As a personal trainer I have had the opportunity to work with a number of people with neurological disorders, the most interesting of which on a results basis, is Multiple Sclerosis (MS). This article will describe some of the techniques and exercises I use to improve the lives of people with MS. But before we discuss my approach, we must become familiar with two things.
What causes multiple sclerosis (MS)?
MS is an autoimmune condition. This is when something goes wrong with the immune system and it mistakenly attacks a healthy part of the body – in this case, the brain or spinal cord of the nervous system.
In MS, the immune system attacks the layer that surrounds and protects the nerves called the myelin sheath.
This damages and scars the sheath, and potentially the underlying nerves, meaning that messages travelling along the nerves become slowed or disrupted.
Also known as brain plasticity, neuroelasticity, or neural plasticity, is the ability of the brain to change continuously throughout an individual’s life, e.g. brain activity associated with a given function can be transferred to a different location, the proportion of grey matter can change, and synapses may strengthen or weaken over time. The aim of neuroplasticity is to optimise the neural networks during phylogenesis, ontogeny, and physiological learning, as well as after a brain injury. Research in the latter half of the 20th century showed that many aspects of the brain can be altered (or are “plastic”) even through adulthood. However, the developing brain exhibits a higher degree of plasticity than the adult brain.
Neuroplasticity can be observed at multiple scales, from microscopic changes in individual neurons to larger-scale changes such as cortical remapping in response to injury. Behaviour, environmental stimuli, thought and emotions may also cause neuroplastic change through activity-dependent plasticity, which has significant implications for healthy development, learning, memory, and recovery from brain damage. At the single cell level, synaptic plasticity refers to changes in the connections between neurons, whereas non-synaptic plasticity refers to changes in their intrinsic excitability.
Neuroplasticity has been key in training people with MS; effectively by repeating a movement pattern or “re-learning” balance we can improve, not cure, symptoms associated with MS.
Balance can be improved by getting the affected individual to focus on the areas in the body where they can feel the weight shift or their centre of gravity move. I normally start by having the individual stand in a wide stance and swing a weight, side to side in front of them. Nothing too heavy and not too high, I merely want them to feel the weight shift through the bottoms of their feet. Once, over time, they can reliably “feel” weight shift through their feet we start in other planes of motion and increased difficulty. Next we use similar techniques to “feel” that weight shift through their hips. Finally, as the individual starts to improve in these areas, we increase the difficulty levels progressively of the exercises to start to have “balance” become once again more of a subconscious instinct and not an area that the individual with MS has to constantly focus on in everyday life.
Foot Droop Correction
Most people with MS that I have encountered are constantly in fear of falling, this often is caused by a lack of response on their left side and by something called foot droop. This is the front of the foot not rising up when lifting the leg. I try to improve this by strengthening the muscles in the lower leg, via calf raises and having the individual do exercises where they specifically try and raise the foot evenly. Eventually progressing to exercises that involve rapid turns and quick foot movements. This through sheer repetition causes them to raise the front of the foot to avoid dragging the foot. After a period, this too becomes more second nature.
Falling is probably one of the single biggest fears of any person suffering from MS, this is further intensified by the feeling of helplessness as you start to fall and are seemingly unable to do anything to arrest your fall. This usually results in the sufferer taking smaller hesitant steps, hunching down to lower your centre of gravity, not lifting the feet as high (foot droop then causes a trip hazard), use of a stick / cane and finally the person self restricts their mobility. Resulting in an overall downward spiral in fitness and health.
To arrest this and try to gain gradual improvement is difficult, but not insurmountable. My technique is to break the movements of walking down and focus on each smaller movement to ensure that the correct signals are being sent, then as the smaller movements improve we move onto supported walking on a treadmill, by supported I mean they are holding on and I am in position on the treadmill to catch them. Once that is starting to show improvement I move onto walking in free space, gradually reducing the support and eventually carrying weights. Then every subsequent session continues to re-enforce these movements. Once improvement is observed we move onto other areas of life that causes difficulty ie stairs, crowds, etc…
This article is far from a complete guide, but it is only meant to demonstrate with some careful planning, thought and support from an exercise professional a person’s freedom and mobility does not necessarily get significantly curtailed after an MS diagnosis and in reality exercising as soon as diagnosed can slow the effects MS has on your life.