What is multiple sclerosis?

What is multiple sclerosis?

‍

Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system (the brain and spinal cord). It is a major cause of disability in young adults. In MS, the immune system mistakenly attacks the protective covering of nerve fibers called myelin. This immune-mediated damage disrupts the normal flow of electrical impulses along the nerves, resulting in weakness, sensory loss, visual dysfunction and other symptoms. The course of MS is highly variable and unpredictable from person-to-person. Complications of MS may affect multiple body systems and require profound adjustments in lifestyle and expectations for patients and their families, therefore a multidisciplinary approach is necessary to optimize clinical care.

‍

MS may be manifested in multiple forms and courses. There are four major clinical subtypes:

‍

1. Relapsing-Remitting MS 

• Characterized by discrete attacks of neurological deficits (relapse) with either full or partial recovery (remission) in subsequent weeks to months.
• The periods between relapses are characterized by lack of disease progression.
• Affects approximately 85% of patients with MS at diagnosis.

2. Secondary-Progressive MS

• Characterized by initial relapsing-remitting course, followed by a change in clinical course with progression to steady and irreversible decline with or without continued acute attacks.
• Affects approximately 20% of patients with MS.

3. Primary-Progressive MS

• Characterized by disease progression and steady functional decline from onset; patients may experience modest fluctuations in neurological disability but discrete attacks do not occur.
• It is associated with later onset and more equal gender distribution.
• Affects approximately 10% of patients with MS.

4. Progressive-Relapsing MS

• Characterized by steady deterioration in disease from onset (similar to primary-progressive) but with occasional acute attacks
• Intervals between the attacks are characterized by continuing disease progression.
• Affects approximately 5% of patients with MS.

‍

Common symptoms of multiple sclerosis

‍

The symptoms of multiple sclerosis can vary widely depending on the location and extent of nerve damage. Some common symptoms include:

‍

1. Fatigue: Fatigue is a prevalent and most disabling symptom in MS, often described as overwhelming tiredness, exhaustion and weakness that is not relieved by rest. It comes abruptly and typically worsens throughout the day.
2. Motor difficulties: MS can cause muscle weakness, spasticity (abnormal muscle tightness), tremors, poor coordination, and difficulties with balance and walking. These motor symptoms can vary from mild to severe.
3. Sensory disturbances: MS can lead to altered sensations such as numbness, tingling, pins and needles, or a feeling of burning in different parts of the body. Disturbances in position sense are also common, as are lower extremity impairments of vibratory sense.
4. Visual problems: MS can affect vision, causing blurred or double vision, eye pain, or partial loss of vision, usually in one eye at a time.
5. Cognitive changes: MS can impact cognitive functions and are related to the specific location of the lesions. It includes short-term memory, attention, problem-solving, and processing speed as well as planning, sequencing and verbal fluency. Some individuals may experience difficulty with concentration and multitasking.
6. Emotional and mood changes: Affective disorders (mood disorders) are present in most cases and can include changes in mood, feelings, emotional expression, and control. Pseudobulbar affect (involuntary emotional expression disorder) may also occur. It is characterized by sudden and unpredictable episodes of crying, laughing or other emotional display. It may occur when the disease damages the area of the brain that controls normal expression. 
7. Depression: Clinical depression is common in patients with MS. It can occur as a direct result of MS lesions, as a side effect of medications (e.g. corticosteroids, interferon), or as a psychological reaction to the stresses of this unpredictable disease
8. Pain: Patients with MS often experience acute pain characterized by sudden and spontaneous onset. The pains are described as intense, sharp, shooting, electric shock-like, and burning.
9. Bladder and bowel dysfunction: Bladder and bowel dysfunction are common and usually occur when the spinal cord is involved. It can lead to urinary urgency, frequency, hesitancy, or incontinence. Constipation is the most common bowel complaint in MS. 
10. Heat sensitivity: Many individuals with MS experience increased symptoms when exposed to heat or hot weather.

‍

Diagnosing MS typically involves a combination of medical history evaluation, neurological examination, imaging tests (such as magnetic resonance imaging or MRI), and analysis of cerebrospinal fluid. While there is currently no cure for MS, various treatment approaches, including disease-modifying medications, symptom management strategies, physical therapy, and lifestyle modifications, can help manage symptoms, slow disease progression, and improve quality of life for individuals with MS.

‍

What causes multiple sclerosis?

