Multiple Sclerosis Basics for Physical Therapists

Over one million Americans live with multiple sclerosis.

A complicated and multifaceted disease, the diagnosis and treatment of MS requires a multidisciplinary approach. From neurologists to physical therapists, speech-language pathologists and dieticians, professionals from all fields contribute to the care of patients with MS.

Related: The Role of Occupational Therapy

What is multiple sclerosis?

Multiple sclerosis is a chronic, progressive demyelinating neurodegenerative disease. It primarily affects the central nervous system, including the optic nerves, brainstem, spinal cord, cerebellum, and white matter.

The disease attacks the myelin, the fatty substance that coats and protects nerves and assists with nerve conduction velocity. This process, known as demyelination, causes loss of nerve signals and scarring, or sclerosis, over time. With these signals interrupted, patients can experience unpredictable symptoms such as numbness, tingling, mood changes, memory problems, pain, fatigue, blindness and/or paralysis.

What exactly causes this autoimmune response remains unknown.

What are the symptoms of MS?

Each patient’s experience of MS is different. For some, symptoms may be mild and short-term. For others, they may be severe and long-lasting. These are some common symptoms of MS:

• Blurred or double vision and dizziness
• Red-green color distortion
• Pain and loss of vision because of swelling of the optic nerve (optic neuritis)
• Loss of coordination
• Numbness, prickling, or pins and needles (paresthesia)
• Muscle weakness in the arms and legs
• Spasticity, muscle stiffness, and spasms
• Fatigue
• Bladder and bowel problems

Around 50% of patients with MS present with cognitive symptoms linked to the disease, including but not limited to issues with:

• Focus and concentration
• Attention span
• Short-term memory
• Poor judgment

How is MS diagnosed?

There is no single, authoritative test by which a healthcare provider can diagnose MS. Instead, neurologists use careful observation, MRI, labs, and other clinical exams to rule out other potential diagnoses.

A patient’s symptoms must meet two core criteria to diagnose MS. They must have experienced at least two attacks of MS symptoms within a one month span, or have an MS symptom that gets worse for at least 24 hours. The patient must also demonstrate damage to myelin in more than one area of their central nervous system.

MS symptom management

Physical therapists, occupational therapists, and speech-language pathologists all play a key role in helping patients with MS manage their symptoms. For patients experiencing muscle weakness and spasticity, physical therapists can provide gait and assistive device training, as well as exercise prescription.

Between 50% and 70% of patients with MS report a fall within the last 2-6 months. Physical therapists can also educate their patients on balance, safety, and fall prevention. Additionally, physical therapy can help strengthen weak muscles and may help alleviate pain caused by MS.

Related: Self-Moderated Exercise: Beyond Clinical Therapies in the Patient with Multiple Sclerosis

While a physical therapist’s primary role involves helping patients manage their mobility and function, they also have the opportunity to equip the patient with the knowledge and tools needed to optimize their overall quality of life with MS.