Physical therapy for Multiple Sclerosis

Overview
From diagnosis of multiple sclerosis (MS) to advanced stages of the disease, physical therapy can help delay disability and preserve quality of life. A physical therapist will focus on your mobility issues and physical challenges and find appropriate exercises and achievable goals. Since MS symptoms and disabilities vary between individuals, your therapist will carefully tailor a program to your specific abilities and needs.

Fatigue, weakness and lack of balance lead many people with MS to give up on physical activity and become increasingly sedentary. However, lack of physical activity can accelerate the progression of the disease and contribute to the development of other conditions such as osteoporosis and obesity.

What does it involve?
Even one to three sessions with a physical therapist may improve mobility and find strategies to work around physical challenges. At your first visit with a physical therapist, they will carefully assess your condition and interview you about your diagnosis and medications. Tests may include assessments of gait, balance and fatigue levels. They will help you prioritize which problems you want to work on during sessions. A good therapist will respect your fatigue level, help make sure you do not become overheated, and be encouraging.

Your physical therapist will teach you different exercises you can do on your own at home. Which exercises you do with your therapist will depend entirely on your condition and your goals. The three main goals of physical therapy are to improve functioning, moderate spasticity and manage energy levels. Exercises may include leg lifts, stretches, gait training to overcome difficulties with walking, or moves to improve strength and range-of-motion.

Another helpful component of physical therapy is education. The therapist will teach you strategies for coping, introduce you to new kinds of equipment, and involve family and care providers in a coordinated, team-oriented approach. The therapist will also help you decide whether home therapy visits or additional assistance may be necessary.

It is important not to become discouraged early on in therapy. Focus on slow, gradual progress toward goals.

Intended Outcomes
Physical therapy can help in different ways during different stages of MS. Soon after diagnosis, a physical therapist may be useful mainly as a consultant about what sorts of exercise are appropriate and safe for you. After a flare-up, physical therapy sessions can safely help you return to your former activities. (It is best to wait two weeks after a flare-up to resume physical therapy.) If your MS becomes progressive, maintain physical therapy to help slow decline; don’t wait until you are struggling. In those with advanced MS, physical therapy can fend off osteoporosis by helping people stand and put weight on their bones; stretch to ease discomfort; and improve breathing and speaking.

Examples of specific goals to achieve during physical therapy might include overcoming a dragging foot that slows you while walking, or walking better in general. You might prioritize relieving pain and spasticity, or improving your range of motion and flexibility. You may want to become more confident in the use of assistive devices.

Results
One 2008 study involving 98 people showed that 70.8 percent of those who received individualized physical therapy treatments showed reduced disability at the end of one year. Of those who did not receive physical therapy, 58.7 percent had experienced increased disability after one year.

Constraints
Most types of insurance will only pay for a limited number of physical therapy appointments.

Some MS symptoms, including fatigue, weakness, pain, bladder incontinence and depression can make it difficult to stay motivated to keep up with physical therapy exercises. Side effects of medication can also interfere.

Depending on where you live and your level of disability, it may be hard to travel to physical therapy visits.