Physical Therapy for Multiple Sclerosis: Regaining Mobility (2022)

If you have multiple sclerosis (MS), then you know how the varied symptoms associated with the disease can affect your ability to function well. Multiple sclerosis may have a profound effect on your ability to sit up, walk, and navigate stairs safely. The symptoms can limit your daily work and recreational activities. Physical therapy for MS may be a useful modality of care, as it may help you maintain strength, flexibility, balance, and overall functional mobility.

Physical Therapy for Multiple Sclerosis: Regaining Mobility (1)

What is Multiple Sclerosis?

Multiple sclerosis is a disease process where your body's own immune system attacks the nerves of your central nervous system. The protective myelin sheath around the nerves of your brain and spinal cord is worn away, leading to abnormal transmission of nerve signals in your body. (You can think of myelin as insulation around a wire; the insulation keeps the electrons in the wire.)

Most people with MS experiencing periods of worsening symptoms followed by periods of few or no symptoms. This relapsing-remitting pattern of MS is most common and can lead to progressive worsening of function over time.

If you suspect you have MS, you should visit your physician right away. They may refer you to a neurologist, a specialist who is an expert on nervous system disorders.

Movement Impairments Caused by MS

There are several impairments that may cause movement difficulty and loss of function in people with MS. These may include:

  • Pain
  • Spasticity (muscle stiffness or change in muscle tone)
  • Muscle tightness
  • Fatigue
  • Ataxia (lack of muscle control or coordination of voluntary movements)
  • Impaired balance
  • Impaired gait (how you walk)

A physical therapist is a movement specialist who can help decrease the damaging effects of these movement impairments. Therapy may allow you to function more freely and reduce the functional impairments caused by MS.

Other symptoms of MS that may cause additional limitations of your mobility and function include:

  • Short-term memory loss
  • Decreased concentration
  • Depression and anxiety
  • Swallowing difficulty
  • Difficulty with speech
  • Bowel or bladder incontinence
  • Decreased libido (lack of sex drive) or impotence

Multiple sclerosis affects each person differently. Some people experience a few symptoms, while others experience several severe symptoms.

Appropriate treatment of MS typically involves a team of healthcare professionals and rehab specialists like occupational therapists, speech therapists, and physical therapists. All of these people work together to help you remain as able and active as possible for as long as possible.

Physical Therapy Evaluation for MS

During your PT evaluation for MS, your therapist will ask you several questions about your condition. The therapist will ask you when your symptoms first started and how they are changing. You may be asked about which tests you have had to confirm your diagnosis. Questions about previous treatments and how well they worked for you will be asked as well. Your therapist also will review your medications and your past medical and surgical history.

After taking down your medical history, the therapist will then perform various tests and measures to get a baseline of the impairments that may be causing your functional limitations.

(Video) Fighting for MS Mobility: Paul’s Patient Story

Common Areas of Assessment

Common areas of assessment include testing for:

  • Pain
  • Gait
  • Range of motion (the extent of movement in your joints)
  • Spasm and muscle flexibility
  • Neurological ability
  • Strength
  • Endurance
  • Balance

Once your therapist assesses your condition, a rehab plan of care and goals will be established. Typical goals of physical therapy for MS include improving endurance, strength, and mobility while reducing the effects of muscle spasms and loss of movement.

PT Treatments for Multiple Sclerosis

Movement and exercise are the primary PT interventions for people with MS. Exercise has been proven to help people with MS improve mobility, decrease anxiety and depression, and maintain a healthy and independent lifestyle for long periods of time. Since there is no cure for MS, treatment will focus on ongoing PT sessions, or episodes of care, to manage symptoms and slow disease progression.

