Complications of Being Mobility-Impaired in Multiple Sclerosis

With good care and attention, these problems can be prevented

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Being Mobility Impaired in Multiple Sclerosis
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People with multiple sclerosis (MS) who sit or lie down for long periods of time due to mobility limitations are at a high risk for developing complications like pressure sores, contractures (when a joint becomes frozen), and bone weakness (called osteoporosis).

While unsettling to hear, the upside is that these complications can be prevented with thoughtful care and assistance from loved ones or care partners.

Pressure Sores

Pressure sores (also called bed sores, pressure injuries, or pressure ulcers) are areas of skin breakdown that occur as a result of prolonged pressure. The excessive pressure interrupts blood flow to the skin and the tissue beneath it. Without adequate oxygenation, a sore forms.

Pressure sores form on a "bony" part of the body, most commonly the tailbone, hip, and sacrum, which is the lowest area of your spine above your buttocks. Other examples of places where pressure sores may form include the heel, shoulder blade, inner knee, elbow, and back of the head.

The tricky thing about pressure sores is that they do not start out looking too bad, (often a small area of red skin), but they can quickly progress to being very serious if not treated promptly with pressure removal.

One of the telltale first signs of a pressure sore is a reddened or marooned area of skin that when pressed, stays red, instead of going back to its normal color (this is called a stage one pressure ulcer).

As the pressure sore progresses, the red area of skin may begin to swell, blister, and eventually slough off. The sore can then deepen, extending to the fat layer underneath the skin, and eventually to the muscle, and possibly the bone (this is called a stage four pressure ulcer).

One of the biggest concerns with pressure sores is the risk of infection, which can be life-threatening.

Signs of an infection that warrant medical attention right away include:

  • Fever
  • Foul smell emanating from the sore
  • Increased redness, swelling, or warmth
  • Thick white/yellow/green discharge

Lastly, it's important to mention that besides immobilization, there are other factors that increase a person's risk of developing pressure sores. Some of these include:

  • Poor nutrition
  • Dehydration
  • Having other medical conditions like diabetes or cardiovascular disease
  • Numbness in the areas of the body exposed to the pressure
  • Being obese (extra weight placed on the already stressed skin)
  • Being underweight (more bony parts of the body exposed to pressure)

Prevention

Prevention is key when it comes to pressure sores. This means staying as mobile as possible (if you can), staying hydrated, and eating a nutritious, well-balanced diet—one that is rich in fruits, vegetables, whole grains, and healthy proteins (fatty fish, lean meats, beans, and legumes).

For people who are malnourished, seeing a nutritionist is essential, as she can counsel you (or your loved one) on optimizing protein and calorie intake.

If you are mobility-impaired, you will need a special mattress for your bed and/or cushion for your wheelchair that can help prevent pressure sores (called pressure-relieving support devices).

To ensure you receive the proper devices, it's best to make an appointment with a physiatrist (a rehabilitation doctor who has experience preventing and managing consequences related to immobilization).

If you are not able to maintain any mobility, (you are bed-bound or chair-bound), it's important to change your position at least every two hours. This may require the care of a nursing aid or caretaker.

Contractures

With a decrease in mobility, there is a loss of elasticity in the connective tissues that attach to bones or muscles within a joint. This loss of elasticity leads to tissue stiffness and a restriction in joint range of motion.

In addition to immobility in multiple sclerosis, contractures may occur in muscles (when the muscle shortens in length and tightens). Muscle contractures in MS occur as a result of spasticity—a symptom that develops due to impaired nerve to muscle signaling.

In severe cases of spasticity, a person can develop painful and uncontrollable muscle spasms and rigidity. Unfortunately, with severe spasticity, mobility issues arise, which further increases a person's chance of developing contractures (a vicious cycle).

Prevention

Treating spasticity is paramount to preventing contractures. This entails two main strategies:

  • Physical therapy for engaging in stretching exercises
  • Medications to relax the muscles, like muscle relaxants (for example, baclofen). Botox injections into the affected muscle can also be helpful for reducing spasticity, increasing movement, and thus, preventing contractures.

Rarely, surgery is needed to lengthen the muscle and tendon and improve range of motion.

Bone Weakening

Being mobility-impaired or sedentary due to MS-related problems, like pain or fatigue, can contribute to the development of osteoporosis—a condition of bone weakening and loss that increases a person's risk of bone breaks or fractures.

The deceptive part about osteoporosis is that it's a silent disease, meaning it does not cause any symptoms, like bony pains or joint aches. In fact, often times osteoporosis is not diagnosed until a person experiences a fall and a subsequent fracture, like of the hip, spine, or wrist.

Besides immobility, other risk factors for developing osteoporosis include having a family history, increased age, reaching menopause, having a history of smoking or excessive alcohol use, and being thin. Certain medications, like corticosteroids (which most people with MS have taken at some point) can also increase your risk of developing osteoporosis.

Prevention

Moving and strengthening your bones through weight-bearing exercises is the best way to prevent osteoporosis, and specifically bone breaks.

Before starting a bone-strengthening regimen, it's best to see a physical therapist who has experience working with people with decreased mobility. This way he can devise a weight-bearing exercise program that is right for you, as you will have to consider your other potential MS problems, like muscle weakness, fatigue, and spasticity.

Examples of weight-bearing exercises include tennis, dancing, lifting weights, speed walking, and jogging (whereas swimming and biking are non weight-bearing).

If you are in a wheelchair, do not feel limited—you can try wheelchair yoga, Tai chi, basketball, or track and field. If this is too difficult or not your cup of tea, try arm strengthening exercises while sitting in your wheelchair with a resistance band or dumbbell.

In the end, a little can go a long way, but try working up to thirty minutes a day to optimize your bone health.

In addition to exercise, eating well is important for maintaining strong bones. As with preventing pressure sores, this means eating meals that are rich in fruits, vegetables, and lean proteins.

Calcium is also good for your bones, although check with your doctor about whether or not a calcium supplement is right for you. Some people can obtain adequate calcium from their diet, while others need to take a supplement in addition to upping their calcium-rich food intake.

Lastly, ensuring an adequate vitamin D level is an important component to building strong bones. The good news is that most people with MS have had their vitamin D levels checked and/or are taking a vitamin D supplement. While there are no guidelines about taking vitamin D for people with MS, research is strongly suggestive of its benefit.

A Word From Verywell

While somewhat troubling to read about these complications, the good news is that with proper care and minimization of your risk factors, these problems can be prevented—and while prevention tactics may be exhausting, they do pay off.

Remain proactive in learning about MS and continue seeing your neurologist (and possibly physiatrist and/or physical therapist).

Living with MS is a journey in, so take each day one at a time, be kind to yourself in the down moments, learn what you can, move forward, and treasure all the ups.

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