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Physiotherapy and Multiple Sclerosis: Spotlight on the movement experts

A physiotherapist works with people with Multiple Sclerosis (MS) to assess and treat physical difficulties.  They are experts in helping maximise strength and movement.

Multiple Sclerosis (MS) can be a challenging condition, presenting a variety of symptoms that can impact your daily life. It’s estimated that there are 2.8 million people living with MS in the world and rates have continued to grow over the last decade.

While current medicine has not discovered a cure yet, physiotherapy can be a powerful tool in your MS management toolbox.

This blog explores how physiotherapy can help you manage symptoms, improve your wellbeing, and empower you to live a fulfilling life.

In this article we’ll cover:

  • What is Multiple sclerosis?

  • What are the different types of multiple sclerosis

  • What are the common symptoms of multiple sclerosis

  • How does physiotherapy help manage MS

  • Which types of physiotherapy exercises are most effective for MS

  • Advice on how to find a physiotherapist


What is multiple sclerosis?

MS is an autoimmune disease. It affects the central nervous system (CNS), the control centre for your body. This includes your brain and all the nerves throughout your body.

Our nerves have a protective sheath surrounding them called myelin. Myelin works to protect the nerves. It also acts like a highway for the signals to travel from the brain to the nerves, telling them what to do and how to do it.

In MS the myelin sheath becomes damaged.  This causes the nerve signals to become disrupted and slowed down.

So the messages that get passed around your nervous system don’t work as well or as quickly.

The diagram below shows a comparison between nerve cells. 

On the left is a normal human neuron. On the right is a neuron with the myelin sheath damaged by multiple sclerosis.

What are the different types of multiple sclerosis:

  • Relapsing-Remitting MS (RRMS): This is the most common type of MS. It is characterised by periods of flare-ups (relapses) followed by recovery periods (remissions).

  • Primary-Progressive MS (PPMS): This type involves a steady worsening of symptoms from the outset.

  • Secondary-Progressive MS (SPMS): This type starts as RRMS. It eventually changes to become a more progressive course with worsening symptoms.

The wide range of MS symptoms depends on the affected areas of the nervous system.

Our nervous system is responsible for nearly everything our body does. 

For example, our nerves control our movements, our touch and sensation, our vision, our bladder and bowel, our speech and hearing, our thinking and memory, and all the other complicated processes our bodies do.

MS can affect any part of the nervous system meaning we can experience symptoms in any of those areas.

However, there are some common themes in how MS presents itself.

Below are some of the most common symptoms experienced by people living with MS.

Please note that this is a general list. It does not mean that every person with MS has or will experience these symptoms. 

If you have any concerns, you should consult your healthcare professional.

What are the common symptoms of multiple sclerosis?

Muscle Weakness: As the nerves signals get worse at passing information from the brain to the muscles, they become less responsive.  Through time this causes the muscles to lose strength. Weakness and stiffness in muscles are common, impacting mobility and coordination.

Muscle tightness (Spasticity): Spasticity feels like a tightness in the muscles. The person can’t relax or switch them ‘off’.  It can cause more pain and at its worst can cause difficulty in moving limbs through their full range of motion.

Balance Problems and Walking Difficulties: Several factors can cause balance problems. Such as, muscle weakness, reduced sensation, especially in the feet and legs, and visual changes.  MS can also affect a person’s core strength meaning they find it more difficult to maintain balance.  Reduced balance can increase the risk of falls.

Fatigue: This is the most common and debilitating symptom, affecting over 75% of people with MS. People often report fatigue has the greatest impact on their quality of life. It can limit tasks in and around the home and also a person’s ability to fully engage in social activities.

Numbness and Tingling (Paresthesias): A person may experience tingling or numbness. It often affects the hands and feet.  Sometimes people find that their ability to feel temperatures or textures is reduced too. These sensations can be uncomfortable and make day to day tasks more difficult. Especially ones that involve small movements like tying shoelaces, doing buttons, and writing.

Vision Problems: When the optic nerve is affected by MS it can lead to blurred or double vision. Optic neuritis is also a painful condition associated with the disease. It’s estimated to affect approximately 20% of people who have MS. In some cases it is one of the first symptoms noted in the diagnosis of MS.


Some Other Symptoms of MS:

Cognitive Difficulties: People can experience problems with memory, concentration, and information processing.  It can affect decision-making, and problem-solving. This can make it more difficult to participate in daily tasks.

