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Multiple sclerosis (MS) is a chronic condition affecting the brain and spinal cord, where the immune system attacks the myelin sheath around nerves. This leads to impaired communication between the brain and body, with symptoms ranging from fatigue and muscle weakness to cognitive decline. MS commonly progresses in distinct patterns, with variations in severity and relapsing or steady symptom progression. While no cure exists, treatments aim to reduce symptoms and slow progression, with physiotherapy and exercise playing a critical role in managing mobility, strength, and function.

Signs & Symptoms

Symptoms vary based on nerve damage location, commonly including:

  • Fatigue: Persistent and often disabling, fatigue is worsened by physical and mental exertion.
  • Muscle weakness and spasticity: Weakness, particularly in the legs, can lead to difficulty walking, while spasticity (muscle stiffness) affects flexibility and comfort.
  • Numbness or tingling: Sensory disturbances, often in limbs and face, are common early symptoms.
  • Visual problems: Blurred or double vision, and even temporary blindness, can result from optic nerve inflammation.
  • Balance and coordination issues: Tremors, balance issues, and loss of coordination increase the risk of falls.
  • Cognitive challenges: Issues with memory, focus, and processing speed impact daily activities.
  • Bladder and bowel dysfunction: Frequent urination, urgency, and constipation are common.

Causes and Contributing Factors

MS appears to be caused by a combination of genetic and environmental factors:

  • Genetics: While not directly inherited, MS is more likely in people with a family history of the condition.
  • Geographical and vitamin D factors: MS is more common in temperate regions, possibly linked to lower vitamin D exposure due to reduced sunlight.
  • Viral infections: Certain viruses, like Epstein-Barr, are associated with an increased MS risk.
  • Smoking and obesity: Both contribute to the risk and severity of MS, impacting disease progression.

Types of MS

MS is categorised by its progression pattern, including several distinct types:

Relapsing-Remitting MS (RRMS): The most common type, affecting 70–80% of people with MS initially. It involves new or recurrent neurological symptoms, lasting 24–48 hours and developing over days to weeks, followed by partial or complete recovery.
Primary Progressive MS (PPMS): Found in 15–20% of cases, PPMS is marked by a gradual, steady decline from onset without remissions.
Secondary Progressive MS (SPMS): Typically follows RRMS and includes a gradual, ongoing decline in neurological function. Relapses may occur but are not consistent.
Progressive-Relapsing MS (PRMS): The rarest form (5%), featuring steady progression with occasional acute relapses.

Prognosis

MS prognosis is highly individualised. Some individuals experience only mild symptoms, while others face increasing disability. With advancing treatments, many with MS maintain a good quality of life, although fatigue, cognitive issues, and mobility challenges often increase over time. Early and consistent treatment can improve long-term function and maintain independence.

Physiotherapy and Rehabilitation

Physiotherapy is crucial in managing MS, helping reduce symptoms, improve strength and flexibility, and maintain independence. Exercise not only enhances physical strength but also positively impacts mood, concentration, and overall well-being. It supports brain health and cardiovascular function, helping to reduce fatigue and the risk of other chronic health conditions. Key benefits include:

  • Strength Training: Increases muscle endurance and strength, especially in the legs and core.
  • Stretching and Flexibility: Reduces spasticity, enhancing mobility and daily function.
  • Balance and Coordination: Exercises improve stability and prevent falls, essential for safe movement.
  • Gait Training: Improves walking mechanics, and physiotherapists may suggest aids like canes or walkers to improve safety.
  • Aquatic Therapy: Water exercises ease movement while enhancing flexibility and cardiovascular fitness.
  • Home Exercise Programs: Tailored home routines support ongoing strength, mobility, and fatigue management.

Types of Exercise Recommended for MS

  1. Aerobic Exercise: Moderate to vigorous activities, such as walking or cycling, improve cardiovascular fitness and reduce fatigue. Individuals with greater fitness levels may include more intense activities, like running.
  2. Strength Training: Strengthening exercises using weights or resistance bands, performed 2–3 times per week, help build muscle endurance and stability.
  3. Balance and Flexibility: Balance exercises reduce the risk of falls and improve posture, while flexibility exercises, like stretching or yoga, enhance range of motion and reduce muscle spasms.
  4. Special Considerations for Fatigue and Heat Sensitivity: Exercise can help manage fatigue long-term, though it’s best to build up gradually. Heat sensitivity is common, so strategies like hydration, cool clothing, and shaded or indoor exercises are helpful.

Addressing Barriers to Exercise

MS-related fatigue, heat sensitivity, and mobility limitations can deter exercise. Physiotherapists can offer personalised strategies to help manage fatigue, work around heat sensitivity, and recommend appropriate exercises to fit individual needs and abilities, making movement achievable for all levels of MS.

Other Treatment Options

Medications

To manage MS comprehensively, medication may be included alongside physiotherapy to reduce relapse frequency and control symptoms:

  • Disease-modifying therapies (DMTs): These medications, including interferon beta and ocrelizumab, reduce relapse frequency and disease activity, particularly in relapsing forms of MS.
  • Steroids: Used to manage acute relapses, corticosteroids reduce inflammation and hasten recovery.
  • Symptom-specific treatments: Muscle relaxants for spasticity, pain relievers, and antidepressants may be prescribed for individual symptom management.

Information is provided for educational purposes only. Always consult your physiotherapist or other health professional.

References

Binshalan, T., Nair, K. P. S., & McNeill, A. (2022). The Effectiveness of Physiotherapy Interventions for Mobility in Severe Multiple Sclerosis: A Systematic Review and Meta-Analysis. Multiple sclerosis international, 2022, 2357785. https://doi.org/10.1155/2022/2357785

Grygorcewicz, B., Chajęcka-Wierzchowska, W., & Nawrotek, P. (2016). The application of bacteriophages and bacteriophage-derived endolysins for treatment of bacterial infections. Asian Pacific Journal of Tropical Biomedicine, 6(4), 312–318. https://doi.org/10.1016/j.apjtb.2016.03.009

Tafti D, Ehsan M, Xixis KL. Multiple Sclerosis. [Updated 2024 Mar 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499849/

Warutkar, V., Gulrandhe, P., Morghade, S., Krishna Kovela, R., & Qureshi, M. I. (2022). Physiotherapy for Multiple Sclerosis Patients From Early to Transition Phase: A Scoping Review. Cureus, 14(10), e30779. https://doi.org/10.7759/cureus.30779