While Multiple Sclerosis (MS) presents differently for different people, 91% of those diagnosed with MS report having difficulty walking and difficulty with movements of the body. Seeing statistics that high, it is important to know about Physical Therapy (PT) and know that there IS help out there for you!
The American Physical Therapy Association defines Physical Therapists (PT) as “highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility - in many cases without expensive surgery and often reducing the need for long-term use of prescription medications and their side effects. Physical therapists can teach patients how to prevent or manage their condition so that they will achieve long-term health benefits.”
Please, read that definition again! You deserve and need highly educated professionals on your journey and you need to be shown how to reduce your pain and/or restore mobility with more natural alternatives instead of only relying on medication or feeling as if there are no options. That is what the power of the right Physical Therapist can do for you.
PT is a vital part of your healing in order to strengthen, reduce pain, improve balance and/or learn how to move your body in ways that are nourishing. Since MS affects myelin, the effectiveness of the nervous system is reduced making it difficult to produce quick and efficient movements. This can create a change in your balance, how you walk, how you experience pain, muscle spasms, memory, breathing, swallowing, your speech and other bodily functions including your urinary and bowel system function. It can feel overwhelming to experience these diffuse and vague ailments that seem impossible to escape, but please know that Physical Therapy is a way for you to safely and effectively work with your nervous system so you can function at the highest level possible, and it IS possible!
As a physical therapist, I often see clients with MS that make one (or several) “common mistakes” when it comes to caring for their body:
1. Pushing through the pain or weakness and doing activities anyway
With MS, it is often a forgotten or overlooked concept to LISTEN to your body and work with it, as opposed to pushing through and working against it. When you can listen and hear what your body is telling you, you will feel the pain, weakness or stress that might be coming on like a wave (but before it gets so bad and that wave crashes on you). When you can sense this, then you can start working WITH your body, not against it. For those with MS, if you work against the body it often will lead to side effects later such as more pain, experiencing a fall or intense fatigue, to mention a few. For example, say that you used to be able to walk 5 miles and you want to keep doing that. If you are present and listening to the messages of your body, you might experience increased pain/muscle tightness/worsening balance at mile 3. You can then make a more holistic decision in that moment! You might decide “ok that is enough for today because I am going on a shopping trip tomorrow and I need to feel good for that” or you might choose to change your speed or take a rest break before continuing. All of a sudden, you will have more choices to care for yourself than just dealing with the consequences of pushing through, which might create stress or frustration later. Know also, that with MS when you “stir the pot” on your symptoms, it typically takes longer to recover than someone with a nervous system that does not have MS.
2. Avoiding certain tasks, or physical activities that used to be enjoyed.
It might seem surprising, especially after the last paragraph, for a Physical Therapist to tell you to find ways to enjoy things you love to do. See, life is all about doing what you enjoy! When MS takes hold of your body, it can seem that it is out of your control and you must stop doing some of the things you love. Perhaps worry or fear has stopped you- “I might fall and hurt myself.” “I might look weird or different.” “I used to do it this way, and if I can’t do it like that, then what is the use of trying?” Physical Therapists are trained to help people adapt, modify and creatively solve movement problems, so someone can continue to enjoy life. For example, I had a patient who had a daughter who was a senior in High School. She wanted nothing more than to walk into the gym and stand, on her own, to clap and celebrate her daughter walking across the stage to receive her diploma. She couldn’t walk though, and standing on her own was a challenge at that time. So she assumed that her dream would never happen. With the right PT training and adaptive equipment, she was able to reach her goal in a way that she was proud of. Anything is possible!
With a trained and supportive PT by your side, you can set goals and return to activities that bring you joy or maintain the ability to keep doing activities you enjoy.
3. Not seeking the expertise of a Physical Therapist, and starting workout programs that are not specifically and carefully designed for YOUR body and present ability.
Sometimes your doctor might not recommend PT, sometimes you might have been referred to PT, but you don’t see how it can help you, so you never make an appointment. Sometimes you feel there are enough resources on the internet or local gym to just start working out and sometimes you feel you aren’t “that bad off” yet and will just wait and conserve the time when you really need it. Whatever the reason, please know you will be doing yourself a favor to learn how to safely and effectively strengthen, stretch and move your body with the aid of a PT before you start an independent (or group) exercise program. This is regardless of where you are physically. What works for someone else might not work for you. You are unique and you need to be evaluated properly and treated with care before you fly on your own. I stress this point because if you injure yourself or create more pain or make the symptoms worsen, it can take longer to recover. It should not be an option, to not love and care for your body. Treat it with respect, seek professional guidance, and it will support you more easily.
There are so many considerations that physical therapists take into account as they start to work with you such as assessing core stability of musculature, joint integrity, posture, balance, mental clarity, shoe choice, using the pool versus weighted bands versus free weights for strengthening, as well as evaluating pain associated with movements. Let me make it clear, with MS, the concept of “no pain, no gain” should not apply. It can lead to more bodily issues and more symptoms. Instead a gradual, but challenging, approach is needed to keep pain as low as possible to ensure symptoms do not increase and new symptoms don’t suddenly arise.
Here are some tips that I believe are vital to successfully finding the right physical therapist, and thus the safest, most effective, exercise routine, to assist you in reducing your most bothersome symptoms and/or regaining function.
