Physical Therapy for Multiple Sclerosis

Rehab for Movement Problems Caused by MS

If you have multiple sclerosis (MS), then you know how the varied symptoms associated with the disease can affect your ability to function well. Multiple sclerosis may have a profound effect on your ability to sit up, walk, and navigate stairs safely. The symptoms can limit your daily work and recreational activities. Physical therapy for MS may be a useful modality of care, as it may help you maintain strength, flexibility, balance, and overall functional mobility.

Being Mobility Impaired in Multiple Sclerosis

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What is Multiple Sclerosis?

Multiple sclerosis is a disease process where your body's own immune system attacks the nerves of your central nervous system. The protective myelin sheath around the nerves of your brain and spinal cord is worn away, leading to abnormal transmission of nerve signals in your body. (You can think of myelin as insulation around a wire; the insulation keeps the electrons in the wire.)

Most people with MS experiencing periods of worsening symptoms followed by periods of few or no symptoms. This relapsing-remitting pattern of MS is most common and can lead to progressive worsening of function over time.

If you suspect you have MS, you should visit your physician right away. They may refer you to a neurologist, a specialist who is an expert on nervous system disorders.

Movement Impairments Caused by MS

There are several impairments that may cause movement difficulty and loss of function in people with MS. These may include:

  • Pain
  • Spasticity (muscle stiffness or change in muscle tone)
  • Muscle tightness
  • Fatigue
  • Ataxia (lack of muscle control or coordination of voluntary movements)
  • Impaired balance
  • Impaired gait (how you walk)

A physical therapist is a movement specialist who can help decrease the damaging effects of these movement impairments. Therapy may allow you to function more freely and reduce the functional impairments caused by MS.

Other symptoms of MS that may cause additional limitations of your mobility and function include:

  • Short-term memory loss
  • Decreased concentration
  • Depression and anxiety
  • Swallowing difficulty
  • Difficulty with speech
  • Bowel or bladder incontinence
  • Decreased libido (lack of sex drive) or impotence

Multiple sclerosis affects each person differently. Some people experience a few symptoms, while others experience several severe symptoms.

Appropriate treatment of MS typically involves a team of healthcare professionals and rehab specialists like occupational therapists, speech therapists, and physical therapists. All of these people work together to help you remain as able and active as possible for as long as possible.

Physical Therapy Evaluation for MS

During your PT evaluation for MS, your therapist will ask you several questions about your condition. The therapist will ask you when your symptoms first started and how they are changing. You may be asked about which tests you have had to confirm your diagnosis. Questions about previous treatments and how well they worked for you will be asked as well. Your therapist also will review your medications and your past medical and surgical history.

After taking down your medical history, the therapist will then perform various tests and measures to get a baseline of the impairments that may be causing your functional limitations.

Common Areas of Assessment

Common areas of assessment include testing for:

  • Pain
  • Gait
  • Range of motion (the extent of movement in your joints)
  • Spasm and muscle flexibility
  • Neurological ability
  • Strength
  • Endurance
  • Balance

Once your therapist assesses your condition, a rehab plan of care and goals will be established. Typical goals of physical therapy for MS include improving endurance, strength, and mobility while reducing the effects of muscle spasms and loss of movement.

PT Treatments for Multiple Sclerosis

Movement and exercise are the primary PT interventions for people with MS. Exercise has been proven to help people with MS improve mobility, decrease anxiety and depression, and maintain a healthy and independent lifestyle for long periods of time. Since there is no cure for MS, treatment will focus on ongoing PT sessions, or episodes of care, to manage symptoms and slow disease progression.

After a Relapse of MS

You may benefit from working with a physical therapist immediately after a period of worsening MS symptoms. The primary goal of PT after a relapse is to help regain your previous level of function. This may be done through:

  • Stretching
  • Progressive endurance exercise
  • Progressive strengthening exercises
  • Balance exercises
  • Gait training
  • Assessment and modification of assistive devices
  • Being fitted for orthotics (medical devices worn in the shoe) for improved positioning or mobility

Sometimes assistive devices will be temporary and only needed during a relapse. Other times, new devices or orthotics will become permanent tools for your safe mobility. Your therapist can help determine your specific needs during your rehab sessions.

Care should be taken when working on exercises for mobility after a relapse of MS. Exercising with too much intensity may make you feel a bit worse. (Becoming overheated tends to worsen MS symptoms.) Your therapist should make sure you progress gradually with your exercises both at home and in the physical therapy clinic.

PT During Stable Times

During times of remittance of MS, you may benefit from working with a physical therapist to ensure that you are maintaining functional mobility. Your therapist may have you check in with weekly or monthly "booster sessions" of therapy. During these sessions, your home exercises for strength, flexibility, and balance can be checked and progressed as needed.

Your physical therapist can also check your adaptive equipment during stable times, ensuring that it is functioning properly and is the right assistive device for you.

PT Can Be Motivating

Regular meetings with your physical therapist can also serve as motivation since it can be difficult to adhere to an exercise program on your own. Your therapist can serve as someone who holds you accountable for your own rehab and care.

PT During MS Progression

Some people with MS experience disease advancement, during which there is progressive worsening of cognitive function, mobility, and endurance. Physical therapy for progressive MS involves ensuring your mobility needs are met.

A physical therapist can review your adaptive equipment and assistive devices and offer advice to you and your family on how to best use them to improve your functioning. Your family may also participate in rehab, learning how to safely and successfully help you with your functional mobility.

Exercise to help maintain endurance, cardio-respiratory function, strength, and balance may be done during this time. Again, care should be taken to avoid exercising too intensely, as this may worsen your symptoms. You should follow the "two-hour rule," which is you should feel fully recovered within two hours after exercising. If not, you did too much.

How Long Should PT Take?

Since MS is a progressive disease with no known cure, you can expect to need PT throughout your life. PT episodes of care usually run four to six weeks, and you may have regular meetings with your therapist (and other rehab professionals) for booster sessions. Your frequency may vary, so be sure to speak with your physician and rehab practitioners to understand your specific course of care.

A Word From Verywell

If you have multiple sclerosis, you may benefit from working with a physical therapist as part of your rehabilitation team. Your therapist can work with you and your family to ensure that you attain and maintain optimal functional mobility. This effort can make it safe for you to engage in your everyday work and recreational activities.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Dobson R, Giovannoni G. Multiple sclerosis – a reviewEur J Neurol. 2019;26(1):27-40. doi:10.1111/ene.13819

  2. Kalb R, Brown TR, Coote S, et al. Exercise and lifestyle physical activity recommendations for people with multiple sclerosis throughout the disease courseMult Scler. 2020;26(12):1459-1469. doi:10.1177/1352458520915629

  3. Giesser BS. Exercise in the management of persons with multiple sclerosisTher Adv Neurol Disord. 2015;8(3):123-130. doi:10.1177/1756285615576663

  4. Baird JF, Sandroff BM, Motl RW. Therapies for mobility disability in persons with multiple sclerosis. Expert Review of Neurotherapeutics. 2018;18(6):493-502. doi:10.1080/14737175.2018.1478289

By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.