Comprehensive Guide to Multiple Sclerosis (MS): Types, Treatments, and the Role of Physiotherapy
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on November 20, 2024
Types of exercises and techniques used at Keilor Road Physiotherapy
How physiotherapy at Keilor Road Physiotherapy improves quality of life
Evidence-based effectiveness of physiotherapy in MS management
Multiple Sclerosis (MS) is a complex, chronic neurological disease in which the immune system attacks the central nervous system (CNS), leading to inflammation and damage to nerve fibers and myelin—the protective coating around nerves. As a result, communication between the brain and the body is disrupted, causing symptoms that vary widely in severity and progression. Approximately 2.8 million people globally are affected by MS, making it a significant public health concern (Thompson et al., 2018). Although there is currently no cure for MS, advances in treatment, including physiotherapy, have improved symptom management, quality of life, and function for many individuals living with this condition.
What is multiple sclerosis?
Multiple sclerosis is classified as an autoimmune and neurodegenerative disease, meaning it is characterized by both inflammation and the progressive loss of neurons. In MS, the immune system mistakenly identifies myelin, a crucial component for nerve signal transmission, as a threat and attacks it. This process, called demyelination, disrupts nerve signals, leading to a range of symptoms affecting motor, sensory, and cognitive functions. Over time, the disease may also lead to irreversible damage to the nerves themselves, contributing to the chronic and progressive nature of MS.
Recent research emphasizes MS as a multifaceted disease involving immune dysregulation, genetic predisposition, and environmental triggers. Studies have highlighted the dual role of inflammation and neurodegeneration, which has prompted a more comprehensive approach to treatment—addressing both the immune response and neuroprotective strategies (Compston & Coles, 2008).
Types of multiple sclerosis
Understanding the types of MS is essential for both diagnosis and treatment planning, as each type progresses and responds to treatments differently:
Relapsing-Remitting MS (RRMS): This is the most common form, affecting around 85% of MS patients initially. RRMS is characterized by episodes of new or worsening symptoms (relapses) followed by partial or complete recovery (remissions). During remission, symptoms may subside, but residual symptoms may linger, and over time, permanent nerve damage can occur even in RRMS.
Secondary Progressive MS (SPMS): Many people with RRMS eventually transition to SPMS, in which symptoms progressively worsen without distinct relapses or remissions. This type marks a shift from inflammatory processes to a more neurodegenerative disease phase.
Primary Progressive MS (PPMS): In this form, the disease shows a steady progression of symptoms from onset without initial relapses. PPMS accounts for around 10-15% of cases and typically leads to gradual physical and cognitive decline.
Progressive-Relapsing MS (PRMS): This is the rarest form of MS, combining steady disease progression with occasional acute relapses. Individuals with PRMS experience continuous disease advancement, with occasional periods of relapse where symptoms worsen.
Understanding the type of MS helps healthcare providers determine appropriate treatments, as different types may respond better to specific therapies or require particular management strategies (Lublin et al., 2014).
Causes of multiple sclerosis
Research suggests that MS arises from a combination of genetic, environmental, and immune-related factors, although the precise cause is still unclear.
Autoimmune Factors: MS is considered an autoimmune disorder, where the body’s immune system mistakenly attacks healthy tissue, specifically the myelin sheath around nerve fibers in the CNS.
Genetic Predisposition: Although not directly inherited, certain genes appear to increase susceptibility to MS. Individuals with a family history of MS or other autoimmune diseases are at a higher risk.
Environmental Factors: MS prevalence is higher in areas farther from the equator, suggesting that vitamin D deficiency (from lack of sun exposure) might play a role. Vitamin D has been shown to modulate the immune system and may have protective effects.
Infections: Viral infections, particularly the Epstein-Barr virus (EBV), have been associated with an increased risk of developing MS. Although EBV is not considered a direct cause, it may trigger an abnormal immune response in genetically predisposed individuals.
These insights have guided preventive strategies and targeted therapies, aiming to modify immune response and reduce environmental risks (Ascherio & Munger, 2007).
Signs and symptoms of multiple sclerosis
Symptoms of MS are diverse and can affect virtually any part of the body due to the involvement of various CNS regions. Common symptoms include:
Fatigue: One of the most disabling symptoms, MS-related fatigue is often described as “lassitude” and can be disproportionate to the level of physical or mental activity.
Vision Problems: Optic neuritis, or inflammation of the optic nerve, can cause pain, blurred vision, and sometimes vision loss.
