Exercise Rehabilitation for Multiple Sclerosis
Multiple sclerosis is a progressive neurological disease in which the immune system attacks the protective covering of the brain and spinal cord, causing damage to nerves and leading to a variety of cognitive and physical impairments. From early stage through disease progression, physical therapy-led exercise rehabilitation can reduce functional dysfunction in MS patients, manage and address symptoms like fatigue and spasticity, slow progression of the disease, and improve quality of life. Exercise rehabilitation can involve aerobic exercise, gait training, manual therapy, balance and coordination training, stretching exercises, pelvic floor therapy, and patient education on symptom and energy management.
Understanding Multiple Sclerosis
Multiple sclerosis is a progressive neurological disease in which the immune system attacks the protective covering, myelin, of the brain and spinal cord, causing inflammation and damage to the myelin. This interrupts the usual flow of nerve impulses along nerve fibers and causes a variety of symptoms, depending on the amount of damage and which nerves are affected.
Multiple sclerosis affects nearly 2.5 million people worldwide, most between ages 18 to 50 with a higher rate of occurrence in females than in men. The most common type of multiple sclerosis (MS) is relapsing-remitting MS, which is characterized by recurrent attacks or relapses during which new symptoms appear or existing ones worsen. Between relapses, patients typically return to baseline function. Eventually, the patient transitions to a phase called secondary progressive, where the disease progressively worsens but there are fewer relapses.
The cause of MS is unknown, through experts know it does result from an abnormal immune system response within the central nervous system. However, there are some factors that can contribute to the development of MS. These include a genetic predisposition; while it is not a hereditary disease, the risk is higher in relatives of a person with the disease than in the general population. Smoking increases the risk of MS and is associated with more severe disease and more rapid disease progression. An infection with the Epstein-Barr virus has also been noted as a possible factor contributing to MS development. Lastly, MS appears to be more common in those who live in places where there is a lack of sun exposure, leading to lower vitamin D levels.
Symptoms of multiple sclerosis can include:
Fatigue, characterized by extreme tiredness and lack of energy, even after minimal physical or mental exertion. Fatigue affects 75-95% of all MS patients.
Difficulty walking or abnormal gait patterns
Headaches, brain fog, tremors, seizures, or memory loss
Vision problems, such as blurred vision, double vision, or blind spots
Bladder and bowel control issues such as urinary or fecal incontinence or constipation
Numbness or tingling in different parts of the body
Spasticity (muscle stiffness and involuntary movement)
Muscle control issues such as swallowing, breathing, or speech difficulties
Balance and coordination problems
Cognitive issues around problem solving, learning, and planning
Mental health issues like depression, mood swings, stress, anxiety, and grief
Multiple sclerosis is often treated with disease-modifying therapies that target immunologic signaling proteins to reduce relapse rates and slow disability progression by reducing inflammatory activity. However, one key aspect of multiple sclerosis management is therapeutic exercise under the supervision of a physical therapist.
Physical Therapy-Led Exercise Rehabilitation for Multiple Sclerosis
From early stage through disease progression, physical therapy-led exercise rehabilitation can reduce functional dysfunction in MS patients, manage and address symptoms, slow progression of the disease, and improve quality of life. Research has noted that targeted exercise rehabilitation may be the single most effective non-pharmacological symptomatic treatment for multiple sclerosis.
Exercise rehabilitation for multiple sclerosis can improve motor function, increase strength, improve balance and coordination, reduce fatigue levels, decrease stress, enhance mood, and allow for greater independence in daily activities. Exercise also helps prevent disease progression by slowing down muscle atrophy and managing symptoms like fatigue, spasticity, and balance problems.
During exercise rehabilitation, the physical therapist carefully monitors the patient for heat tolerance and sensitivity to allow the patient to exercise without exacerbating symptoms. The therapist may use cold packs and other cooling devices to ensure the patient’s temperature remains steady and make sure the patient stays well hydrated.
Exercise rehabilitation for multiple sclerosis can include:
Patient education on activity pacing and energy management, working on breaking down daily tasks into more manageable segments that don’t exacerbate symptoms.
Targeted strength training, specifically focusing on weak muscle groups to improve muscular endurance, strength, and power for functional activities. Strength training is also used to combat fatigue, building up muscular endurance so that muscles do not tire as quickly or easily during normal activities.
Progressive low-impact aerobic exercise such as walking, using a stationary bike or elliptical, or water aerobics to enhance cardiovascular capacity. The therapist has the patient start slow, gradually building up the patient’s tolerance and aerobic capacity without exacerbating symptoms.
Balance and coordination training can involve vestibular exercises, dual-task drills, tandem walking, and single-leg stands to decrease the risk of falling and improve the patient’s ability to maintain stability on uneven surfaces. This can also involve postural control training.
Stretching exercises and relaxation techniques can help reduce muscle tightness, enhance range of motion, and manage spasticity.
Gait training helps patient’s maintain an efficient and safe walking pattern and address any abnormal walking patterns due to muscle weakness or altered sensation. Training may involve practicing proper stride length, foot placement, and leg coordination as well as weight-bearing and weight-shifting drills.
Pelvic floor therapy is used to address bowel or bladder dysfunction, strengthening weak pelvic floor muscles through targeted exercise or relaxing tight pelvic floor muscle through relaxation techniques.
Manual therapy utilizes 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, or braces to improve stability, manage fatigue, and reduce fall risk.
Functional electrical stimulation may be used to help address muscle weakness using a mild electrical stimulation to a muscle or muscles to help activate them to move. This is most often done in the thigh muscle, activating the thigh muscles to lift the foot or move the leg.
Research studies have found that exercise rehabilitation is effective in managing the most debilitating of MS symptoms, fatigue. A 2020 systematic review found that physical exercise significantly reduced fatigue in patients with multiple sclerosis. 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.
Another study noted that initiating an exercise program at the time of diagnosis of MS is optimal for treating the many symptoms of MS before they occur. The authors of the study found that exercise can act as a disease-modifying intervention by providing neuroprotective effects.
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!