After a Relapse of MS

You may benefit from working with a physical therapist immediately after a period of worsening MS symptoms. The primary goal of PT after a relapse is to help regain your previous level of function. This may be done through:

  • Stretching
  • Progressive endurance exercise
  • Progressive strengthening exercises
  • Balance exercises
  • Gait training
  • Assessment and modification of assistive devices
  • Being fitted for orthotics (medical devices worn in the shoe) for improved positioning or mobility

Sometimes assistive devices will be temporary and only needed during a relapse. Other times, new devices or orthotics will become permanent tools for your safe mobility. Your therapist can help determine your specific needs during your rehab sessions.

Care should be taken when working on exercises for mobility after a relapse of MS. Exercising with too much intensity may make you feel a bit worse. (Becoming overheated tends to worsen MS symptoms.) Your therapist should make sure you progress gradually with your exercises both at home and in the physical therapy clinic.

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PT During Stable Times

During times of remittance of MS, you may benefit from working with a physical therapist to ensure that you are maintaining functional mobility. Your therapist may have you check in with weekly or monthly "booster sessions" of therapy. During these sessions, your home exercises for strength, flexibility, and balance can be checked and progressed as needed.

Your physical therapist can also check your adaptive equipment during stable times, ensuring that it is functioning properly and is the right assistive device for you.

PT Can Be Motivating

Regular meetings with your physical therapist can also serve as motivation since it can be difficult to adhere to an exercise program on your own. Your therapist can serve as someone who holds you accountable for your own rehab and care.

(Video) Multiple Sclerosis Physical Therapy [Live Class]

PT During MS Progression

Some people with MS experience disease advancement, during which there is progressive worsening of cognitive function, mobility, and endurance. Physical therapy for progressive MS involves ensuring your mobility needs are met.

A physical therapist can review your adaptive equipment and assistive devices and offer advice to you and your family on how to best use them to improve your functioning. Your family may also participate in rehab, learning how to safely and successfully help you with your functional mobility.

Exercise to help maintain endurance, cardio-respiratory function, strength, and balance may be done during this time. Again, care should be taken to avoid exercising too intensely, as this may worsen your symptoms. You should follow the "two-hour rule," which is you should feel fully recovered within two hours after exercising. If not, you did too much.

How Long Should PT Take?

Since MS is a progressive disease with no known cure, you can expect to need PT throughout your life. PT episodes of care usually run four to six weeks, and you may have regular meetings with your therapist (and other rehab professionals) for booster sessions. Your frequency may vary, so be sure to speak with your physician and rehab practitioners to understand your specific course of care.

Rehabilitation Therapies to Manage Your MS

A Word From Verywell

If you have multiple sclerosis, you may benefit from working with a physical therapist as part of your rehabilitation team. Your therapist can work with you and your family to ensure that you attain and maintain optimal functional mobility. This effort can make it safe for you to engage in your everyday work and recreational activities.

4 Sources

(Video) Success story - How to regain mobility in people with multiple sclerosis

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Dobson R, Giovannoni G. Multiple sclerosis – a review.Eur J Neurol. 2019;26(1):27-40. doi:10.1111/ene.13819

  2. Kalb R, Brown TR, Coote S, et al. Exercise and lifestyle physical activity recommendations for people with multiple sclerosis throughout the disease course.Mult Scler. 2020;26(12):1459-1469. doi:10.1177/1352458520915629

  3. Giesser BS. Exercise in the management of persons with multiple sclerosis.Ther Adv Neurol Disord. 2015;8(3):123-130. doi:10.1177/1756285615576663

  4. Baird JF, Sandroff BM, Motl RW. Therapies for mobility disability in persons with multiple sclerosis.Expert Review of Neurotherapeutics. 2018;18(6):493-502. doi:10.1080/14737175.2018.1478289

Physical Therapy for Multiple Sclerosis: Regaining Mobility (2)

By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.

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FAQs

Can MS patients regain mobility? ›

It is certainly possible to restore motion and enhance fitness and well being even with severe disability but often to achieve success requires the use of sophisticated rehabilitation equipment such as the lokomat system, the Giger MD locomotion system and the functional electrical stimulation bicycle.

