Written by Kimberly Holland | Published on September 9, 2014
Medically Reviewed by George T. Krucik, MD, MBA on September 9, 2014
Learn more about the role physical therapy can play in treating the symptoms of multiple sclerosis, as well as the types of physical therapy that may be used.
Multiple sclerosis (MS) is a progressive autoimmune disease. Autoimmune diseases mistake normal, healthy parts of the body as foreign and attack them. In the case of MS, the body attacks and destroys the protective sheath that surrounds your nerves. This sheath is called myelin. The damage to and destruction of the myelin eventually affects the nerves. Nerve damage delays and disrupts communication between your brain and parts of the body.
MS is unpredictable. It fluctuates and changes from month to month and person to person. For some people, MS is only mildly intrusive. The symptoms and signs of the disease are minuscule compared to more invasive conditions, such as a spinal cord injury or stroke.
However, that’s not the case for everyone. MS can also progress quickly. Flares can be very difficult, and recovery might not be possible. Over time, MS destroys the myelin around your nerves. This damage cannot be repaired.
How Physical Therapy Helps People with Multiple Sclerosis
Each person’s MS progression is different. MS can be aggressive and become advanced quickly. In other cases, MS can be mild and progress at a much slower pace, with long periods of inactivity.
In any case, physical therapy (PT) can be an important treatment option for people with MS. PT can help patients learn to cope with their changing bodies, develop strength and stamina, and regain abilities after a disease flare.
Physical Therapy at Different MS Stages
By the time a diagnosis is made, you may already be experiencing symptoms of the disease. Still, it’s important you meet with a physical therapist for a baseline evaluation. This exam allows the therapist to see what you are capable of now and compare that to your future abilities. You can also discuss your physical limitations and understand what appropriate levels of exercise and physical activity are. After a diagnosis, you may not need to continue seeing a physical therapist unless you wish to or if you have an aggressive, rapidly progressing case of MS.
During a Relapse
A relapse, or flare, is a period of time when the signs and symptoms of MS are more prevalent. During this period, you may experience greater difficulty with everyday tasks, including working, cooking, walking, and showering. Your physical therapist will be able to understand how the flare is affecting you by conducting an exam and comparing it to your baseline evaluation. Once the flare has ended, meet with your physical therapist again to resume PT. Therapy after a flare may help you regain some of the strength you lost during the flare.
Progressive Multiple Sclerosis
If you have primary-progressive MS, you do not experience flares and remissions. Instead, your disease is on a gradual but constant decline. If you are diagnosed with this type of MS, ask your doctor to refer you to a physical therapist right away. It’s crucial to your health and well being that you start PT as soon as you can. PT can teach you how to compensate for the changes you will experience. You may also need to learn how to use a mobility aid, such as a standing device or wheelchair.
Advanced Multiple Sclerosis
Patients with advanced MS experience significant disease burden. In most cases, people with advanced MS are non-ambulatory—they cannot get around without aid from another person or a motorized device. Also, people at this stage have an increased risk of developing secondary health conditions, such as osteoporosis and epilepsy.
Patients with advanced MS can still benefit from physical therapy. Namely, PT can help patients learn to sit properly, develop upper body strength, and maintain the ability to use mobility aids.
Venues for Physical Therapy
Physical therapy can be conducted in several venues, including the home, an outpatient facility, a gym, or even MS treatment centers. PT for MS may be different based on the venue you use. In some cases, the stage of the disease determines what type of venue you require. In other cases, you may be able to select the option that works best for you and your lifestyle.
Inpatient (acute, transitional, rehabilitation, or long-term care)
PT conducted in an inpatient facility is often done in a hospital, MS treatment center, or long-term care facility. Most people who require inpatient PT have experienced a fall or some type of injury because of their MS. People with advanced-stage MS may also be living in an assisted-living center, and PT may be required as part of treatment.
PT that takes place in a doctor’s office, physical therapy office, or therapy center is considered outpatient. People who undergo outpatient PT come to the venue for therapy and leave afterward. These venues are good for people who are recovering from a relapse or learning to handle physical changes caused by MS.
People in all stages of MS can use home care. This type of therapy may be useful for people who have recently been diagnosed with MS and are learning to deal with slight changes in their physical abilities. Home care can also be used for patients who are experiencing late-stage MS and are non-ambulatory. Instead of going to an outpatient facility, a physical therapist may visit a patient and conduct PT in the home if their MS is advanced.
Making Treatment Plans
If you have been diagnosed with MS, talk with your doctor about your course of treatment. If you would like to begin working with a physical therapist, ask your doctor for a referral. Even in the earliest stages of the disease, people with MS need to learn how to support their bodies, avoid exacerbating symptoms, and use mobility aids as necessary. A discussion with a physical therapist can also help you understand how your body will change as the disease progresses and how you can prepare for these changes by building strength, maintaining or improving your healthy lifestyle, and incorporating therapeutic activities.