there is strong evidence supporting their role in improving the lives of people with MS.
PTs may also work with physiatrists — medical doctors who specialize in physical medicine or physical rehabilitation.
Physical activity has been shown to improve strength and recovery from impairments arising from MS. Exercise therapy increases muscle strength and has been shown to reduce fatigue. Exercise also prevents deconditioning, which is when muscles and nerve fibers become weak from lack of use.
One MyMSTeam member commented, “I have had MS over 30 years, and exercise has saved me in so many ways. Mentally and physically, it gives me purpose and direction when dealing with my MS!”
Following are a few types of exercise that are especially beneficial for people with MS.
Strength training, also known as resistance training, increases the strength of different muscle groups in your body. Strength training with a PT is typically a gradual process over several weeks. Your PT may start slowly, first getting you to move your arms and legs with gravity, then against gravity, and then using increasingly heavy weights until you reach your baseline (pre-MS) strength.
Your muscles need a lot of oxygen to work properly. Aerobic training, as opposed to anaerobic training, involves exercise that allows your muscles to “breathe” by focusing on routines that get your heart rate up over time. This involves more gradual, endurance-based activities such as walking, jogging, or swimming, rather than more intense exercises over a shorter time frame.
Stretching exercises and frequent stretching can help you improve the range of motion of your arms and legs, which may become stiffer if you have MS, and can worsen during flares (exacerbations). Yoga and tai chi are great ways to stretch at home, as explained below.
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Many home exercise routines have been reported to improve the strength and flexibility of people with MS. Of course, it is important to find a regimen that works for you, that is safe, and that accounts for any limitations you may have.
Some low-impact exercise regimens can provide gradual workouts at home. One of them is tai chi — also known as tai chi chuan — a Chinese martial art involving slow, deliberate movements. Tai chi, specifically adaptive tai chi, has been shown to benefit people with MS. Yoga, which combines physical stances and breathing techniques, can yield similar benefits.
One MyMSTeam member shared their personal experience with tai chi: “Tai chi class was challenging, but I made it through. My legs are really feeling it now, but the good, slow movements of tai chi are helping my balance and my overall well-being!”
When performing exercises, especially at home, take care not to overexert yourself. Exercising too intensely in a short period of time can cause your body to overheat. MS symptoms are often reported to become even more severe with increasing core body temperature, which worsens the body’s immune system. Aside from avoiding hot environments as much as possible, it may be wise to take breaks and go steadily while exercising so as not to overheat.
Up to 80 percent of people with MS experience some loss of bladder control, e.g., feelings that urine will leak and that they have to go to the bathroom much more often. Much of this stems from weakness of the pelvic floor muscles that surround the bladder and normally control the release of urine. Because of this, PTs may recommend certain exercises that will strengthen these muscles and hopefully improve your bladder control.
Assistive devices include wearable items, such as braces (orthotics), as well as devices that help maintain balance, such as:
You may need to wear arm or leg braces if your arm or leg is deformed, contracted, or otherwise unable to move in a certain direction. For example, MS may affect your ability to bend or straighten your knee, requiring knee braces to help you do things such as driving.
One MyMSTeam member wrote, “the knee on my ‘bad’ leg often hyperextends (locks backward) and on most days I can't stop it from doing so … a brace ... would help. Leg-strengthening exercises help, I know, but this is to keep me from injuring the knee while I work on building strength.”
Whether you have relapsing-remitting MS or primary-progressive MS, physical therapy can help you maintain independence and improve your overall health. Outpatient providers such as PTs can also teach family members and caregivers how to work with you in improving your physical health so that you can continue to live a fulfilling life with MS.
MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 167,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.
Are you undergoing or about to follow up with physical therapy for MS? Share your experience in the comments below, or start a conversation by posting on MyMSTeam.