Can MS muscle weakness be reversed? ›

This occurs when there's an injury to, or disease of a nerve such as with MS. This type of muscle atrophy tends to occur more suddenly than disuse atrophy. This type of atrophy can't usually be reversed since there is actual physical damage to the nerve.

Does physical therapy work for multiple sclerosis? ›

Physical therapy can play an important role in helping people with multiple sclerosis manage the condition. Its benefits include strengthening the body, preventing symptoms from getting worse, and helping a person regain lost function.

What is the best exercise for a patient with MS? ›

Diana: The best MS exercises are aerobic exercises, stretching, and progressive strength training. Aerobic exercise is any activity that increases your heart rate, like walking, jogging, or swimming. You just don't want to overdo it—it should be done at a moderate level.

Can walking improve with MS? ›

studies in ms have shown that various forms of aerobic exercise and weight training regimens can improve muscle strength and the ability to walk.

Why does MS make it hard to walk? ›

Spasticity: Muscle tightness or spasticity can interfere with gait. Balance: Balance problems typically result in a swaying and “drunken” type of gait known as ataxia. Sensory deficit: Some people with MS have such severe numbness in their feet that they cannot feel the floor or know where their feet are.

How can I strengthen my legs with MS? ›

Strengthen Your Legs When You Can't Stand | Exercises for MS

How do you rebuild muscle atrophy in the legs? ›

You can recover from muscle atrophy by exercising regularly and eating a healthy diet. You may start seeing improvement after a few months, but it may take much longer for you to fully recover your strength.

Can atrophied muscles be rebuilt? ›

Additionally, we study muscle regeneration and regrowth, which occurs in reambulating muscles following a period of inactivity. Although muscles from young healthy individuals typically regenerate and regrow well, muscles from elderly fail to regenerate and recover muscle mass and function following muscle disuse.

What does MS mean in physical therapy? ›

If your physical therapist has a clinical doctorate degree, they will sign their name, and then write "PT, DPT" after their name. For example, I have a Master's Degree in Physical Therapy, so I should be identified as Brett Sears, PT, MS.

What is the difference between PT MPT and DPT? ›

One of the main differences between the Masters and the Doctor is the duration of the degree. A typical MPT program is two years long with fifteen weeks of clinical experience, which had been the norm for years. In comparison, a typical DPT program is three years long and requires one full year of clinical experience.

Why is it called hippotherapy? ›

Hippotherapy consists of the words meaning “horse” “hippos”, and “treatment” “therapy” in ancient Greek. It is defined as equine-assisted treatment. Firstly, it was mentioned in the works of Hippocrates. However, it has not become a discipline with an established protocol up to 1960s.

What foods to avoid if you have multiple sclerosis? ›

7 Foods to Avoid When You Have MS
  • Saturated Fats. Saturated fats come primarily from animal products and by-products, such as red meat and full-fat dairy, and are also found in foods that contain palm oil or coconut oil. ...
  • Trans Fats. ...
  • Cow's Milk. ...
  • Sugar. ...
  • Sodium. ...
  • Refined Carbs. ...
  • Gluten.
7 Feb 2022

What stretches are good for MS? ›

Lying on back with knees bent and feet flat, slowly lower knees from side to side. The goal is to stretch the trunk and hips, not to touch the knees to the floor or bed. Hold for 30–40 seconds. Repeat 2–3 times per leg.

Is massage good for MS? ›

While massage does help a patient with MS to relax, there are even more benefits. MS patients who receive massage have shown reduced spasticity and improved range of motion, improved circulation, increased muscle and joint flexibility and of course, reduction of pain.

Which drug for multiple sclerosis is specifically prescribed to improve walking? ›

AMPYRA® (dalfampridine) Extended Release Tablets, 10 mg, is the first and only brand prescription medicine indicated to help improve walking in adults with multiple sclerosis (MS).

