Maximise your potential with exercise
Multiple sclerosis is a collection of symptoms due initially to damage to the nervous system, but secondarily due to gradually deconditioning and moving poorly. The deconditioning and poor movements continue to compound and can lead you to be less active than you need to be. If you continue to stay active and do targeted strengthening programs, you will be the best you can be physically.
Some of the symptoms,
reasons they occur &
their effect on movement
Muscle Weakness
results from:
- Damage to the nervous system within the brain or spinal cord and slowing down of messages getting to the muscle, this changes the overall effectiveness of the muscle contraction by reducing
- The ability of individual muscles to get to peak force and power, and
- The ability to get a number of muscles to work together
- Deconditioning or decreased use of muscles because you are feeling tired, unwell and/or unsteady will lead to more muscle weakness.
Sensory Problems
Vision - Damage to optic nerve, brain stem nerves or brain interpretation areas may result in things such as:
- visual field loss
- loss of visual acuity
- changes in colour vision
- changes in depth perception
- double vision
You may stop you moving your head, and tense your neck to help to keep head still, or do the opposite and move your head more than normal to try and 'see'. You may begin to minimise your faster activities because you don't feel confident.
Somatosensory and Proprioception - are the feelings from skin, joints and muscles that tell you where you are in space; these get reduced due to damage to tracts in spinal cord or brain, but also secondarily to less movement. Lack of these feelings means less information about where you are in space and further loss of movement.
Vestibular - the sense of position in space from your inner ear may be reduced due to damage to the cells and nerves in the nerve pathways or central part of the brainstem. Loss of vestibular sense leads to dizziness, and loss or accurate information about where you are in space.
An individual or combined loss of sensory information leads to less information going to the brain resulting in poorer muscular responses, so that overall movements become less accurate and more unsteady.
Inco-ordination
Damage to cerebellum and pathways, sensory problems or muscle weakness, all reduce the accuracy of movements due impaired switching muscles on and off with the correct timing. This reduces overall effectiveness of the muscle contraction causing wobbly or unsteady movement and giving further loss of confidence.
Loss of Movement Isolation
Damage to a specific part of brain can cause difficulties with correctly switching some muscles on and some off; this appears as 'spasticity' or overactivity in some muscle groups. 'Spasticity' can also occur when the brain tries to substitute one group of muscles for weakness in other muscles.
Joint and muscle structural changes
Muscles can become tighter as the brain resets muscle tension and changes the muscle tone to cause the muscle to tighten and shorten. Lack of movement and poor resting position can also lead to muscle shortening.
Joints can become tight and change their alignment due to muscle weakness, poor movement patterns, poor resting positions or exacerbation of old injuries.
Fatigue
Fatigue is multifactorial and can be generated centrally due to presence of chemical and hormonal changes or be a symptom of moving differently, stress and deconditioning.
Memory and Planning problems
Changes in the way you think can lead to less activity through; forgetting to exercise or difficulty planning how to get something done.
Examples of movement changes are:
- Rolling over, you may notice that you now need to reach for something to help pull yourself over rather than use your trunk muscles.
- Standing still may be difficult and you now stand with your feet wide apart or need to hold onto things for support.
- Walking starts to become slow, stiff or unsteady
- Reaching for a cup, you may notice that you need to turn your entire body and get close to reach rather than reaching out with one hand.
Secondary effects of not moving well:
- Depression
- Pain
- More muscle tightness and weakness
- Further unsteadiness resulting in falls & fractures
- Changes in peripheral circulation & ulcers/pressure sores
physiotherapy and exercise
Your potential is maximised
by minimising the secondary deconditioning
How to minimise secondary deconditioning
- Have regular assessment of the changes in movements that are occurring and the underlying impairments that are causing this.
- Minimise the changes by working with doctor and therapist to minimise the impact of impairments, or reverse impairments.
- When in remission/less aggressive phases use exercise to maximise strength and control.
Is exercise safe with MS?
Strength training has been shown to:
- Not cause further deterioration in MS symptoms
- Improve strength of muscle groups trained
- Improve daily activities such as walking and balance
- Reduced depression
Components of an exercise program
- Flexibility
- Strength
- Cardio-vascular capability/general fitness
The program needs to be balanced for all components, in particular targeting specific strengthening as advised by your therapist.
Moderating exercising with MS
is achieved by:
- Working in small chunks - 5 minutes could be enough for some - gradually increase the time
- Working in a suitable climate, for example, in the cool of day or cool environment
- Allowing enough energy for strength component, not all cardiovascular training
- In a group situation you should be aware of your needs and focus on these
- Keep hydrated, cool water will help to cool your body
Types of exercise
- Tai chi
- Yoga
- Walking and stretching
- Swimming, aqua aerobics
- Horse riding
- Home exercise program
- Gym program
Signs of overdoing exercise
- Deterioration in movement control
- Muscle soreness for more than 24 hours
- Excessive fatigue or feeling unwell
If you think you've done too much
Rest the next day, then try again with half the amount of exercise and build up in slow increments. Discuss with your health professional.
Other aspects
- Nutrition, eating well to fuel your body
- Hydration, taking in enough water to ensure all your systems are working at their best
- Foot wear, ensuring that you have comfortable, supportive and appropriate shoes
All exercises and activity should be a "challenge", but never a "struggle."
Benefits of exercise
- Minimise progression of disability due to deconditioning
- Minimise other symptoms eg bladder dysfunction, sexual difficulties
- Minimise cognitive effects -keeps you thinking better
- Minimises the role of MS in your life and lets you be you.
What to expect from physiotherapy
- Being listened to, addressing the problems most affecting you
- Differential diagnosis, sorting through the problems
- Discussing various options available
- Long-term support, ie intermittent help as and when needed and/or short-term regular treatment.
You are a person with MS, let the MS be a very small part of you, take control, be active.
useful websites
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