Choose a Physical Therapist:
1. Who is able to work with you one on one, at least half of the session.
The landscape of healthcare has changed, which sometimes makes it difficult to spend a vast amount of individual time with patients. The complexities that need to be considered when providing exceptional rehab care requires (in my humble opinion!) that the PT work with you for at least some of your expected treatment time uninterrupted.
2. Who can (and is WILLING to) educate you about living with MS.
Education is known to reduce worries and fears around anything. The more we know, the more calm we can be in a given situation. You owe it to yourself to be around a Physical Therapist who can help you think outside the box and to maintain and improve your quality of life. The power of education will enhance your quality of life.
3. Who has a Neurologic Specialist Certification and has significant experience working with MS patients.
You wouldn’t tolerate going to see a knee surgeon when you really need eye surgery! So it is OK to seek out a Physical Therapist who is a specialist in neurologic conditions. PT’s have the option to sit for advanced Board Certifications! Some companies encourage this, and will help their PT’s educate and sit for the exam. Other PT’s do not feel the need to get the extra certification BUT they still specialize and spend a lot of time learning about neurological disorders and working with many patients who have similar needs. These are the types of PT’s you want to be on your team.
4. Who has knowledge of hands-on manual therapy skills that can address issues associated with MS
Some of the types of manual therapy techniques are: Proprioceptive Neuromuscular Facilitation (PNF), Myofascial Release techniques, Soft Tissue Mobilization, joint mobilizations and manipulations, Craniosacral technique, Ortho-Bionomy techniques, Traction, Muscle Energy Techniques (MET), Strain-Counterstrain techniques, and many others…
Other therapy tips that you should be aware of:
1. There IS such a thing as a Pelvic Floor Physical Therapist (also referred to as a Women’s Health PT or a Men’s Health PT)!
If you suffer from pelvic pain, incontinence/leaking of urine or feces or urgently needing to use the bathroom, have constipation, or issues with intercourse there IS therapy to help you!
2. Physical Therapy duration is dictated by achieving goals.
It is not unusual to go for a prescribed period of time, determined by your PT, and then you will be discharged. This does not mean you “failed” or “there is no hope.” Instead it is an opportunity for the next phase! Make sure you have your home exercise program, have found a gym, workout buddy, personal trainer or online safe program set in place to continue to make gains.
3. There are many different types, and focuses of Physical Therapy. If one type does not work for you, there are other options to try!
For example, you can find PT’s in hospitals, in nursing homes and rehabilitation centers (short stays in a nursing home like setting), home health (if you are found to be home bound then a PT can come to your home), outpatient clinics (some are large facilities within hospitals, and others are small and privately owned). So, no matter what stage of mobility you are currently dealing with, there is usually a PT to help you.
Some people do well with a “land based” therapy approach while others need the gentle buoyancy of the water in aquatic therapy. Some therapists and offices focus on using machinery for regaining balance, gait and strength. Other therapists focus on a core and body weight strengthening and stretching approach. Sometimes you might need someone who helps with custom orthotics and helping you find the best assistive device. Other times your focus is more on cardiovascular endurance and breathing training.
Bottom line, the more questions you ask and the more you share your top 1-3 current needs, then you can be directed to the best type of therapy for you.
4. There is also help for vision, memory difficulties, and speech and swallowing difficulties
Occupational Therapy and Speech Therapy can assist with these symptoms. These are also important members of your wellness team that can help you! Therapy for your memory?! How cool is that. *A neurologically trained PT will also have you sometimes do movements or balance exercises and also working on your memory.
Now the most important aspect of finding a physical therapist (or occupational or speech therapist) is making sure the provider is: competent and skilled (of course!), kind, listens to you, and you look forward to working with them. Someone you feel safe enough to let them know if a treatment approach did not work for you, or hurt, and you need to adjust it. If you cannot communicate effectively and work together to find solutions to complex situations, it is much harder to heal and manage your symptoms. So above all else, as you seek the assistance of a therapist, make sure you enjoy spending time with them and trust them! Your body will thank you!
Physical Therapy can be vast and can help with so many of your symptoms. If you live in a city or area with lots of choices for PT’s know that it is OK to ask to speak to a PT before you schedule an initial appointment so you can ask questions and determine if it will be a good fit. Also know that if that particular therapist was not the best fit for you, don’t give up! Try another PT to find the one you are comfortable with.
When living with MS it is important to treat your body and mind with kindness and compassion, so that it can support your daily activities in an easier way. As I tell so many of my MS patients, expect that every once in a while you will need to come back to PT for a “tune up!” Just like our cars need a tune up, you might find that your body also needs a refresher course, is ready for more of a challenge or you have experienced a setback. Having a professional, caring PT on your team is vital to living the best, most fulfilling life possible.
Dr. Sara Smith, DPT, RYT-200, CHC
Sara uses long-distance Transformational Coaching to uncover CORE habits that have been creating stress, pain, and dysfunction in any key areas of life. Sara has combined coaching with her expertise as a pelvic floor and chronic pain management Physical Therapist as well as a yoga and mindfulness teacher. Using her simplistic and loving approach, these habits can finally be released creating joyous, healthy, abundant lifestyles for her clients.
Sara Smith Wellness, LLC.
Find her on Facebook: Sara Smith Wellness
“Physical Therapist's Guide to Multiple Sclerosis” January 30, 2014 http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=92d87e05-dcb7-4cae-9c0a-4fcbde1b1c02
“Who Are Physical Therapists” November 24, 2015 http://www.apta.org/AboutPTs/