Is stationary bike good for MS patients? ›

If you are able to do some cycling, that is a fantastic aerobic workout. However, if MS is causing balance issues, a stationary bike will be much safer than riding a bicycle out on the road. Walking at a good pace can also count as aerobic exercise.

What percentage of MS patients Cannot walk? ›

Among people with MS, 41% reported having difficulty walking, including 13% with inability to walk at least twice a week. Of those with difficulty walking, 70% said it was the most challenging aspect of having MS.

Are hot tubs good for MS patients? ›

Exercising and Keeping Cool

Swimming is a great exercise because the water dissipates heat. It is recommended that the pool not be heated to more than about 85 degrees. In general, persons with Multiple Sclerosis should avoid hot tubs and saunas.

Is cold feet a symptom of MS? ›

Nicholas R. Metrus, MD, is a board-certified neurologist and neuro-oncologist. He currently serves at the Glasser Brain Tumor Center in Summit, New Jersey. If you have multiple sclerosis (MS) and often feel like your feet are cold, even when they're warm to the touch, you're experiencing a symptom known as dysesthesia.

Why are my legs so weak with MS? ›

What causes weakness in MS? The muscle weakness that you are feeling can be directly linked to MS because the damage to your nerves can disrupt signals to the muscles. This nerve damage makes it hard to move your muscles and leads to a heavy feeling in your legs (or other areas of your body).

How do you break spasticity? ›

Daily stretching of muscles to their full length will help to manage the tightness of spasticity and allow for optimal movement. ✓ Keep in mind that moving a spastic muscle to a new position may result in an increase in spasticity. If this happens, allow a few minutes for the muscles to relax.

Are bananas good for MS patients? ›

Fresh fruit is one of the best foods for Multiple Sclerosis because it provides a myriad of micronutrients and antioxidant chemicals, including polyphenols, carotenoids, and anthocyanins. Many fruits, like kiwi, berries, banana, and papaya, are also high in magnesium, a lack of which could be linked to MS progression.

What foods help muscle atrophy? ›

Great options include fruits and vegetables, whole grains, plain yogurt, and milk, as they can have acceptable amounts of fiber and be free of added sugars. Eat good fats such as omega-3 fatty acids: These good fats help prevent the breakdown of muscle by interfering with the inflammatory process.

How long does it take to rebuild atrophied muscle? ›

How long it takes to will depend on the amount of atrophy that occurred and your physical condition beforehand. It will take at least two weeks of physical therapy before you start to feel a difference in your muscles. It can take several months of physical therapy for muscle size and strength to be fully restored.

How long does it take to rebuild leg muscles? ›

You're likely to see some results two to four weeks after starting a leg exercise program. This includes slightly better stamina and a little muscular definition. However, depending on your starting fitness level, it usually takes three to four months to really notice and tell improvements in leg strength and stamina.

Do muscles hurt when they atrophy? ›

Muscle Atrophy: Signs, Symptoms & Treatments. Muscle atrophy refers to the loss of muscle tissue caused by a long-term lack of physical activity. Individuals with this condition experience mobility issues, pain, and discomfort, reducing their quality of life.

Can you build muscle after 70? ›

Seniors Can Still Bulk Up On Muscle By Pressing Iron Our muscle mass decreases at surprising rates as we get older. But researchers found that people older than 50 can not only maintain but actually increase their muscle mass by lifting weights.

What is restorative rehabilitation? ›

While rehabilitation services like physical therapy help people regain physical functions after illness or injury, ​restorative therapy ​helps maintain physical abilities to perform activities of daily living (ADLs) that promote independent living.

What is an SPT in Physical Therapy? ›

APTA supports the designations “SPT” and “SPTA” for physical therapist students and physical therapist assistant students, respectively, up to the time of graduation.