Mobility and Balance Issues: Muscle weakness, spasticity, and coordination issues contribute to walking difficulties and fall risk.
Numbness and Tingling: These sensory symptoms, often an early sign, occur due to nerve fiber damage.
Cognitive and Emotional Changes: MS can affect memory, attention, and emotional regulation. Depression and anxiety are also common.
These symptoms vary widely between individuals and can change over time. In RRMS, symptoms may follow a pattern of relapses and remissions, while in progressive forms, symptoms gradually worsen over time (Dendrou et al., 2015).
Diagnosing multiple sclerosis
MS diagnosis involves a thorough clinical evaluation and diagnostic tests to confirm CNS involvement and rule out other conditions:
MRI Scans: MRIs detect lesions in the brain and spinal cord, offering a non-invasive way to view areas of demyelination.
Lumbar Puncture (Spinal Tap): Analyzing cerebrospinal fluid (CSF) can reveal immune system markers specific to MS, such as oligoclonal bands.
Evoked Potential Tests: These tests measure nerve response times to assess CNS function and detect areas of damage.
Prompt diagnosis is vital, as early treatment can slow progression and improve long-term outcomes (Polman et al., 2011).
Prevention and risk reduction for multiple sclerosis
While MS cannot be prevented outright, some lifestyle adjustments can potentially reduce the risk or delay progression:
Vitamin D: Vitamin D has immune-modulating effects, and maintaining adequate levels may reduce MS risk (Lucas et al, 2011).
Exercise and Healthy Diet: Physical activity and a balanced diet can enhance general health and may mitigate MS-related disability.
Avoid Smoking: Smoking is a well-documented risk factor for MS and may also accelerate disease progression.
Treatment options for multiple sclerosis
Treatment strategies include:
Disease-Modifying Therapies (DMTs): DMTs, such as interferons and monoclonal antibodies, target the immune system to reduce relapses and slow progression (Dargahi et al, 2017).
Symptom Management Medications: Medications target specific symptoms, including pain, fatigue, muscle stiffness, and bladder dysfunction.
Emerging Treatments: Experimental treatments, like stem cell therapy, aim to promote remyelination and repair damaged CNS areas.
Physiotherapy for multiple sclerosis
At Keilor Road Physiotherapy, we understand the complexities of multiple sclerosis (MS) and are dedicated to providing targeted, personalized physiotherapy care to help our patients manage symptoms, maintain functionality, and enhance their quality of life. Our physiotherapy services are designed to address the unique challenges of MS, with a focus on improving mobility, balance, and overall physical well-being through a structured and individualized approach.
Benefits of physiotherapy for MS patients
Physiotherapy offers MS patients a comprehensive, holistic approach to managing their condition (Beer et al, 2012). Our team works closely with each patient to preserve muscle strength, enhance mobility, and minimize fatigue, all while supporting mental well-being. By building a structured exercise plan tailored to each individual's needs, we empower our patients to take an active role in their health, fostering confidence and resilience.
Improving mobility and balance
Mobility and balance are often impacted by MS due to muscle weakness, coordination challenges, and sensory deficits. At Keilor Road Physiotherapy, we use targeted exercises to strengthen core and lower body muscles, improve postural control, and help patients move with more stability and ease. Our physiotherapists integrate controlled walking drills, weight-shifting exercises, and resistance training into treatment plans to enhance stability, reduce the risk of falls, and restore confidence in daily movements.
Managing fatigue
Fatigue can be one of the most challenging symptoms for MS patients, often affecting both physical and mental well-being. Our approach to managing fatigue involves energy-conservation techniques and carefully structured exercise routines to build endurance without overwhelming the patient. We guide our patients through pacing strategies, which balance rest and activity, and incorporate breathing and relaxation techniques. By gradually building strength and stamina, we help patients reduce fatigue, allowing them to feel more energized throughout the day.
Enhancing overall function
At Keilor Road Physiotherapy, our goal is to improve every aspect of our patients' functional abilities. Our tailored programs include exercises to build strength, flexibility, and coordination, all aimed at enhancing independence in daily activities. Through functional exercises that mimic day-to-day tasks, we help patients maintain their independence and ability to perform tasks like standing, walking, and reaching—empowering them to live more active, fulfilling lives.
Types of exercises and techniques used at Keilor Road Physiotherapy
Our team uses a variety of exercises and therapeutic techniques, each serving a specific purpose in managing MS symptoms and supporting physical health.
