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#018: Movement limitations in MS – how to best maintain strength, balance and mobility

This episode is dedicated to the movement limitations caused by MS. Multiple sclerosis manifests itself in a wide variety of symptoms and it can also affect your overall mobility. To be mobile you need strength, coordination, balance and you need to be stretched. When one or more of these building blocks are affected, your mobility decreases.

Learn more about how these disorders occur, when they happen, what you can do about them, and what support services are available.

A word of advice right from the start: The best thing you can do is to buck the trend. So instead of limiting yourself and your life, try to exercise all the weak points on a regular basis, but also preventively the areas that are not affected.

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Table of Contents

When do movement limitations occur?

Many people with MS experience movement limitations in one way or another early in their disease. If the disease remains active and is not stopped, these limitations increase over time. As the disease progresses, about 90 percent of people with MS have problems with them. In the process, they can reduce your mobility more and more. Significantly earlier than would normally be the case due to age.

How are movement restrictions manifested?

Often there is an interaction of several components. The muscles become weaker. Mobility decreases due to spasticity. Motor coordination decreases. Balance problems and numbness in the feet make walking difficult. And on top of that, you may experience chronic fatigue. Or you may experience a temporary worsening due to the Uhthoff phenomenon, when your body overheats.

But what does that mean in detail?

Muscle weakness

If you suffer from muscle weakness, you may find it difficult to walk because you can no longer lift your foot properly. Perhaps your arms are also affected and carrying, holding or lifting becomes a problem.

A common manifestation is foot lift weakness, which causes you to drag your foot without assistance. Other patients lift the hip from the weak leg.

Spasticity

If you are affected by spasticity, your muscle tension is increased so much that your muscles cramp, harden and your movements become stiffer. Spasticity in the calf, thigh and trunk muscles in particular makes walking difficult.

Balance disorder

Balance problems can make it massively difficult to play wild tag with your kids, dance, or even walk normally. As they increase many need assistive devices to walk safely. In any case, the balance problems make walking more difficult. Many walk more and more wide-legged to gain a little more security and minimize the risk of falling.

Fine motor skills & tremor

With one or even two numb feet, you lack feedback from the ground and as soon as it becomes uneven, you run the risk of tripping and falling.

With numb hands, meanwhile, it becomes more difficult to grasp and hold on to something properly. You may no longer be able to make targeted movements because your coordination is no longer working properly. You notice this when brushing your teeth, getting dressed or undressed, or when you try to open or close small buttons. In order to succeed in fine motor skills, different muscles have to work together perfectly and this can be made difficult or even prevented by muscle tremors. Writing on the keyboard is then only possible very slowly.

Fatigue & Uhthoff Phenomenon

If you also suffer from fatigue, it is more difficult for you to compensate for disturbances. Because then you are equipped from the outset with less mental and physical energy. And if you do manage to compensate in part, this will probably increase your fatigue.

If your body temperature rises – in summer, when taking a sauna, fever, etc. – your fatigue will increase. – the symptoms intensify even more.

What can you do if you have movement impairments?

In no way should you feel ashamed or withdrawn. It’s not your fault that you have multiple sclerosis. But you can support your body as best you can by exercising regularly, seeking support and using aids where it makes sense.

After all, it’s your life and it should be as enjoyable and carefree as possible.

Occupational therapy and physiotherapy are important services that you can take advantage of. If you also exercise regularly on your own, from strength to stretching to balance and coordination, you can certainly make a big difference. And don’t be discouraged if successes take a little longer to come. The motto is to keep at it. Because here, a lot helps a lot and the more varied, the better.

How can physiotherapy and occupational therapy help?

Physiotherapy

Your physiotherapist can support and guide you in many ways, depending on where your weak points are. Describe exactly your problems, then you can train specifically.

You should strengthen your muscles in any case, regardless of whether you suffer from muscle weakness or can compensate for limitations with muscle strength. This also makes sense as a preventive measure, especially since nowadays only a few people use and train their muscles in everyday life. Especially with a lot of sitting work, it is important to activate the muscles again more.

In the case of spasticity, your physiotherapist can help you to stretch and relax the affected areas. Stretching is an important training element to make your body more flexible again. And this is immediately followed by fascia training.

Balance exercises almost always include strengthening and can improve your coordination. I’ve come across some complicated ones that train the head at the same time. This saves time and increases the training effect. If it is too difficult for you, your therapist can certainly shift down a gear and reduce the complexity.

If necessary, targeted gait training is possible. Depending on your condition, it can be done freely in the room, on a treadmill with a bar on the wall or other aids.

By the way, you should always train in the area where it exerts you, but does not overstrain you. Then it is just right. When it comes to balance, an exercise is too easy if you don’t wobble at all. But it is also too hard if you always fall over immediately.

If you manage to do additional training in your free time, it will increase the training effect. This way you will see progress faster or if you are more affected, you will be able to keep your level better.

Also, if you’re not a competitive athlete and you need that quickness, endurance comes before quickness. It’s more beneficial to be able to run a longer distance at a stretch than to be able to sprint for a short time.

Occupational Therapy

Occupational therapy tries to help you cope with your everyday life. The primary goal is for you to relearn the skills you have lost. If this is not possible, the aim is to find the best possible compensation.

For example, special exercises are used to train your fine motor skills or to specifically stimulate nerves in numb hands or feet.

There are many activities that you can do better again thanks to occupational therapy. This ranges from writing by hand or with the keyboard, to coordination training so that you can grip and hold objects better.

Unhealthy postures should be trained away, your trunk stabilized and your sense of balance trained.