What can trigger MS symptoms? ›

What Causes an MS Flare-Up?
  • Stress.
  • Fatigue.
  • Heat.
  • Infections.
  • Diet.
  • Medications.
  • Smoking.
7 Jun 2021

Which is better DPT or MPT? ›

A Doctorate of Physical Therapy (DPT) is a transitional degree that is pursued by individuals who already hold a professional MPT degree. It takes 3 years to hold a DPT degree, which offers better preparation to students when entering the workforce.

What does MTC mean in Physical Therapy? ›

Manual Therapy Certification (MTC)

Which is better DPT or BPT? ›

Bachelors in Physiotherapy is better than Diploma in Physiotherapy as BPT is a undergraduate degree. And in most of the hospitals, educational institutes BPT graduates are appointed. BPT is a more in-depth and pertinent course as it is a four years programme, while DPT is of only one year.

Does insurance cover horse therapy? ›

Hippotherapy, because it is integrated into physical, occupational, or speech therapy, is part of a one-on-one medical treatment. It focuses on specific patient outcomes. A doctor's prescription is required and treatment, depending upon your insurance benefits, is generally covered by health insurance.

What is the difference between therapeutic riding and hippotherapy? ›

Physical, occupational or speech therapy in which hippo- therapy is utilized, is reimbursable by medical insurance (third party). Therapeutic riding is recreational horseback riding lessons adapted to individuals with disabilities.

What is aqua therapy used for? ›

The goal of aquatic therapy is to reduce stress and promote relaxation while working to strengthen muscles, improve flexibility, and increase the range of motion.

Can vitamin D reverse MS? ›

However, the supplement didn't reduce the number of relapses people experienced or slow progression. The trial involved 66 people with relapsing MS who were taking beta interferon. A 2012 Norwegian study also found that vitamin D did not reduce relapses or levels of disability. The trial involved 69 with relapsing MS.

Is CBD oil good for MS? ›

CBD is generally considered safe, and some research shows that it likely helps treat pain and spasticity caused by MS. However, CBD is not FDA approved for treating MS or its symptoms. You should speak with your healthcare provider about using CBD to treat MS.

Is walking good for spasticity? ›

When spasticity affects the legs, it can make it difficult to walk and put you at greater risk of falling. Therefore, exercising the legs is an essential step for lower limb spasticity treatment.

Can you strengthen muscles with MS? ›

Strength training is shown to be beneficial for people living with MS because it helps you perform daily activities,” says Reilly. Working major muscle groups in your lower body (quads, hamstrings, glutes) can help improve or maintain strength with walking, standing, balance, and muscular endurance.

How do you build muscle with MS? ›

Resistance training (with bodyweight, free weights, or machines) and swimming are effective ways to build and maintain strength in exercisers with MS, says Ashley Davis, C.P.T., a trainer with Marianjoy Rehabilitation Hospital in Wheaton, IL.

Can MS damage be reversed? ›

Myelin is repaired or replaced by special cells in the brain called oligodendrocytes. These cells are made from a type of stem cell found in the brain, called oligodendrocyte precursor cells (OPCs). And then the damage can be repaired.

Are leg massagers good for MS? ›

Many people with multiple sclerosis (MS) use massage for prevention or relief of the following symptoms: Spasticity — Massage can help relax muscles and enhance range of motion exercises. Pain — Massage is useful in any condition in which a reduction in swelling or mobilization of tissues leads to pain relief.

Is chiropractic good for MS? ›

There is no evidence that chiropractic can alter the underlying disease process or the disease course in MS. While there is anecdotal evidence that people with MS have experienced some symptom relief, there are no controlled clinical trials demonstrating treatment safety or efficacy in MS.

What percentage of people with MS lose mobility? ›

Impaired mobility, walking in particular, has been observed in early MS disease, and cross-sectional surveys according to MS clinical criteria have shown that approximately 50 % of existing patient populations with MS require mobility support, such as wheelchairs or walking aids, some or all of the time.

