A Physical Therapy Guide to Multiple Sclerosis

Multiple Sclerosis (MS) is a progressive inflammatory autoimmune condition. Areas of the central nervous system (your brain and spinal cord) come under attack by the body's immune system. This affects your strength, balance, sensation, vision, emotions, and cognition.¹

MS is primarily diagnosed in young adults, and it is a chronic condition. Although there is currently no cure for MS, studies show that a combination of medication and exercise can work to control the disease.

Almost 1 million people over the age of 18 in the United States live with Multiple Sclerosis.² Read on to learn more about MS and how CityPT therapists can help people with MS maintain healthy and active lives.

Table of Contents

• Understanding Multiple Sclerosis
• Symptoms of Multiple Sclerosis
• What Causes Multiple Sclerosis?
• Diagnosing Multiple Sclerosis
• What to Expect from Physical Therapy for Multiple Sclerosis
• Why Do I Need PT for Multiple Sclerosis?
• Do I Need Medication?
• Preventing Relapses if you have Multiple Sclerosis

Understanding Multiple Sclerosis

Multiple Sclerosis is a progressive autoimmune disease and a neurologic condition. It occurs when the immune system begins to attack the nerve cells — specifically in the myelin (the protective layer around the cells in your brain and spinal cord). This stops the nerve's ability to send signals from your brain to other areas in your body.³

There are three subtypes of MS: ¹⁴

• Relapsing Remitting: The most common type (87%), is characterized by a loss of neurologic function due to attacks, followed by periods of recovery and return to function.
• Primary Progressive: The least common form, it is characterized by worsening of disability from the onset of symptoms. The onset can be gradual or rapid depending on the individual.
• Secondary Progressive: Considered the second phase of relapsing remitting, it's characterized by a general progression of impairments, with or without relapses.

It's important to note that there will be times when people with MS might be symptom free, with intermittent attacks on their immune system.

Symptoms of Multiple Sclerosis

Due to it's relationship with attacking the nerves in the brain and spinal cord, MS can affect any part of the body. These neurologic symptoms are varied and it's difficult to predict when they will come on, how debilitating they can be, or how long they will last.

Recovery time depends on which type of MS the person has, how much rehab therapy they are getting, as well as the medications they are on. Each attack may present with a new symptom, and it's important to consult with a CityPT therapist to improve as much function as possible during a remission period.

Some of the most common symptoms include¹:

• Changes in sensation such as numbness and tingling
• Difficulty walking due to weakness, spasticity (increased muscle tone), impaired balance, tremors, and ataxia (clumsy movement)
• Fatigue
• Impaired vision such as double or blurred vision
• Gastro-intestinal dysfunction such as constipation or incontinence
• Cognitive and emotional difficulties with impaired memory and depression
• Dizziness often due to vertigo
• Sexual dysfunction

Less common symptoms include:¹

• Speech and swallowing difficulties
• Hearing loss
• Respiratory impairments
• Seizures
• Headaches

Often times, due to the decrease in movement and changes in functional mobility, secondary complications such as urinary tract infections and psycho-social challenges can occur.¹

What Causes Multiple Sclerosis?

Currently, there is no particular cause for MS and researchers are actively working to identify a cause. However, there are certain risk factors that may contribute:^{3 1}

• Exposure to a certain virus or bacteria — for example, some research suggests a relationship between MS and the Epstein-Barr virus
• Smoking
• Vitamin deficiency (especially vitamin D and B12)
• Diet (especially one which is high in animal fat)
• Location — people living in areas away from the equator have a higher rate of being diagnosed with MS
• Genetics — having a family member with MS increases a person's risk of being diagnosed²

MS is 2 to 3 times more prevalent in females than in men.²

Diagnosing Multiple Sclerosis

The earlier MS is diagnosed, the sooner it can be treated and a long term plan can be initiated. Neurologists are responsible for diagnosing MS, and a CityPT therapist can also screen for signs and symptoms to refer you to a neurologist.

Most people are diagnosed with MS between the ages of 20-50 years old.²

MS is diagnosed utilizing a combination of patient history and specific medical exams which include:¹

• Blood tests (to rule out other neurological conditions that may seem like a person has MS)
• An MRI of the brain and spinal cord to look for scar tissue caused by the autoimmune attacks
• A lumbar puncture to assess the cerebrospinal fluid for autoimmune markers
• An eye exam
• Utilizing evoked potential testing to measure nerve function

At the time of diagnosis, CityPT physical therapists specializing in neurologic conditions can offer educational resources on energy conservation and fatigue management. Plus, they can gather baseline physical information to set up a specific exercise program catered to each individual.⁵

What to Expect from Physical Therapy for Multiple Sclerosis

CityPT therapists can help someone with MS throughout all stages of their diagnosis.

Early Stages

In the early stage, physical therapy focuses on education on: what to expect, how to manage symptoms, support groups and online resources, as well as legal rights. Sessions may include family members or designated care partners.⁶

Even during periods of stability and remission, it's important to have check-ins with your physical therapist every 3 to 6 months to continue to monitor your mobility and update any exercise programs to continue to maintain optimal functional mobility.⁵

During a Relapse

During a relapse, you may see a physical therapist — depending on the timing of your medications and overall treatment plan established by your neurologist. Symptoms such as fatigue will play a large role in how much a person can participate in physical therapy sessions.

Therapists can help problem solve what type of assistive devices and equipment will help a person move as safely as possible to decrease the risk of falling during a relapse, as well as provide training to care partners.

After a Relapse

After relapse, the goal of physical therapy training is to assist them to get as close as possible to their prior level of function. CityPT therapists can assist in creating a specialized exercise program, as well as establish goals centered around the patient's specific interests.

Physical therapists can also address cognitive challenges a person may face by utilizing dual task activities (such as walking while talking) to challenge both physical and cognitive areas of the brain.

Progression

As the disease begins to progress in people with MS, an increase in physical and cognitive dependency occurs. In this stage, CityPT therapists can:

• Participate in transfer training with care partners (such as teaching them how to help a person stand up or pivot to the chair)
• Recommend appropriate medical devices and adaptive devices (such as walkers, wheelchairs, bed safety)
• Provide exercise programs involving stretching in seated and laying down positions
• Reinforce appropriate breathing exercises for respiratory health

Why Do I Need PT for Multiple Sclerosis?

Physical Therapy is essential for people with MS, especially post-relapse, when return to function is key. Therapists can help address difficulties with walking, balance, vision, cognition, endurance, respiratory function, stiffness in the muscles, and coordination.

Do I Need Medication?

Although there is no clear cure for MS, the FDA has approved some medications to help decrease the amount of attacks the immune system has on the body. They are designed to help to slow down the progression of the disease.

In addition, corticosteriods are often used for people who have severe relapses to quickly decrease inflammation and the damage to the nerve cells.

Preventing Relapses if you have Multiple Sclerosis

Simple lifestyle changes help reduce the frequency of attacks from the immune system onto the nerve cells.³ These include:

• Managing stress via strategies such as check ups with a mental health provider, yoga, meditation, and regular exercise is important
• Eating a healthy diet and limiting sugars and processed foods to keep your immune system functioning at an optimal level
• Not smoking and keeping alcohol intake at a minimum
• A regular exercise program. Exercise programs should include aerobic, strength, flexibility, and balance training.

Get in touch with one of our specialized neurologic CityPT therapists to optimize your recovery potential.

This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.

References