Managing Multiple Sclerosis with Physical Therapy
Exercise rehabilitation under the supervision of a physical therapist can help multiple sclerosis patients conserve and regain functional abilities, manage symptoms, and improve quality of life. Multiple sclerosis (MS) is a chronic neurological disease that affects the central nervous system and can lead to physical and cognitive impairments. Research suggests that targeted exercise rehabilitation may be the single most effective non-pharmacological symptomatic treatment for multiple sclerosis. A structured rehabilitation program can improve mobility, muscle strength, aerobic capacity, and quality of life in multiple sclerosis patients.
How Multiple Sclerosis Impacts Physical Function
Multiple sclerosis is a chronic neurological disease that affects the central nervous system, characterized by chronic inflammation and progressive demyelinating lesions in the brain and spinal cord. This interrupts the usual flow of nerve impulses along nerve fibers and can lead to physical and cognitive impairments. Multiple sclerosis can cause a wide array of symptoms depending on what part of the brain and which nerves have been affected.
Multiple sclerosis affects 2.8 million people worldwide. In Europe and North America, multiple sclerosis is the leading cause of non-traumatic neurological disease in young adults. It is more prevalent in women (69%) than in men (31%).
Depending on the type of multiple sclerosis, individuals may experience periods of remission when symptoms cease and periods of relapse, in which previous or new symptoms flare up. There are three distinct types of multiple sclerosis:
Clinically Isolated Syndrome (CIS): this is the earliest form of multiple sclerosis, in which a single episode of neurological symptoms suggests multiple sclerosis. A diagnostic MRI is completed, showing abnormalities in the brain and spina cord.
Relapsing-remitting multiple sclerosis: this type of multiple sclerosis has unpredictable but clearly defined relapses (exacerbations or flare-ups of symptoms) during which new symptoms appear or existing ones get worse. Between relapses, during times of remission, the individual returns to baseline function. Eventually, this type of multiple sclerosis progresses to secondary progressive stage multiple sclerosis in which there is a discernible worsening of the individual’s condition.
Primary progressive multiple sclerosis: this type of multiple sclerosis involves a slow steady accumulation of disability with minor improvements, but no periods of remission.
Common symptoms of multiple sclerosis can include:
Debilitating fatigue
Gait deficits and difficulty walking
Vision problems like blurred vision
Bladder control issues like urinary frequency and urgency or incontinence
Numbness and tingling in different parts of the body
Spasticity of muscles, involving involuntary muscle stiffness and muscle spasms.
Balance and coordination problems
Difficulty learning and planning cognitively
Sexual dysfunction such as pain with intercourse, pelvic pain, or erectile or ejaculatory dysfunction
Cognitive and mood changes
Multiple sclerosis can be treated with disease-modifying therapies that target immunologic signaling proteins, using pharmacology to reduce relapse rates and slow disability progression by reducing inflammatory activity. However, exercise rehabilitation is a critical intervention for multiple sclerosis management.
Physical Therapy Exercise Rehabilitation for Multiple Sclerosis
Exercise rehabilitation under the supervision of a physical therapist can help multiple sclerosis patients conserve and regain functional abilities, manage symptoms, and improve quality of life. In fact, research suggests that targeted exercise rehabilitation may be the single most effective non-pharmacological symptomatic treatment for multiple sclerosis. A structured rehabilitation program can improve mobility, muscle strength, aerobic capacity, and quality of life in multiple sclerosis patients. Starting physical therapy early in a multiple sclerosis diagnosis is key to prevent complications in the long run and establish a strong baseline of function in the patient.
Fatigue is one of the most common and most debilitating of multiple sclerosis symptoms. A 2020 systematic review found that physical exercise significantly reduced fatigue in patients with multiple sclerosis. Benefits of exercise rehabilitation in multiple sclerosis patients included increased cardiorespiratory fitness, muscle strength, and endurance; reduced body fatigue; improved mood; and increased ability to perform daily tasks. Another review of 58 studies noted that exercise was effective in decreasing fatigue in multiple sclerosis patients; exercise interventions included aerobic training, resistance training, aerobic training paired with resistance training, balance training, combined exercise, Pilates, and motor control exercises.
A 2021 review found that exercise helps reduce and manage multiple sclerosis symptoms, restores function, improves general wellness, increases activity levels, and boosts quality of life. A review of 54 clinical trials over a 10-year period reveals that for those with MS, exercise was associated with positive effects on walking, mobility, neurologic disability, pain, cardiorespiratory fitness, muscular strength and endurance, body weight, balance, mental health, and quality of life.
Physical therapy interventions for multiple sclerosis can include:
Patient education on activity pacing and energy management, breaking down everyday tasks into smaller, more manageable segments that don’t worsen symptoms.
Progressive aerobic exercise, slowly building up the patient’s tolerance and aerobic capacity without exacerbating systems, using a stationary bike or elliptical. Aerobic training can help address MS fatigue.
Targeted strength training, focusing on specific muscle groups that are weak and contribute to limited function to improve muscular endurance, strength, and power for functional activities.
Balance and coordination training, using vestibular exercises and dual-task drills to decrease the risk of falling and improve the patient’s ability to maintain stability on uneven surfaces. The therapist also work on postural control with the patient while reducing energy requirements as much as possible.
Stretching to manage muscle spasticity and improve range of motion in limited joints
Gait training using weight-bearing and weight-shifting drills and body positioning to improve the patient’s ability to walk. Research has shown that gait training is beneficial in maintaining neuroplasticity in the MS patient through the activation of motor units and firing rate synchronization to maintain mobility.
Pelvic floor training to address bowel or bladder dysfunction, addressing weak or tight pelvic floor muscles through targeted strengthening or relaxation techniques
Manual therapy using soft tissue and joint mobilizations to improve circulation and range of motion, decrease muscle tone and spasticity, ease stiffness, and improve soft tissue extensibility
Assistive device training with canes, walkers, and braces to improve stability and reduce the risk of falls and manage fatigue
Functional electrical stimulation is a treatment that involves mild electrical stimulation to a muscle or muscles to help them activate to move. This can help address weakness in the thigh muscles, activating the thigh muscles to lift the foot or move the leg.
As a patient engages in aerobic and resistance training, the therapist carefully monitors the patient for heat tolerance and sensitivity to allow the patient to exercise without triggering the onset or exacerbation of symptoms and uses cold packs and other cooling devices to ensure the patient’s temperature remains steady.
If you or a loved one are currently living with multiple sclerosis, consider working with a physical therapist to manage symptoms and regain function and mobility safely through targeted therapeutic exercise!
