Facilitating Positive Movement for clients with Multiple Sclerosis (MS)

Polestar Educator Nichole Anderson PMA-CPT has had the pleasure of working with many clients with MS and has enjoyed the constant learning process it has provided.

What is MS?

The National Multiple Sclerosis Society defines MS as a “disease that involves an immune-mediated process in which an abnormal response of the body’s immune system is directed against the central nervous system (CNS) which includes the brain, spinal cord and optic nerves”. In other words, MS involves a person’s immune system attacking their nerves. In our huge network of nerves, information has to travel quickly to allow us to act spontaneously. Many nerves are covered in myelin which both insulates them and accelerates the rate at which information travels. When the immune system consistently attacks the myelin, it becomes damaged and forms scar tissue (sclerosis), which gives the disease its name. As the disease progresses, the nerve fiber itself can become damaged and destroyed.

What does this mean on a larger scale? When the myelin is scarred or the nerve fiber damaged or destroyed, a large number of nerve impulses from the brain and spinal cord are interrupted and/or distorted. When we consider that all actions in the body and brain are triggered by some sort of nerve impulse, it is understandable that symptoms can vary from person to person.

Who gets MS? 

Without getting too deep into the epidemiology of MS, here are a few facts: 

  • MS is a very difficult disease to diagnose as there are currently no single tests for MS. Because of this challenge, MS is often mis-diagnosed or not diagnosed at all, and most epidemiological statistics on MS are estimates.
  • Most people are diagnosed between the ages of 20 and 50.
  • In general, MS is more common in areas further from the equator, though there are many communities far from the equator that have little to no reported incidences of MS.
  • MS is at least 2-3 times more common in women than men.
  • Genetic factors seem to play a large part in determining who develops MS.
  • As with many diseases, MS is believed to be triggered by an environmental factor, as yet unidentified, in a person who is genetically predisposed to respond. 

What are some common symptoms

Because of the variety of symptoms associated with MS, every client with MS will have different struggles in regards to movement. That being said, there are a few things that are very common in clients with MS:

  • Foot drop : This is where there is weakness in the muscles that dorsi flex the ankle. When this progresses, walking can be dangerous as there is an increased fall risk. 
  • Numbness : This is often one of the earliest and most common symptoms of MS. It can be numbness anywhere in the body, face and extremities. It can cause the affected area to be disconnected and difficult to control. We will discuss later some ways to facilitate movement when certain body parts are numb.
  • Fatigue : In a movement class, this often means being unable to do high repetitions of movements, especially at a high load.
  • Weakness : This can occur from basic deconditioning of muscles that aren’t used due to damage to the nerves that stimulate them. Weakness can also occur when a client with MS has gotten overheated or fatigued.
  • Spasticity : This is when there is an involuntary muscle spasm that can cause prolonged rigidity in the limb that is spasming. 

What are considerations for working with clients diagnosed with MS?

  • Keep it cool! : A warm room can create a challenging movement experience for someone with MS and can even precipitate a flare up.
  • Take frequent breaks : Even if your client feels like they can keep going, it is important to take frequent rests to avoid fatigue.
  • Spot, Spot, Spot! : While this is dependent on ability, because MS frequently causes numbness, it is important to spot any moving apparatus that can slip out of a hand, off a foot and onto your face

Ideas and suggestions for building a session

Warm up with hand and foot stimulation and movement :

  • Foot stimulation and movement : Depending on ability, I either do this for clients or have them do it to themselves. This can include toe pulling, tapping the bottoms of the feet with fingers, vigorous rubbing of the feet and ankles, interlacing fingers with toes and making circles, and active movement of the ankle such as tracing the alphabet in the air with each foot. 
  • Hand stimulation and movement : This is a great time to move an area that we don’t traditionally “exercise” in Pilates. I like to have people move through tight fists to hands stretching wide, followed by “piano fingers” – playing a fake piano slowly and quickly, getting some individual movement in each digit. After getting some movement, I give them some free time to self massage their hands, rubbing them together vigorously, kneading the palm of one hand with the other, and interlacing the fingers and squeezing.

Allow transfers to become a part of the class : Depending on how far the disease has progressed, one of the most challenging parts of a class can be the transfer of one position to another. I like to discuss strategy for making these transitions- gaze, moving from sitting to standing, maybe pausing somewhere in the middle of a transfer to do some movement there, and finally settling into the next position, allowing for time to rest from the transition. This is also great because it is functional and allows clients to have strategies for getting out of sticky situations when they are going through their daily lives.

Explore Breath : Spend time in each class breathing and working on the movement of the diaphragm and ribcage.

Work safely on balance : Use the equipment to your advantage! I often pull the tower bar through to the back and attach the safety strap. This creates a solid bar they can hold to practice heel raises, balancing on one leg, etc. I also find the Core Align to be a great tool for working with clients with MS as it enables reciprocal leg movement with the support of a ladder to hold on to.

Support distant extremities : 

  • Use velcro straps to connect feet to the footbar and hands to dowels if there is too much numbness in the feet or hands to hold on well.
  • Utilize Y-straps to secure both feet and hands when doing work with springs and pulleys.
  • Use therabands to hold thighs together for bridging, pelvic clock and other exercises that require legs to be still. This is only necessary if the client is struggling to connect to their legs.
  • Use your tactile cues to bring awareness to less responsive areas : With your client’s permission, palpate areas that are not connecting well to help them find their feet/hands/legs/etc before going into a movement.

Keep in mind that no two days are alike : What may have been strengths one day may be weaknesses other days. The temperature outside, activities of the day before, stress and other external influences can vastly affect the capabilities of clients with MS from day to day. It is always important to check in, and to allow for progress to be relative.

Connect with Polestar Educator Nichole Anderson on social media @nicholemoves.  Including information from The National MS Society

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Facilitating Positive Movement for clients with Multiple Sclerosis (MS) is written by Polestar Pilates for

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