What percentage of MS patients end up in wheelchairs? ›

MS does affect gait, mobility, muscle strength, and flexibility, but not for everyone. Research shows that only one in three people with MS use wheelchairs two decades following diagnosis.

Can you lose mobility with MS? ›

Mobility impairment, particularly walking, is one of the most common and disruptive consequences of multiple sclerosis (MS) and can have a profound effect on independence, quality of life (QoL) and activities of daily living (ADL) for many patients.

Will I need a wheelchair with MS? ›

Although MS can cause some disability, most people never need to use a wheelchair on a regular basis. The treatment and care of people with MS is improving so people diagnosed with MS today can expect a better quality of life than was possible previously.

What is the average age of death for someone with MS? ›

Average life span of 25 to 35 years after the diagnosis of MS is made are often stated. Some of the most common causes of death in MS patients are secondary complications resulting from immobility, chronic urinary tract infections, compromised swallowing and breathing.

Can MS stay in remission forever? ›

A remission can last for weeks, months, or, in some cases, years. But remission doesn't mean you no longer have MS. MS medications can help reduce the chances of developing new symptoms, but you still have MS.

What does walking with MS feel like? ›

Characteristics of the MS gait pattern

You may lack in confidence when you walk – leading to hesitation and stumbling. You might feel unsteady when turning or walking. You might find placing your foot on the ground difficult. You might feel a heaviness in your legs as you step forward.

Does MS always end in paralysis? ›

Whether a person with MS becomes paralyzed may depend upon the severity of the MS and where the lesions, or damaged areas on the nerve fibers, are located.

How many lesions is alot for MS? ›

According to the team, patients with a combination of more than 13 lesions, with a maximal lesion diameter greater than 0.75 cm, and lesions perpendicular to the corpus callosum, had a 19 times greater chance of progressing to MS during the following year.

Is life worth living with MS? ›

Most people can enjoy a good quality of life with MS, especially if they have appropriate support. However, a person may need to make lifestyle adjustments in order to retain their quality of life.

How can I strengthen my legs with MS? ›

MS Exercises | Strengthen Legs With Multiple Sclerosis - YouTube

How many people Cannot walk with MS? ›

Difficulty in walking, also referred to as gait disorders, is one of the more common symptoms reported among people with MS. A 2011 study on MS and walking found that 41 percent of people living with MS had difficulties walking, with 13 percent unable to walk at least two times per week.

Which drug for multiple sclerosis is specifically prescribed to improve walking? ›

AMPYRA® (dalfampridine) Extended Release Tablets, 10 mg, is the first and only brand prescription medicine indicated to help improve walking in adults with multiple sclerosis (MS).

Do all MS patients end up in wheelchairs? ›

MS is different for everybody and not every person diagnosed with MS will end up in a wheelchair. 80% of people with MS don't consider themselves as having severe symptoms or disabilities.

Can you drive a car with MS? ›

One of the first questions many people have when they're diagnosed with MS is: “Will I still be able to drive?” The good news is that most people with MS continue to drive as normal.

Do you ever feel normal with MS? ›

Some people with MS live symptom-free for long periods of time. Others with severe MS symptoms may need special accommodations just to go out to a restaurant, especially if they have physical limitations.

Videos

1. Physiotherapy treatment for multiple sclerosis - Dr Susan Coote, UL
(UniversityofLimerick)
2. Fix a stiff leg: How to treat severe spasticity
(Rehab HQ)
3. Herb Karpatkin, PT, DSc, NCS, GCS, MSCS: Science-Based Approaches to Exercises with MS 2021
(Multiple Sclerosis Foundation)
4. Multiple Sclerosis Stole My Mobility. Now I am $129,000 Away from Regaining It.
(A New Day for Ice)
5. Why Exercise Is Important For Multiple Sclerosis | EXERCISE PROGRAM FOR MS
(MS Workouts)
6. 2021 - MS Symposium - An interactive discussion on Physical Therapy designed for MS patients
(The MS Views and News Learning Channel)

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