Living with multiple sclerosis as a woman comes with unique physical, emotional, and hormonal challenges—especially during life transitions like pregnancy, postpartum, or menopause. But what if there were a community that truly understood these needs? In this episode, I speak with Dr. Irina Fedulow Plante, a neurologic physical therapist and the founder of NeuroMamaTribe, an initiative that combines science, creativity, and heartfelt support for women with MS.
From her clinical insights into movement therapy—including ballet, yoga, and hippotherapy—to practical advice on managing symptom fluctuations during the menstrual cycle or postpartum, Irina brings a refreshing, empowering perspective to the MS care landscape.
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More InformationTable of Contents
Introduction & Personal Journey
Can you tell us a little about your background and what drew you to specialize in MS rehabilitation?
I’m a Doctor of Physical Therapy and a Board-Certifi
I’ve been practicing as a physical therapist for about 10 years with my board certification in neurologic physical therapy. I obtained my doctorate in physical therapy from the University of New England in Portland, Maine and completed my residency in neurological physical therapy at the Kaiser Neurologic Physical Therapy Residency in Redwood City, California. Soon after, I started working at the University of California, San Francisco (UCSF) in the outpatient neurorehabilitation setting. A few years later, my husband and I decided to lay down our roots in the Tahoe area where we are raising our children and I started my own physical therapy practice during the pandemic.
I was drawn to specializing in treating individuals with Multiple Sclerosis (MS) several years ago while in school and learning how to personalize interventions given the complexity and varying presentations of MS. Many of the patients I had experienced issues with diagnoses and understanding their symptoms at the beginning of their journey and I wanted to help optimize their quality of life as much as possible.
ed Neurologic Clinical Specialist. I’ve always been drawn to working with neurological conditions. My passion for helping women with MS emerged from noticing a lack of tailored support in the rehab world. Many women I encountered felt unseen, and their needs—especially during hormonal transitions—weren’t fully addressed. That motivated me to create a more holistic approach to care.
What inspired you to start NeuroMamaTribe, and what makes it unique for women living with MS?
NeuroMamaTribe was created during the pandemic. A former patient of mine who has MS reached out and asked if I knew of clinicians that she can see close to her area. As we were catching up, we learned we both had babies within a few months of each other and navigating motherhood during a challenging time. She asked if I would be interested in treating her virtually and as time went on, it became apparent the gaps in the medical care for women with MS in regards to family planning, pregnancy and postpartum. This inspired NeuroMamaTribe so more women with MS can be educated and empowered when planning and starting a family.
NeuroMamaTribe is unique because the services and resources focus on current research principles, clinical practice and experience and feedback from women with MS. The services focus on every aspect of the woman with MS with a strong emphasis on hormones and goals. Women with MS were told just a few decades ago that starting a family is unrealistic, but with what we know about MS through research and medical advancements, this couldn’t be farther from the truth and NeuroMamaTribe wants to help change this outdated perspective.
Movement & MS
What are some common misconceptions about exercising with MS?
One of the biggest misconceptions is having to achieve a certain amount of exercise weekly, an older recommendation that can still be found all over the internet is exercising at moderate intensity for at least 120-130 minutes weekly with the incorporation of flexibility and strength training. This is problematic because individuals with MS often experience fatigue, which can impact the ability to exercise at that level causing frustration, burn out and less motivation to exercise.
For women with MS, there are no recommendations on how to modify exercise or activity levels when experiencing hormonal changes such as the menstrual cycle or treatments for family planning, which can create a lot of confusion and issues with exercising when experiencing symptoms related to hormones. It’s vital to understand how to adapt and there is less guidance on how to do this.
There is a large misconception that exercise needs to be done once or twice a day for bigger chunks. Breaking down exercises throughout the day and staying active is much more beneficial overall and research continues to show that quality over quantity is far better when it comes to exercising.
Lastly, there is this unrealistic expectation that you need to exercise every day to make gains; by trying to do too much constantly contributes to injury, boredom and burnout. It’s incredibly important to take rest breaks, vary your exercise routine and maintain consistency. It’s far better to exercise two to three days per week for six weeks versus exercising six days in a row and then not exercising for three weeks.
You integrate ballet, hippotherapy, yoga, and outdoor activities—how do these creative approaches benefit MS patients physically and emotionally?
All these interventions create a strong sense of empowerment to do things creatively and outside the box. Often after receiving a diagnosis such as MS, there can be a lot of fear in regards to staying active and with preparations and adaptations, many sports and activities are possible. Many women with MS that are part of NeuroMamaTribe say they always wanted to be ballerinas and by doing ballet as adults helps them achieve a childhood dream creating a sense of nostalgia and joy.
Hippotherapy is the utilization of the equine’s movement to achieve functional gains. Having the experience of interacting with a 1,ooo lb animal that mirror our emotions is humbling and powerful. By learning how to adapt your body mechanics and communication skills boosts neuroplasticity in a meaningful and incredible way.