Speech and Swallowing Problems: Slurred speech and difficulty swallowing can occur. Studies have suggested that swallowing difficulties affect approximately 43% of people with MS.

Bladder and Bowel Problems: Bladder and bowel difficulties can occur for some people with MS. It can have an obvious impact on a person’s quality of living.  There are a number of ways to manage this both medically and physically.


How Physiotherapy Can Help Manage MS Symptoms

By now you will have learned that Multiple Sclerosis has a wide range of symptoms. Physiotherapy has been proven to help with the physical aspects of the disease.  

Physiotherapists are professionally-trained to offer treatments that use a variety of physical approaches. 

Recent national guidelines say that physiotherapy is a very valuable treatment. It can work alongside the wider medical team and pharmacological (medication-based) treatments. 

It is very effective in improving movement, managing pain, and enhancing overall well-being. 

So, how can physiotherapy specifically treat the symptoms of MS?

Expert movement analysis: Physiotherapists are experts at analysing a person’s movement. They can detect areas of weakness or instability. They can create a bespoke treatment programme to address the unique way a person is affected by MS.

Improve Mobility and Balance: Physiotherapists design personalised exercise programs. They focus on strengthening muscles, improving flexibility, and coordination. This gives better control of movement. It can reduce the risk of falls, and increases confidence in daily activities.

Managing Fatigue: Physiotherapy can help manage fatigue by:

Improving Strength and Endurance: Exercise programs can increase fitness and reduce fatigue throughout the day.

Energy Conservation Techniques: Physiotherapists teach strategies to conserve energy. Learning how to pace yourself during daily activities is crucial for tiredness.

Reducing Pain and Spasticity:

Physiotherapy offers various techniques to improve pain and spasticity. These include:

Manual Therapy: Therapists use specialist massage to improve muscle tone and reduce spasticity.

Stretching Exercises: Regular stretching helps maintain flexibility and reduce muscle tightness. This can help with pain significantly.

Strengthening Exercises: Stronger muscles give better support and less pain when moving. 

Spasticity clinics: many healthcare Trusts have access to a specialised spasticity management service. Physiotherapists help with decisions on how to manage a person’s muscle tightness.  This could include Botox injections or prescription of specific medications.

Maintaining Independence: Physiotherapy empowers you to manage your MS effectively. It helps maintain independence in daily living.

Adapt Daily Activities: Learn how to adapt your everyday tasks, such as dressing, bathing, and cooking. They help to conserve energy and ensure safety.

Use Assistive Devices: Explore walking sticks, hiking poles, walkers, or outdoor walkers. These can provide support and improve your ability to navigate your environment. Physiotherapists also support with general aids such as grab rails, and specialist equipment. 

Types of Exercises Used in Physiotherapy for MS

A physiotherapy program incorporates a variety of exercises tailored to your specific needs. Here are some common types:

Strengthening Exercises: These exercises target specific muscles. The aim is to improve strength, endurance, and overall function.

Balance Exercises: These exercises challenge and improve your balance. They help you develop better stability to prevent falls.

Postural Exercises: Posture is very important in maintaining balance and mobility. Physiotherapists can help to specifically target this. 

Flexibility Exercises: Stretching maintains or improves your range of motion. It helps reduce stiffness and discomfort.

Aerobic Exercises: Activities like walking, swimming, or cycling can improve cardiovascular health. It also reduces fatigue, and boosts mood. Research strongly suggests better outcomes when cardiovascular exercise is completed. 


Finding the Right Physiotherapist

Whilst all physiotherapists will have some skill in treating MS those who specialise in neurological physiotherapy will have more specialist skills and knowledge.  

You can access physiotherapists through the NHS in the UK or seek private physiotherapy options. 

The Chartered Society of Physiotherapy, UK has a fantastic resource that helps you find a suitably qualified physiotherapist in your area.

If you do not have a diagnosis of MS but are concerned that you're experiencing any of the symptoms then seek medical advice as soon as possible.  

Early diagnosis leads to early treatment and often better outcomes.


In this article we’ve looked at:

  • What Multiple sclerosis is,

  • What are the different types of multiple sclerosis

  • What the common symptoms of multiple sclerosis are

  • How physiotherapy can help treat and manage MS

  • What types of treatments are commonly used by physiotherapists for MS

and finally…

  • How to find the right physiotherapist for you

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