However, that doesn’t mean that people who have MS need to give up on being able to get around on their own. Indeed, experts suggest many ways that people with MS can work to maintain their mobility for as long as possible. “Difficulty walking is among the most common of the symptoms that first bring a person with undiagnosed MS to the clinic,” notes Alexius E.G. Sandoval, MD, medical director of the multiple sclerosis rehabilitation program at Johns Hopkins in Baltimore. “It’s often the first noticeable symptom, and while we still can’t cure or reverse MS, we can help maintain the function that you do have, use compensatory strategies, and keep you moving for as long as possible,” Dr. Sandoval says. Here are eight things you can try to stay mobile with multiple sclerosis:
1. Physical Therapy
In physical therapy (PT), therapists evaluate the body’s ability to move and function, then look for strategies to strengthen or compensate for weaknesses or other problems. Valerie Block, adjunct instructor of physical therapy at the University of California in San Francisco’s Weill Institute for Neurosciences, says physical therapy for a person with MS might include a program of exercises and stretches, as well as training in using walking aids like canes, crutches, scooters, or wheelchairs. The idea, she says, is to keep you safe while restoring confidence in your legs and balance. RELATED: Rehabilitation for People With Multiple Sclerosis
2. Occupational Therapy
Although occupational therapy (OT) is a separate discipline from PT, Block says that its goals are essentially the same: increasing independence, safety, and quality of life during daily activities such as personal care, hobbies, family life, and work. To facilitate walking, Block says occupational therapisths usually work with physical therapists to train people with MS to use assistive devices and to simplify tasks at home. Ideally, Sandoval adds, therapists may visit a patient’s home to perform a home evaluation and offer advice on what people with MS can do to make their homes safer, more accessible, and compatible with their limitations and needs. “We may advise people to remove rugs or pieces of furniture they can trip over or to install ramps and grab bars,” he says. RELATED: 6 Hand Exercises for Multiple Sclerosis
3. Aerobic Exercise
Historically, Block says, it was thought that exercise was bad for people with MS because it can increase the fatigue they often experience. However, she says, now it’s generally accepted that a customized exercise program tailored to the needs of the individual can help improve energy levels as well as endurance, balance, and strength, all of which can lead to better walking and better overall quality of life. While the types of exercises recommended differ from person to person, those aimed at improving walking generally focus on maintaining muscle strength in the legs and, if necessary, weight loss, Block notes. “Maintaining a healthy weight is crucial in MS,” she says. “The less weight you carry around, the less strain on the legs and the better balance you have.” A review and meta-analysis published in April 2021 in the Archives of Physical Medicine and Rehabilitation found that both aerobic training and resistance training are equally highly effective at improving lower extremity physical function and fatigue in people who have MS. Another study, published in June 2021 in the Annals of Clinical and Translational Neurology, found that resistance training led to metabolic changes in people with MS that are linked to improved hip strength, increased walking distance and speed, and reduced fatigue.
4. Walking Aids for Mobility and Independence
Although the goal of most MS treatment plans is to maintain mobility without the need for assistance for as long as possible, many people who have MS will need to use an assistive device at some point. Sandoval recommends working with a multidisciplinary team of specialists — including physicians, physical therapists, occupational therapists, and orthotists (specialists who fit orthotic devices or braces) — to choose and learn to use the right device. “People are usually initially resistant to using things like canes to get around,” Block says. “People see reliance on assistive devices as a loss of freedom. But these devices can actually help people maintain their freedom by enabling them to get around safely.” A study published in June 2021 in the International Journal of MS Care compared assistive devices used by people with MS and found that participants reported more positive psychosocial impact, and walked faster and with higher quality, with the single-point cane and a trekking pole than with a four-point cane. RELATED: All About Assistive Devices for MS Mobility
5. Working With a Podiatrist
The services of a podiatrist or other foot-care specialist may be helpful as well. Foot health can sometimes be a serious issue for people with MS, Sandoval says, and podiatrists can help in a number of ways, from trimming toenails (if you can’t do it yourself) to treating foot ulcers. Podiatrists can also recommend shoe inserts or prescription shoes as needed.
6. Botox to Reduce Spasticity
According to Sandoval, Botox (onabotulinumtoxina) is often used to treat a spastic foot drop, in which certain muscles in the leg and foot abnormally force the foot downward, disrupting the natural heel-to-toe gait. If you have this type of foot drop, your doctor may try to correct the problem by injecting Botox into the spastic muscles that force the foot downward. The injections must be performed by a trained medical professional, and the effects of Botox usually last about three months, so injections are repeated when necessary to maintain the desired effect. “The side effects are minimal if the injections are performed properly,” Sandoval says.
7. Functional Electrical Nerve Stimulation
For some types of walking problems, a functional electrical stimulation (FES) device can help, according to the NMSS. An FES device transmits a mild electrical stimulus to a muscle, which helps it move better. This can help some people with issues like foot drop and lower extremity weakness. The goal, Sandoval says, is to facilitate and retrain muscles to perform their intended function. “Unfortunately, the device is expensive and often not covered by insurance,” Sandoval says. But for properly selected individuals, it can work really well and can be more convenient to use than a brace.
8. Medication for Walking Help
Most medications prescribed to help people with MS walk better are designed to address specific symptoms that make walking difficult, such as fatigue, pain, or muscle spasticity. One drug, called Ampyra (dalfampridine), is approved by the Food and Drug Administration specifically to improve walking in people with multiple sclerosis. Ampyra comes in tablet form and is thought to improve the transmission of signals along nerves damaged in MS. “It works well in about a third of MS patients, with minimal side effects,” Sandoval says. A meta-analysis published in February 2021 in the Orphanet Journal of Rare Diseases found that dalfampridine has a positive effect on walking ability, finger dexterity, and cognitive function. However, Block says that some people with MS “are wary about taking medication, because MS is a lifelong disease.” As a result, many specialists will recommend other approaches, like PT, OT, exercise, and orthotics, as a “first line of defense,” Block notes. Regardless of what method or methods you choose, experts emphasize that it’s vital to follow the prescribed treatment plan. If you do, you should see the benefits. “Because MS is a progressive disease, people too often get stuck on what they can’t do,” Block says. “Our job is to show them what they can do, and how these tools can help them get through their day.”