There are many forms of yoga and it’s been a wonderful experience learning and teaching the different types of yoga for individuals with MS. By educating individuals on how to adapt yoga principles depending on how they are feeling or what symptoms they are experiencing is an amazing to create a deeper sense of body awareness and calm the nervous system.
Lastly, getting outdoors is often intimidating given its element of unpredictability. There are many ways to safely enjoy the outdoors with goal setting, planning and preparation. Being in nature has been shown to reduce stress and inflammation, improve body functioning among many other benefits.
All these interventions have the potential to engage our nervous systems in a meaningful way and challenge individuals to be present in the moment, which is critical for enhancing neuroplasticity.
For someone newly diagnosed or feeling overwhelmed, what’s one simple movement or routine you’d recommend starting with?
I would recommend reflecting on your goals and find something that brings you joy. If the movement or routine feels like a chore, there is little chance that you will find consistency with it. Find something that incorporates functionality, practicality and an element of fun to stay motivated and inspired.
Hormones, Life Stages & MS
How do hormonal changes—like menstruation, pregnancy, or menopause—impact MS symptoms or disease progression?
Many women with MS report an increase in symptoms during menstruation and fluctuations throughout their cycle and this is typically the same in menopause, which can create confusion as to which symptoms are hormonal or more MS in nature. Pregnancy is typically a stage where women with MS report a remarkable reduction in symptoms and researchers believe this occurs because of the immunological changes that happen with a developing fetus.
What are some practical ways women with MS can manage symptom fluctuations during hormonal transitions?
Some practical ways include tracking symptoms for at least 3-6 months to identify trends and correlations and see what interventions help, incorporate strength training that is ideal for maintaining bone density and reduce inflammation, incorporate calming nervous system activities such as mindfulness, grounding and yoga and figure out strategies to optimize sleep.
What should women with MS know about family planning, pregnancy, and postpartum care from a physical therapy perspective?
First, women with MS should look for specialists that incorporate neurorehabilitation and women’s health principles. Components of the physical plan of care should include, but not limited to depending on the individual and goals are pelvic floor rehabilitation, functional exercises that align with navigating motherhood, strategies to calm the nervous system and how to modify activities if an exacerbation occurs. Preparation and planning is everything!
Integrative Wellness & Mental Health
How do you incorporate wellness practices like breathwork, mindfulness, or body awareness into physical therapy?
I always start with an introduction to body awareness, breathwork and strategies to be more present during physical therapy sessions. I discuss with my client ways to gradually integrate these practices into their daily routine and problem solve to make sure it’s the right approach for that individual. There is a lot of practicing, handouts and reminders sent (if the client would like) during the week.
Why is it important to look beyond just the physical symptoms and take a whole-person approach in MS care?
Every individual with MS that I’ve worked with has a very different story and presentation, so it’s important to address all aspects to see what works for that individual. If a cookie-cutter approach is given, there are so many things are missed that could contribute positively to the quality of life for that individual.
Empowerment, Community & Support
How can women with MS recognize when they need professional rehab support versus doing exercises at home?
It’s important to seek professional rehab help and support if women with MS experience a medical change, such as an exacerbation, sustain an injury or see no improvements with their current routine. Also, ff there is a specific goal in mind, it’s better and safer to get the guidance from a professional as well.
Can you share what resources or types of support NeuroMamaTribe offers for women at different life stages?
NeuroMamatribe offers physical therapy services in California and wellness/educational consultations that can be accessed by anyone, anywhere. There are some written projects and virtual offerings that will be up on the website soon! There are also educational classes that are being recorded as well. Stay tuned!
Quickfire Q&A Session
Complete the sentence: "For me, multiple sclerosis is...."
This was a tough one because I cannot say enough amazing things about the women with MS that I work with every day. I think of “incredibly strong individuals” that show up every day for themselves, their families and communities and continue to learn how to adapt and shift despite obstacles.
What development would you like to see in the field of multiple sclerosis in the next 5 years?
I would like to see more focus on disease modifying therapies and learning how they improve overall quality life and daily function. Also, what holistic strategies to reduce inflammation within the nervous system can be implemented more into standard care.
Farewell
What message of hope or encouragement would you like to share with ndividuals living with MS?
We are continuing to learn all the time how incredible and adaptable our brains and nervous systems are; there is still a lot we don’t know, so always be curious to learn more about your own and how to adapt and challenge yourself in ways that are meaningful and involve an element of fun.
How and where can interested people follow your activities?
You can connect with me on Instagram at @neuromamatribe, and find resources on my website neuromamatribe.com. I also offer a newsletter where I share tools, stories, and upcoming events.
Thank you Irina for all the great knowledge and inspiration you are offering so women with MS can find their individual way to become more active and excercise regularly.
See you soon and try to make the best out of your life,
Nele
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