‍

The exact cause of multiple sclerosis is still not fully understood. However, it is believed to involve a combination of genetic, environmental, and immunological factors. Some factors that may contribute to the development of MS include:

‍

1. Autoimmune response: The immune system mistakenly identifies myelin as a foreign substance and launches an immune attack against it, causing inflammation and damage to the myelin sheath.
2. Genetic predisposition: Certain genetic variations increase the risk of developing MS. However, having these genetic factors does not guarantee that a person will develop the disease.
3. Environmental factors: Various environmental factors, such as infections (e.g., Epstein-Barr virus), low vitamin D levels, smoking, and exposure to certain toxins, may play a role in triggering or exacerbating MS in individuals with a genetic predisposition.

‍

How can physical therapy help? 

‍

Physical therapy can play a significant role in the management and treatment of multiple sclerosis (MS). Here are some ways in which physical therapy can help individuals with MS:

‍

1. Mobility and gait training: Physical therapists can work with individuals with MS to improve their mobility and gait. This may involve exercises such as stepping, marching in place, leg, heel and toe raising, and other exercises that are necessary for improving joint mobility and gait patterns.  
2. Strengthening Exercises: Determining an appropriate exercise prescription to improve strength, endurance and performance is challenging and needs to be carefully individualized for each patient with MS. In most cases, strengthening exercises include weight machines, free weights, and resistance bands as tolerated by the patient. Progression is generally slower.
3. Functional training: As the patient’s muscle strength, endurance, performance, balance and coordination improve, a physical therapist can focus on activities of daily living (ADLs) and functional movements to enhance independence and quality of life. They can provide strategies and techniques to facilitate tasks such as getting up from a chair, climbing stairs, or transferring from one surface to another.
4. Balance and coordination exercises: Balance  and coordination impairments are common in MS and can greatly affect the gait and mobility of the patient. Physical therapists can design exercises and activities that target these areas, helping individuals improve their static and dynamic stability, reduce the risk of falls, and enhance overall coordination.
5. Flexibility and range of motion exercises: MS can lead to muscle stiffness and reduced flexibility. Physical therapists can prescribe stretching and range of motion exercises to help maintain or improve joint flexibility, counteract the effects of spasticity (abnormal muscle tightness), and prevent contractures.
6. Fatigue management: Fatigue is a common symptom in MS that can greatly impact daily functioning. Physical therapists can develop tailored exercise programs and energy conservation strategies to manage fatigue and optimize energy levels. These can include modifying the task or modifying the environment to ensure successful completion of daily activities. They can also teach individuals activity pacing techniques, which refers to the balancing of activity with rest periods. 
7. Breathing exercises: MS can affect respiratory muscles and lung function, leading to breathing difficulties. Physical therapists can teach breathing exercises and techniques to improve respiratory muscle strength and efficiency.
8. Aerobic Conditioning: Aerobic conditioning exercises with low to moderate intensity are usually prescribed by the physical therapists for patients with MS, to enhance cardiovascular and pulmonary fitness as well their overall well-being.
9. Pain management: Physical therapists can employ various pain management modalities and techniques, such as manual therapy, massage, heat/cold therapy, ultrasound and electrical stimulation, to help individuals with MS manage pain symptoms.
10. Assistive device assessment: Physical therapists can evaluate the need for assistive devices, such as canes, walkers, or orthotic devices, to improve mobility and safety. They can provide recommendations, fit the devices properly, and teach individuals how to use them safely and effectively.
11. Education and self-management: Patient education is particularly important because the overall success of the rehabilitation program is influenced by the individual’s understanding of the condition and its treatment process. Physical therapists can educate individuals with MS about their condition, symptom management strategies, and ways to adapt their lifestyle and environment to accommodate their specific needs. They can also provide guidance on safe home exercises and strategies for maintaining physical well-being.

‍

It's important for individuals with MS to work with a physical therapist who has experience and expertise in managing the unique challenges associated with the condition. The physical therapy plan should be individualized based on the person's specific symptoms, functional limitations, and goals, taking into consideration the fluctuating nature of MS. Collaborating with a multidisciplinary healthcare team can further optimize the management of MS and improve overall outcomes.

Trust PeteHealth for multiple sclerosis treatment

Looking for a physical therapist to help you manage and treat multiple sclerosis? PeteHealth is the trusted physical therapy solution that you can access on your schedule, bringing you the care you need wherever you need it – including your home or office. Our licensed physical therapists are at the top of their profession, and we accept most insurance carriers.

‍

Finally – the all-in-one, professional, convenient approach to physical therapy that you deserve with PeteHealth.

‍