Aerobic exercises
Aerobic exercises, such as Reformer Pilates based exercises, stationary cycling, treadmill walking, and aquatic exercises, are used to improve cardiovascular health and overall endurance. We focus on low- to moderate-intensity activities that enhance energy levels and boost mood without exacerbating fatigue. Research has shown that aerobic exercise can reduce inflammation and improve energy in MS patients, so we prioritize this as part of our treatment plans, adapting exercises to each patient’s current abilities.
Strength training
To address muscle weakness, our physiotherapists incorporate strength training exercises that target both the upper and lower body. We use resistance bands, weights, and bodyweight exercises, carefully structured to avoid overexertion. Progressive strength training builds muscle stability and supports daily movements like walking and standing, which are essential for functional independence. Our team ensures each exercise is safe and achievable, promoting both physical strength and patient confidence.
Flexibility and stretching
Managing spasticity and preventing stiffness are key components of MS care. We integrate flexibility exercises and stretching routines, including static, dynamic, and proprioceptive neuromuscular facilitation (PNF) stretching techniques. These exercises help ease muscle tightness, improve joint range of motion, and make everyday movements smoother and more comfortable, enabling our patients to maintain a fuller range of activities.
Balance and coordination exercises
At Keilor Road Physiotherapy, balance and coordination training is crucial for reducing fall risk in MS patients. We use balance-focused exercises like tandem walking, standing on one leg, and stability ball work to enhance control and proprioception. Additionally, coordination exercises—incorporating visual cues and reaction-time drills—help strengthen motor skills. These techniques are particularly valuable for progressive MS types, where maintaining balance and coordination becomes increasingly challenging.
How physiotherapy at Keilor Road Physiotherapy improves quality of life
Our physiotherapy programs prioritize quality of life by supporting independence, reducing fall risk, and managing pain, with each patient’s goals and abilities in mind.
Maintaining independence
One of our primary goals at Keilor Road Physiotherapy is to help MS patients retain independence in their daily lives. Through targeted strengthening and functional exercises, we empower patients to complete everyday tasks more effectively, from walking unaided to managing personal care. This independence not only boosts physical capability but also positively impacts mental and emotional well-being.
Reducing the risk of falls
Falls can be a serious concern for MS patients. Our physiotherapists integrate balance and proprioception exercises specifically designed to reduce fall risk, helping patients move safely in their environments. By enhancing stability and reaction time, we give our patients the tools they need to navigate their daily lives with confidence and security.
Managing pain
Physiotherapy is also highly effective in alleviating MS-related pain. Our team uses stretching, massage therapy, and gentle joint mobilization to relieve discomfort caused by muscle stiffness, spasticity, or joint stress. Additionally, our exercise plans are designed to release natural endorphins, which act as pain relievers, and we educate patients on postural correction and ergonomic techniques to further reduce discomfort during everyday tasks.
Evidence-based effectiveness of physiotherapy in MS management
The approach at Keilor Road Physiotherapy is grounded in evidence-based practices. Research supports physiotherapy's positive effects on mobility, fatigue, and overall functionality for MS patients. A systematic review by Heine et al. (2015) found that MS patients who participated in physiotherapy experienced notable improvements in mobility, reduced fatigue, and decreased spasticity. In our practice, we apply these evidence-based techniques to deliver effective care and achieve measurable improvements in our patients' quality of life.
Customized physiotherapy plans for different types of MS
Understanding that each type of MS presents unique challenges, we customize our physiotherapy plans based on the specific type and progression of MS:
Relapsing-Remitting MS (RRMS): Our treatment plans for RRMS focus on strengthening and regaining function after relapses while maintaining endurance during remission periods. We prioritize rest breaks and energy-conservation techniques to prevent overexertion.
Secondary Progressive MS (SPMS): With SPMS, we emphasize slowing the progression of symptoms, preventing further decline, and addressing spasticity and stiffness. Strength and flexibility exercises, along with adaptive techniques, support mobility and functional independence.
Primary Progressive MS (PPMS): In PPMS, where steady decline is common, we focus on maximizing remaining function through strength training, balance improvement, and adaptive strategies to reduce fall risk and improve quality of life.
Progressive-Relapsing MS (PRMS): For patients with PRMS, our team addresses both the steady decline and intermittent relapses, focusing on recovery from relapses while supporting ongoing function and minimizing progressive decline.
