Multiple Sclerosis (MS) is a neurological condition which affects the nerves in the brain and the spinal cord. It is an inflammatory, degenerative disease which causes damage to the myelin sheath which surrounds the nerves and speeds up the transmission of electrical signals. When nerve fibres are “demyelinated” (stripped) as in MS, they fail to transmit signals within the nervous system efficiently, causing the impulses to travel slower.
MS typically affects more women than men and diagnosis is most commonly made between the ages of 20 and 40. It is estimated that 100,000 people in the UK have been diagnosed with MS and 100-120 people per 100,000 in the UK are affected.
There are different types of MS but that is not to say that an individual’s symptoms and progression always “fit” with one type. In relapse remitting MS people experience an acute exacerbation in their symptoms which is followed by a period of some recovery. Most people with relapse remitting MS then develop secondary progressive MS characterised by an ongoing gradual deterioration. In this instance, the frequency of relapses often decreases but disability increases. In 10% of individuals, symptoms gradually get worse over time, such is the case with primary progressive MS.
People who suffer with MS may experience fatigue, difficulty walking, changes in their vision, dizziness, poor balance and changes to their muscle tone (stiffness or floppiness). Depending upon the type of MS that an individual has, the symptoms will vary in their presentation. Some people for example, may recognise a deterioration in their walking due to an acute exacerbation in their symptoms; others may notice a gradual decline in their ability to get out and about or even around the home.
Physiotherapists play an important role in the management of individuals with MS by maintaining and improving functional ability and managing the long term symptoms. Physiotherapists will compile a tailor made rehabilitation programme to manage specific symptoms including pain alongside issues with tone, stiffness, spasm and balance which may involve land based or water based (hydrotherapy) treatment. The aim of physiotherapy is to encourage normal movement patterns, normalise tone and improve postural and core (trunk) control.
Evidence suggests that exercise as part of a rehabilitation programme can serve to increase activity levels and improve the health and wellbeing of individuals with MS. The results of randomised controlled trials indicate that exercise programmes can improve functional ability, cardiovascular fitness, endurance and muscle strength. Furthermore, exercise releases endorphins which are chemicals that produce feelings of euphoria and calmness which can help to improve mood and elicit a general state of well being.
Physiotherapy should commence soon after a diagnosis is made because the greatest potential for the central nervous system to adapt occurs in the early stages of the disease. Early intervention can help to reduce disability and maximise potential for rehabilitation thus reducing the impact that the condition has on quality of life.