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.
Multiple sclerosis (MS) 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.
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.
Research suggests that targeted exercise rehabilitation may be the single most effective non-pharmacological symptomatic treatment for multiple sclerosis.
Exercise rehabilitation under the supervision of a physical therapist can help multiple sclerosis patients conserve and regain functional abilities, and manage symptoms. 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.
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.