Physiotherapy at Keilor Road Physiotherapy is a critical part of MS management, providing practical tools for symptom relief, functional independence, and improved quality of life. Our team is committed to helping our MS patients move with confidence, reduce pain, and enhance their overall well-being, guiding them through each step of their journey with expert care and support. At Keilor Road Physiotherapy, we believe that tailored, patient-centered care is essential in managing MS. Our experienced physiotherapists work one-on-one with each patient to develop a plan that meets their needs and adapts to their unique experience with MS.
Living with multiple sclerosis
Supportive strategies for living with MS include:
Emotional Support: Therapy, support groups, and social networks can provide valuable emotional resources for coping with the disease.
Assistive Devices and Home Modifications: Equipment like canes, grab bars, and ramps can make daily tasks easier and safer.
Ongoing care, regular check-ups, and lifestyle adaptations can help people with MS manage the disease effectively.
Conclusion
Multiple Sclerosis (MS) is a complex and variable neurological condition that affects millions worldwide. Its causes remain multifaceted, involving a combination of genetic, environmental, and autoimmune factors. MS presents as four main types—Relapsing-Remitting, Secondary Progressive, Primary Progressive, and Progressive-Relapsing MS—each with distinct progression patterns and symptoms, ranging from fatigue and mobility issues to cognitive changes. Diagnosis often involves MRI, lumbar puncture, and evoked potential tests to confirm CNS damage and guide treatment planning. Although no cure exists, treatments—including Disease-Modifying Therapies (DMTs), symptom management medications, and emerging therapies—have advanced significantly, helping to manage symptoms, slow progression, and improve the quality of life for many individuals with MS.
A key part of MS management is lifestyle modification, from maintaining a healthy diet and exercise routine to avoiding known risk factors like smoking. Additionally, physiotherapy stands out as a vital tool in MS management. Through tailored exercise regimens and specialized therapies, physiotherapy improves mobility, balance, flexibility, and strength. It empowers individuals with MS to maintain functionality, manage fatigue, and reduce the risk of falls, significantly enhancing overall quality of life.
If you or a loved one is experiencing symptoms suggestive of MS, it is crucial to seek medical advice from a healthcare provider. Early diagnosis allows for prompt intervention, which can slow disease progression and limit long-term disability. Furthermore, connecting with support networks—such as MS societies, support groups, and mental health professionals—can offer emotional and practical support to help navigate the physical and emotional challenges of living with MS.
Physiotherapy, specifically, plays a crucial role in MS management. A physiotherapist with experience in neurological conditions can develop an individualized program to address specific physical needs, promote independence, and improve daily functioning. Physiotherapy sessions not only focus on managing physical symptoms but also support mental well-being by building confidence and resilience through achievable goals. With ongoing advancements in MS research and treatment, the future holds promise for improved therapies and quality of life for those affected by MS.
References:
Ascherio, A., & Munger, K. L. (2007). Environmental risk factors for multiple sclerosis: Part II: Noninfectious factors. Annals of Neurology, 61(6), 504-513.
Beer, S., Khan, F., & Kesselring, J. (2012). Rehabilitation interventions in multiple sclerosis: an overview. Journal of neurology, 259(9), 1994–2008. https://doi.org/10.1007/s00415-012-6577-4
Compston, A., & Coles, A. (2008). Multiple sclerosis. The Lancet, 372(9648), 1502-1517.
Dargahi, N., Katsara, M., Tselios, T., et al. (2017). Multiple sclerosis: Immunopathology and treatment update. Brain Sciences, 7(7), 78.
Dendrou, C. A., Fugger, L., & Friese, M. A. (2015). Immunopathology of multiple sclerosis. Nature Reviews Immunology, 15(9), 545-558.
Lucas, R. M., Ponsonby, A. L., Dear, K., et al. (2011). Sun exposure and vitamin D are independent risk factors for CNS demyelination. Neurology, 76(6), 540-548.
Lublin, F. D., Reingold, S. C., & Cohen, J. A. (2014). Defining the clinical course of multiple sclerosis: The 2013 revisions. Neurology, 83(3), 278-286.
Polman, C. H., Reingold, S. C., Banwell, B., et al. (2011). Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Annals of Neurology, 69(2), 292-302.
Thompson, A. J., Banwell, B. L., Barkhof, F., et al. (2018). Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. The Lancet Neurology, 17(2), 162-173.
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.