Canada has one of the highest rates of multiple sclerosis (MS) in the world, with an estimated 1 in every 385 Canadians living with the disease.¹ At Propel, we use physiotherapy in multiple sclerosis management as part of an integrated approach to addressing the needs of this clientele.
Evidence has shown that rehabilitation is still the only way to improve functional outcomes in individuals with multiple sclerosis.² A recent review of the literature suggests structured rehabilitation programs and physical therapy can improve mobility, muscle strength, aerobic capacity and quality of life.³
Before we take a closer look at the rehabilitation and physiotherapy in multiple sclerosis management, let’s define MS and its different forms.
What is Multiple Sclerosis?
Multiple sclerosis (MS) is a chronic neurodegenerative disease. In MS, the immune system attacks the protective covering, myelin, of the brain and spinal cord, causing inflammation and often damage to the myelin. When this happens, the usual flow of nerve impulses along nerve fibres (axons) is interrupted. The signs and symptoms of MS vary widely on the amount of damage and which nerves are affected. Not all people with MS will experience all symptoms and often the symptoms will improve during periods of remission.
Different Forms of MS
The earliest form of MS is clinically isolated syndrome, or CIS. CIS refers to a single episode of neurological symptoms suggestive of multiple sclerosis. Often, through MRI investigation there is evidence of abnormality in the brain or spinal cord.
Relapsing-remitting MS is characterized by unpredictable but clearly defined relapses (also known as attacks, exacerbations or flare-ups) during which new symptoms appear or existing ones get worse. In the period between relapses, a person typically returns to their baseline function.
Most people with relapsing-remitting will eventually transition to a phase of the disease called secondary progressive. This phase of the disease has progressive worsening and fewer relapses.
Primary progressive MS is characterized by a slow accumulation of disability, it may stabilize for periods of time, and minor improvement may occur, but there are no periods of remission.4
Related story: Physiotherapy Helps Symptoms of Parkinson’s Disease
How Physiotherapy Helps Manage Symptoms of MS
Physiotherapists and exercise therapists can help address the needs of individuals with MS. This can include the treatment of symptoms such as fatigue, balance, weakness and spasticity.
Fatigue can be a debilitating part of MS symptoms, affecting a person’s physical, emotional and social well being. Studies have found that endurance exercise in MS clients can improve walking distance and quality of life measures.5 Our therapists can help design a tailored and comprehensive exercise program that can alleviate the effects of fatigue.
Balance deficits can lead to an increased risk of falls, gait deviations and decreased independence. MS can cause a wide range of symptoms that can influence balance including decreased coordination, muscle weakness, sensory changes, tremors and dizziness. A systematic review of research has shown significant positive effects of physiotherapy on balance for individuals with MS who have mild to moderate levels of disability.6
Weakness is a common problem in individuals with MS. Resistance training can help improve muscular endurance, strength and power. This in turn can help with functional activities, walking ability and physical independence. Our therapists can help design and execute a resistance training program that helps address areas of weakness an imbalance in the body.
Spasticity is a common symptom is MS that characterized by involuntary stiffness and/or muscle spasms. Spasticity can have a serious effect on a person’s mobility and independence. The effects of spasticity can vary from one MS client to the next. Positioning, stretching, and bracing are all ways to help mitigate the effects of spasticity.
Physical Activity a Vital Component of MS Treatment
Previous concerns that exercise in people with MS would cause more damage and fatigue have been discredited. We now know that the evidence supports that physical activity is a vital component in the treatment of MS. Exercise is beneficial for your physical, emotional and mental health.
Ask our experienced team of clinicians how you can get started.
 StatsCan – Neurological conditions in household population
Retrieved from https://mssociety.ca/about-ms/types, 2019
 Kraft, GH Lancet. 1999 Dec 11;354(9195):2016-7. Rehabilitation still the only way to improve function in multiple sclerosis. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5200850/
 Retrieved from https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012732.pub2/fullApril 21, 2019
 Paltamaa J1, Sjögren T, Peurala SH, Heinonen A.J Rehabil Med. 2012 Oct;44(10):811-23. Effects of physiotherapy interventions on balance in multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.
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