If your hand strength is too low, this can also be trained. The field of action is really very wide and it is worthwhile that you inform yourself more exactly. By the way, occupational therapy is a recognized form of therapy and services prescribed by a doctor are paid for by health insurance.

How can you train strength, balance, coordination and flexibility yourself?

I was able to try therapeutic climbing for the first time during rehab, and it was great. Because it combines a lot of things. You need strength, you have to be well stretched, you have to be able to keep your balance, you have to be able to reach around in a complicated way and you have to be very concentrated. It’s a great thing and I had a lot of fun noticing the small improvements that are possible from time to time.

For strength, you can of course do specific exercises at home or in the gym. Always keep in mind that free exercises with your body weight have the huge advantage that you train all the small muscles as well. With guided exercises on a machine, you usually only need the large muscles.

For balance exercises you can train super with a ball seat cushion and a balance pad seat cushion. Usually you get a few exercises included or ask your physiotherapist for them. Try to train in such a way that you wobble but do not risk any accidents. If the exercises are too easy for you, look around the room with your eyes or move your head, this will increase the difficulty. And if you have great difficulty, stand close to a wall that will give you enough stability if necessary, or place mats on the floor next to you.

Sports like yoga, tai chi or qigong also train your balance and can help you become more relaxed inside, which in turn reduces the stress on your body and psyche. Because stress often makes MS symptoms even worse.

Meditation, progressive muscle relaxation and autogenic training can help you with an unsteady gait or trembling during conscious movements. Try out what suits you best. You may also use a different relaxation training depending on the situation.

What medications are available for movement limitations?

Gait disorders can be treated with medication. You will achieve the greatest success if you also carry out intensive gait training with your therapist.

If spasticity hinders your mobility, antispastic drugs can help you. Consult your neurologist about this.

Sometimes mild spasticity can also help you to continue walking despite weakened muscles. In this case, you do not want to correct the spasticity completely. In any case, you should use physical therapy and, if needed, occupational therapy.

Movement and stimulation cannot be replaced by any medication.

Unfortunately, disturbances in balance and coordination cannot yet be treated with medication.

Which aids can be considered in case of movement restrictions?

The offer is extensive. What is certain is that you should also understand aids as what they are – a means to make your life easier. So please don’t be ashamed, but be grateful for the support they offer you.

There are special splints that make walking easier, forearm supports, canes, crutches, walkers and wheelchairs of various types. The last new thing in this direction is probably the nearly full body neuromodulation suit that is used to relax spastic and tense muscles, activate weak muscles and relieve associated pain.

Keep in mind that all of these aids are designed to prevent you from falling and also to allow you to continue to be mobile and thus participate in your personal and professional life. You are probably also much faster on the road.

For cycling, the choice ranges from e-bikes, to tricycles with or without electronic support, to handbikes. And cycling in the fresh air is great, refreshes your mind and recharges your vitamin D stores.

If your fine motor skills are impaired, you can use a large-area keyboard. The keys are spaced farther apart, which makes typing easier and reduces the number of typos.

Special cutlery that is thicker and weighted can also be helpful if you have problems with coordination or tremor.

Are there any surgical options?

A very strong tremor can in principle be operated. However, surgery should always be the absolute last step. Please think very carefully beforehand, get advice from your neurologist and possibly get a second opinion.

First exhaust all non-invasive methods and aids.

During the operation, a probe is inserted into the corresponding area of the brain, which includes a pacemaker. The impulses sent out ensure that the tremor is reduced or stopped.

And if the movement restrictions remain permanent?

Then don’t be sad and unhappy for too long, but try to live with the symptoms as best you can. Make intensive use of the offer of physiotherapy and occupational therapy to maintain your level and to compensate for the limitations or to quickly come to terms with the possibly necessary aids. Unfortunately, doing nothing will only worsen your situation.

Train and be proud of all that you manage to do, how well you keep at it and how strong you are mentally. And if you are not so strong at the moment, then seek help through a self-help group, exchange with others on a social media platform or within the framework of the offers of your local MS patient organization. Find out which people, exercises and relaxation techniques are good for you.

What is the best prevention against movement impairments?

The best prevention has been shown to be rapid initiation of disease-modifying therapy, the goal of which is to stop or greatly slow MS in you. Three categories of efficacy are available for mild, active and very active progression.

If you are taking a disease-modifying therapy and still have relapses or new lesions on MRI, the recommendation is to move up one efficacy class.

Within each of the three classes, there are several medications that allow for some choice, in terms of the route of administration and the potential side effects. Also, for women of childbearing potential, certain medications are ruled out from the start.

Additionally, you can do a lot with a healthy lifestyle. This includes exercise, nutrition, a stable psyche and being integrated into the social fabric. Low alcohol consumption and abstaining from nicotine are also important factors.

So, you can do a lot, use your possibilities and enjoy your life as much as possible.

Food for thought

Turn on your favorite music at home and dance. Just for you. It doesn’t matter if you just imagine dancing and the movements only take place in your head. This already sends impulses and can make you happy. And the more movement is possible for you, the better. Move your head, your hands, your arms. Tap your feet, take a few steps and sing along. This can make you so happy and trains you by the way. But please don’t get so caught up in joy that you hurt yourself. Everything to the extent that it is possible for you, for you and without the inner critic. Because it is beautiful and dancing makes you happy.

Question for you

Have you had problems with lack of strength, increased stiffness, balance or coordination?

Stay as healthy as possible, well informed and try to make the most of your life,
Nele

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Nele Handwerker

Blogger & Patient Advocate

I show you how to make the best of your life with MS from family to career to hobbies. Thanks to science and research, a lot is possible nowadays.

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