Physical Therapy in the Treatment of Multiple Sclerosis
By Betsy Perry

Current statistics show multiple sclerosis (MS) affects approximately 400,000 people in the U.S. and 2.5 million people worldwide. It is one of many progressive neurological diseases in which the precise causes are unknown. We now know, however, that MS is an autoimmune disease in which the body attacks the myelin sheath protecting the nerve cells of the brain, spinal cord and optic nerves.

There are similar patterns seen in those with the disease.  First, it occurs more often in regions farther from the equator (above 40° latitude), and is possibly correlated with decreased levels of vitamin D, which the body makes when it’s exposed to sunlight. Therefore, MS is more common in Caucasians of Northern European ancestry than in other ethnic groups.

Second, having a close relative – for example, a parent or sibling -- increases the risk of developing MS, reinforcing the theory that people have a genetic predisposition to react to something in the environment, such as a virus or toxin, that can trigger an autoimmune response.

Third, the incidence of MS is two to three times greater in women than in men, suggesting hormones may play a role in the disease.

Finally, most people are diagnosed with MS between the ages of 20 and 50. 

Treatment of MS can be difficult as no two people have the same symptoms and each person’s symptoms fluctuate over time. The most common symptoms of MS are fatigue; numbness; problems with gait, balance and coordination; bowel or bladder dysfunction; vision problems; dizziness or vertigo; sexual dysfunction; pain; cognitive difficulties; emotional changes; depression; and spasticity.
 
To be diagnosed with MS, a person must meet three criteria: First, show evidence of myelin damage in two separate areas of the central nervous system. Second, the damage must have occurred at least one month apart. Finally, all other diagnoses must be ruled out. This is done through an extensive medical history, a neurological exam and diagnostic tests such as brain and spine MRIs, a visual evoked potential (VEP) exam, a spinal tap and blood tests. 

There are four different disease courses of MS, two of the most common to be discussed here. About 85% of patients are initially diagnosed with relapsing remitting MS, an acute attack followed by complete recovery lasting at least 30 days. The goal of physical therapy is to help the person return to his or her baseline functioning during this course of MS. Half of patients with MS progress over time to secondary-progressive MS, in which the disease worsens steadily with or without minor remissions. Physical therapy treatments are based on the patient’s goals, which often involve pain control, improving flexibility and strength, reduction of spasticity, improved gait and balance, transfer training and possibly acquiring specific mobility devices.

It’s especially important for people with MS to avoid overheating the core body temperature during exercise and pace themselves to avoid fatigue. Increased core body temperature affects the nervous system’s ability to conduct nerve impulses to the muscles, resulting in a worsening of symptoms and mobility. Muscles also tend to fatigue more quickly and unpredictably, so pacing and knowing the body’s signals of fatigue are especially important.  As physical therapist Patricia G. Provance states in an article, “Physical Therapy in MS Rehab,” “all exercises and activity should be a challenge but never a struggle.”

I have worked with many people with this unpredictable disease over the past few years, and I can attest that almost every one noticed some type of improvement or least avoided decline in their functional status when they exercised regularly and correctly. That is what the physical therapist is there to do: help get you on the right path and encourage you along the way in fighting the effects of the disease.

Betsy Perry, MAPT, CSCS, is owner of Perry Physical Therapy in Palm Desert. She has worked with the Coachella Valley’s ACT for MS organization since 2007 and feels privileged to work with its clients. Call her at 760-773-2179 or e-mail her at perrypt@dc.rr.com with any questions or to make an appointment.