Multiple Sclerosis and Physiotherapy
Daniel Smit | Physiotherapist
Movement, function and participation
Multiple sclerosis (MS) affects the central nervous system and can influence movement, balance, strength, sensation and energy in different ways. Physiotherapy can help you work towards meaningful everyday goals with a plan adapted to your symptoms, abilities and priorities. It does not replace care from your neurologist or change the underlying disease process.
What is multiple sclerosis?
MS is a long-term condition involving inflammation and damage in the brain and spinal cord. The course and effects vary considerably: symptoms may change over time, fluctuate from day to day, or affect different people in different ways. A person’s physiotherapy needs can therefore change over time too.
How MS can affect movement and daily life
MS may affect walking, transfers, balance, coordination, strength, muscle tone and endurance. Some people experience stiffness or spasms, altered sensation, pain, visual changes, bladder or bowel symptoms, or fatigue. Heat, infection, poor sleep and other health factors can also affect how a person feels and moves. Not everyone experiences all of these changes.
How physiotherapy may help
A physiotherapist can assess how MS is affecting the activities that matter to you and develop a practical plan with you. Depending on your goals, this may include:
- Strength and aerobic exercise to support fitness, strength and physical capacity.
- Balance, coordination and walking practice, including turning, stairs and negotiating uneven surfaces.
- Transfers and everyday movement such as getting up from a chair, moving around the home or accessing the community.
- Strategies for stiffness, muscle tightness, positioning and maintaining comfortable movement.
- Fatigue planning, pacing and ways to adapt activity across better and more difficult days.
- Falls risk review, walking-aid advice and recommendations for equipment or home set-up where appropriate.
- A home or community programme that is reviewed as your symptoms, health and goals change.
Exercise with MS
Regular physical activity is encouraged for people with MS. Exercise does not appear to increase the risk of an MS relapse, and it can support fitness, strength, mobility and general health. NICE recommends considering supervised programmes that combine moderate, progressive resistance and aerobic exercise for people with MS who have mobility problems or fatigue [1].
International exercise recommendations describe 150 minutes per week of exercise and/or lifestyle physical activity as a potential longer-term target, while emphasising individual assessment and tailoring for symptoms, ability and other health conditions [2]. This is not a starting requirement or a pass/fail goal. A smaller, manageable amount is a useful beginning, and activity can be built up gradually with advice from your healthcare team.
Making activity manageable
- Choose activities that connect with your goals and can be adjusted on the day.
- Use shorter sessions or planned rests if fatigue makes longer sessions difficult.
- Plan demanding activities for the time of day when you usually have more energy.
- Stay cool where possible. A rise in body temperature can temporarily bring on or worsen familiar MS symptoms for some people; this usually settles as you cool down and is not necessarily a relapse.
- Pause or modify the session if you feel unwell, unusually weak, dizzy, unsafe or significantly more fatigued. Ask your clinician how to adjust your plan.
Fatigue and pacing
MS fatigue can have several contributors, including the condition itself, sleep disruption, pain, mood, medications, infection and reduced conditioning. A physiotherapist can help you identify activity patterns, balance activity with recovery and build exercise progressively. Persistent or changing fatigue is worth discussing with your GP or MS team, particularly if it is new or affecting daily life.
When to seek medical advice
Contact your neurologist, MS nurse or GP about new, significant or persistent symptoms, a marked change in walking or balance, repeated falls, or symptoms that are not settling as expected. Do not assume a new symptom is simply an MS fluctuation; your treating team can help assess possible causes. Call 000 for sudden severe symptoms or an emergency such as facial droop, difficulty speaking, severe weakness, chest pain or serious breathing difficulty.
Working together
Physiotherapy is one part of MS care. With your consent, your physiotherapist can work alongside your neurologist, GP, occupational therapist and other members of your team. Bring your questions, current goals and any relevant walking aid or equipment to an appointment. Let your physiotherapist know what has changed and what helps you feel safe.
How Strides Health Group can help
Strides Health Group provides individualised neurological and disability physiotherapy in Narre Warren. We can discuss your movement goals and whether physiotherapy is suitable for your needs. Contact us on 0411 876 851 or admin@strideshealth.com.au.
Download the multiple sclerosis and physiotherapy handout (PDF)
References and further information
1. National Institute for Health and Care Excellence. Multiple sclerosis in adults: management (NG220). Published 2022. Recommendations on exercise and fatigue. View source
2. Kalb R, Brown TR, Coote S, et al. Exercise and lifestyle physical activity recommendations for people with multiple sclerosis throughout the disease course. Multiple Sclerosis Journal. 2020;26(12):1459-1469. View source
3. MS Plus. Exercise and physiotherapy prescription in multiple sclerosis: best practice resource. View source
This information is general and does not replace individual medical advice or assessment.
Related resources and physiotherapy support
Explore Neurological & Disability physiotherapy in Narre Warren. Selected appointments are available in Nunawading. View appointment and booking information or ask us about your needs.
