Originally found in: Everyday Health 

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Functional Exercise for Multiple Sclerosis: Advice From a Physical Therapist

June 11, 2018 ~ by: Robbie Gillies

All persons with multiple sclerosis (MS) should exercise, but not all exercises confer the same benefits. That’s because MS can result in different deficits in each person, so an exercise program needs to be tailored to a person’s individual needs. In fact, each exercise within an exercise program should have a specific goal.

It is this level of specificity that will lead to success in achieving exercise-related goals. And since MS often affects mobility — including walking, balance, and positional changes — the exercises chosen for a person with MS typically address mobility impairments.

Fitness and Function Not the Same Thing

There is a difference between exercising with a purpose and exercise in general. Years ago I (Dr. Karpatkin) saw a patient with MS who couldn’t understand why he was having trouble with walking and balance. He spent multiple hours a day in the gym or the pool, but no matter how much or how hard he worked out, his walking was not getting any better.

When pressed for details of his gym routine, he mentioned doing pushups, situps, upper-body exercises, the stationary bike, and swimming. Never did he mention that he was working on exercises that would target the impairment that was causing him the most trouble — walking.

After an examination and gait analysis, it became apparent that the reason that he was having difficulty was a foot drop (an inability to lift the front of the foot during walking) that was causing him to trip and fall. In his multiple hours in the gym, none of the many exercises he was doing was addressing this issue. He had exercised to increase his fitness but not his function.

Exercises to Improve Foot Drop

What should this individual have been doing? To address the problem of foot drop, we worked on stretching his calf muscles to prevent them from pulling the foot down further. We also progressively strengthened the muscles in the shin that pull the foot up, starting simply by performing that motion and then progressing to adding resistance using TheraBands or manual resistance.

Then we practiced walking, with a focus on landing on the heel and pushing off of the toes. Even within the first session he could see that his walking had improved.

This example of task-specific exercise is one that all persons with MS should consider.

Below are some common functional deficits seen in MS that many people deal with at one time or another, and all of these can be addressed with functional exercises.

Help for Improving Balance and Preventing Falls

Falls can become common for many persons with MS. But the reason for falls may be complex, potentially involving impairments in strength, flexibility, sensation, vision, coordination, and attention. These impairments may be present either singly or in combinations with each other.

A physical therapy evaluation can determine what is causing the balance deficit and what exercises can address that deficit. The severity of the impairment will determine the starting point for these exercises. Here’s an example of a progression of exercises for improving balance:

1. The first step a physical therapist might take is to determine if an individual can stand with a wide base of support (with feet shoulder-width apart).
2. Once this becomes comfortable, the feet can be brought closer together.
3. Then balance can be challenged further by taking a step forward with one foot and then bringing that foot directly in front of the other in what is known as tandem stance.

If a person has difficulty with any of these tasks, practicing that task would be the basis of this person’s functional exercise regimen.

Further exercises would be to balance with the eyes closed, on different surfaces, and on unstable surfaces.

Decreased strength or flexibility can also lead to loss of balance and falls. Testing by a physical therapist can determine if these are present and what exercises should be used to address these impairments.

Finally, loss of balance can occur while standing relatively still or while walking, so a PT will test a person’s balance in each situation and recommend interventions for difficulty in each, if needed.

Gait Speed and Endurance

Many people with MS complain of gait difficulties related to speed and endurance as well as balance. People with MS often slow their walking speed as a means of limiting falls or saving energy. But this may lead to a habitually slower gait, as well as a decreased ability to speed up when needed.

Practicing walking for brief distances at a faster-than-normal pace may improve this.

Loss of gait speed may also be due to impaired leg flexibility or strength. For example, if the muscles that flex the knee or hip are tight or weak, a person’s step length will be shortened, and gait will slow.

To begin to correct the problem, specific exercises would be done to strengthen and stretch the appropriate muscles. Then a PT would have a person walk with a focus on addressing specific impairments. For example, a PT might use various cues to help a person increase his step length, avoid foot drop, or shift weight more evenly between the legs.

To address endurance, the focus would be on progressively increasing walking distance. Research has shown that longer walking distances in persons with MS can be achieved if the person takes breaks while walking, rather than walk continuously. This allows a greater total distance to be walked, without being limited by fatigue.

RELATED: How to Get Fit When You Have MS: Interval Training May Help

Sitting Down and Standing Up

One of the most common complaints among individuals with MS is having difficulty transitioning from sitting to standing. Critical aspects of this task include:

• Getting the feet back behind the knees
• Leaning forward with the trunk
• Using momentum to bring the body weight forward

By breaking the task down to its component parts, practicing each part separately, then practicing all three parts together, one can make standing up from a sitting position easier.

But it may be necessary to break the task down even further. To stand up easily, a person needs adequate ankle flexibility, trunk flexibility, calf, thigh, and hip strength, as well as upper-body strength.

Identifying areas of weakness or inflexibility allows the PT to recommend specific exercises that, when practiced, will eventually enable the person to perform the entire task of standing up.

Use It, Improve It!

Functional decline often becomes a vicious cycle. An individual has trouble with a specific task and begins to avoid performing that task. But if you don’t use it, you lose it.

The good news is that the opposite is also true: If you use it, you improve it! If you choose a functional goal that is important to you and perform specific activities to address that goal, it will maximize your chance of improvement.