Multiple sclerosis (MS) is a chronic neurodegenerative condition that largely affects young adults between the ages of 20-50, and is thus often known as the great crippler of young adults. It is a disabling disease of the brain and spinal cord, in which the immune system attacks the protective myelin sheath that covers nerve fibers and thus causes communication problems between the brain and the body. Slowly, the disease can cause permanent damage or deterioration of the nerves. Symptoms of this disease vary widely depending on the type of nerve affected and the amount of damage. Some people with severe MS might lose the ability to walk independently, whereas others may experience long periods of remission without any new symptoms. There is a range of treatments that may help to treat this condition like medication, hypnosis, tai chi, rehabilitation, etc. Rehabilitation services include a team of professionals working together to provide quality life to the patient. Physiotherapists are one such professional. The physiotherapist helps to create an individualized program that suits the abilities and addresses the goals of an individual. In this blog, we have mentioned a few exercises which are used by physiotherapists to provide education and treatment to promote good health and general conditioning to reduce fatigue and help the patient to feel and function at their best.


Multiple Sclerosis

Multiple sclerosis may differ greatly from person to person and the course of the disease depends on the location of the affected nerve fibers. Multiple sclerosis often causes numbness or weakness in one or more limbs that can occur on one side of the body at a time, or the legs and trunk, shock-like sensations that occur on neck movements, especially while bending the neck forward i.e. Lhermitte sign, Tremor, lack of coordination or unsteady gait, vision problems. Patients may also feel slurred speech, fatigue, dizziness, tingling, or pain in parts of the body even problems with sexual, bowel, and bladder function. It can also cause problems with mobility and gait. Some people with MS have a gradual onset and steady progression of symptoms without any relapses, known as primary-progressive MS. And those with relapsing-remitting MS, eventually develop a steady progression of symptoms, with or without periods of remission, within 10 to 20 years from disease onset. This is known as secondary-progressive MS. The rate of disease progression varies among people with secondary-progressive MS.

The causes of multiple sclerosis are unknown. It is an autoimmune disease, in this condition body's immune system attacks its tissues. This immune system malfunction destroys the fatty substance (myelin) that coats and protects the nerve fibers in the brain and spinal cord. When the myelin sheath is damaged and the nerve fiber is exposed, causing the messages that travel along that nerve fiber to slow down or get blocked.


Physiotherapy Treatment:

Physiotherapy helps the patient to achieve and maintain optimal function essential for the quality of life. The physiotherapist evaluates and treats the body's ability to move and function by emphasizing pain, strength, walking, balance, fatigue. Most individuals living with MS have difficulty in physical activity.  Physiotherapy treatment includes a combination of exercises, equipment, and management strategies that help the patient. Physiotherapists can keep them moving and prevent the worsening of symptoms.  The therapist designs a treatment plan and a list of recommendations to improve the mobility, strength, and physical wellbeing of the patient. Exercise is not only beneficial for physical well-being but also for emotional and mental health.


Balance exercises:

These exercises are given to minimize the increased risk of falls and gait deviations. The physiotherapist provides balance retraining by strengthening and flexibility exercises. Balance can be improved by the use of visual causes or techniques to reduce upper extremity tremors. Balance training focuses on controlling the posture so that the patient can control the body mass more stably. Balance exercises involve standing on one leg at a time and then challenging the balance by performing another movement. For example, balancing in tree pose, or standing on one leg while doing a bicep curl. While maintaining a pose, care should be taken that the individual doesn't fall. Increasing core strength also helps with balance.


Mobility exercises:

Walking requires balance, coordination, upper limb control, strength, and endurance. The tools for mobility are now lighter and easier to handle. The physiotherapist can recommend the mobility tools that are appropriate for the patient and also teaches the individual to use them.


Strengthening exercises:

Weakness is a common problem in patients with MS. Strengthening training can help improve muscle endurance and strength.  This can help to increase functionality, walking ability, and physical independence. Exercises help to design and execute training program that helps to address areas of weakness and imbalance in the body e.g. marching exercises help to strengthen the legs, improve balance and increase fitness. Resistance training also requires the muscles to work against weight or exterior force, this can be done by using one's body weight, working with dumbbells or resistance bands, and using weightlifting machines. Strengthening exercises can help to retain muscle mass, which is important in maintaining function.


Stretching exercises:

Multiple sclerosis patients are characterized by involuntary stiffness or muscle spasms. Spasticity can affect the mobility and independence of an individual. Therefore, proper positioning, stretching, and bracing can be used to help minimize the effects of spasticity. Structured physiotherapy programs are planned to improve mobility, muscle strength, aerobic capacity, and quality of life. Daily stretching can be beneficial as it increases range of motion, improves flexibility, and decreases spasticity. Stretching should be done for 10 to 15 minutes per day, the focus being spastic muscles. The muscles should be moved slowly to give them time to respond to the stretch and hold each stretch for 20 to 60 seconds, but shouldn't be painful.


Endurance exercises:

These exercises can improve walking distance and quality of life measures. Physiotherapists can help design a tailored and comprehensive exercise program that can alleviate the effects of fatigue. Modifying exercises to help manage fatigue so that the individual can continue doing the things he/she loves. Endurance exercises can be done to be stronger, but in MS weakness comes not only from the disease but from deconditioning. So if an individual has a lot of fatigue, then he/ she is resting more or is more sedentary. Their muscles become deconditioned, to counter this, 3-4 four days of strengthening training per week should be done.


Aerobic exercise:

Aerobic exercises, provide cardiovascular conditioning and is important for cardiovascular health. The physiotherapist recommends doing cardio exercises 3 days a week for 30 minutes each time. Alternatively,

3 -10 minute sessions if 30 minutes is too difficult to maintain. An individual with MS can do low-impact aerobic exercises like walking, bicycling, or using an elliptical machine.


Water aerobics:

In water aerobics, water produces force to work against, providing resistance. Because of this, water aerobics is one of the best exercises that can be done in the case of MS.  Water aerobics is a great mode of exercise because of the buoyancy, which makes it easier to move.


Functional movement:

Functional exercises are beneficial because these exercises recruit multiple muscle groups at the same time, for example, push-ups, use core, chest, and back muscles. Another benefit is that some of the exercises, like squats, mimic motions that an individual does in daily life like sitting down in a chair or standing up from the chair. These exercises are very helpful, for people with MS, because they train the muscles to perform daily tasks effectively.

Exercises are not only helpful to maintain function but also reduce inflammation in the central nervous system and have a positive impact on the disease. People with MS feel less fatigued and improve their mood after doing resistance training. But patients should keep in mind that results don't happen overnight, they should be followed with a consistent schedule to experience any potential benefits of exercises for MS.