How Physical Therapy Can Help When You Have Multiple Sclerosis

The nerve damage caused by multiple sclerosis (MS) can disrupt a person’s ability to walk, balance, and even carry out the most basic everyday activities. Staying physically active can improve sleep and overall health for everyone, including people with MS, but debilitating fatigue along with other symptoms like muscle weakness, spasticity, and numbness can be major barriers.

Physical therapy (PT) can help you safely navigate those obstacles. From improving walking ability to reducing fatigue, targeted physical therapy programs give many people with MS the strength and skills to move more freely and significantly improve their quality of life.

Nearly everyone with MS can benefit from physical therapy, says Kameron Jacobson, DPT, of the Cleveland Clinic's Lou Ruvo Center for Brain Health in Las Vegas. “I love getting to see people in physical therapy who are newly diagnosed with MS, because it allows us to slow down disability and address problems before they become more problematic. But it’s also never too late to get started with physical therapy, as improvements are always possible,” says Dr. Jacobson.

Learn how physical therapy can improve your MS symptoms and keep you doing the things you enjoy for as long as possible.

Building strength and improving your muscle power will help in a host of ways, including making balance, walking, and everyday activities like showering and getting in and out of a car easier. Getting stronger usually means that people can maintain their independence longer.

Strengthening exercises can also help with spasticity and stiffness, which can come in the form of involuntary muscle spasms or sustained muscle contractions. A spastic muscle isn’t necessarily a strong muscle, so exercises to improve strength in the muscles can help, says Jacobson.

Stretching exercises can help keep muscles flexible and allow for larger movements, as well as help with spasticity, says Laura Kennedy, DPT, a neurologic clinical specialist in Duke Health's department of rehabilitation services in Durham, North Carolina.

Prolonged stretching (holding a stretching pose for a minute or longer) can also improve spasticity, Dr. Kennedy says.

Jacobson agrees that spasticity is most commonly addressed with stretching exercises, “with a focus on the calf muscles, front and back of the thighs, and muscles in the front of the hips, as these are often most impacted,” he says.

Issues with balance are common in people with MS. Vertigo and dizziness can make it harder to get your bearings, and sensory changes can cause numbness, tingling, or pain in your extremities, including the legs and feet.

“Physical therapists can address balance difficulties by challenging the body and brain in a variety of contexts to introduce instability in a safe environment,” says Jacobson. Therapists mix it up in a safe way by adding challenges that simulate the real world.

That could include exercises like practicing walking while avoiding obstacles or walking while counting backwards, says Heather Ray, DPT, who works with people with neurological conditions at Duke Health.

This kind of exposure helps promote motor learning: The brain and body become more adapted to challenging scenarios, which translates into improved balance and fewer falls, says Jacobson.

If dizziness is affecting balance, vestibular rehabilitation can help, he says. “This can involve exercises to improve gaze stabilization and habituation, whereby the brain is exposed to provoking triggers in a controlled manner that results in reduced severity of symptoms over time,” says Jacobson.

“Fatigue is the most commonly reported symptom in multiple sclerosis and can often be the most disabling, affecting anything from activities of daily living to walking endurance and safety,” says Jacobson.

There’s a difference between fatigue and objective fatigability, he says. “Fatigue is a perception of tiredness, while fatigability is a measurable decline in performance of a physical task over time,” says Jacobson.

While subjective fatigue can be addressed by psychological interventions like cognitive behavioral therapy or compensatory techniques like energy conservation or pacing, objective fatigability can be improved with physical therapy, he says.

Many physical therapy exercises can improve endurance, including strengthening, stretching, and interval training, which involves bouts of exercise interspersed with regular rest intervals.

“This can help prevent accumulated fatigue, resulting in higher overall volume of tolerated exercise,” says Jacobson.

How much is too much? “A good rule to follow is the two-hour rule,” says Dr. Ray. “After exercising, you should feel the same or better within two hours. If you still feel tired, you may need to do less next time. A physical therapist can help guide you through a tailored exercise program for your needs,” she says.

“Walking is often a central priority for our patients, as it is a core requirement for so many roles and activities in life,” says Jacobson.

Gait training is often a combination of strengthening exercises, balance exercises, and stretching, he says.

“We often see improvements in the quality of steps themselves, such as reduced variability of stepping and improved length of steps, translating to improved walking speed, endurance, and stability,” says Jacobson.

“Assistive devices are often recommended if falls start to occur, ideally even earlier, when fall risk is detected to help prevent future falls,” says Jacobson.

But assistive devices aren’t just about safety; they also have a place in improving walking or mobility, which can help people with MS complete tasks faster or for longer, he says.

“It can feel discouraging to begin using an assistive device, but I try to help patients view these devices not as a crutch but as a tool that allows them to continue being independent and getting out in the world to participate in the things that are important to them,” says Jacobson.

Because assistive devices often help people stay more active safely than they would otherwise, they can help slow the progression of disability, he adds.

Physical therapy is highly personalized; therapists will spend much of your first visit gathering information. “I ask a lot of questions to get to know the person and learn about what they want to achieve through physical therapy,” says Kennedy. A PT plan will develop over several stages:

Initial Evaluation A thorough physical exam will be completed to assess strength, spasticity, balance, gait, and endurance and to determine what is contributing to your challenges with mobility, says Kennedy.

Treatment Plan After your assessment, your therapist will work with you to identify meaningful goals and improve your quality of life. “We want to make sure that we are working on things that are important to you,” says Kennedy.

Ongoing Sessions The number of sessions you’ll have with your physical therapist will depend on what your doctor recommends, as well as your goals and practical considerations, such as insurance coverage.

At-Home Exercises All the experts agree: Exercising consistently at home is the key to improving and maintaining those improvements. Ray encourages her clients to keep practicing what they’ve learned. She also tries to tailor at-home exercises to the activities they enjoy the most. “Home exercise does not always have to include a traditional set of structured exercises,” she says.

Jacobson says, “The goal is to build exercise as a habit to integrate exercise as a part of their lifestyle. Our brain and bodies have a remarkable ability to adapt to challenges we place upon them, but these changes happen incrementally over time. Life happens, and it’s inevitable to miss days, but long-term participation is what’s most important.”

Communication With the Healthcare Team Your physical therapist is part of your overall healthcare team, which also includes your primary care doctor, neurologist, and other healthcare providers.

Make sure that your providers know that you’re working with a physical therapist; they may have suggestions for areas that you could work on to improve your symptoms and help address any deficits.

If you haven’t connected with a physical therapist, Jacobson suggests asking your doctor about seeing one who specializes in neurologic conditions, especially if you have any concerns about your mobility or are unsure how best to utilize exercise to help slow disability.

• Physical therapy can significantly improve mobility, reduce fatigue, and enhance quality of life for people with MS, whether they are newly diagnosed or have been living with the condition for years.
• Targeted exercises such as strengthening, stretching, and balance training can address core MS symptoms like muscle weakness, spasticity, and poor coordination, making daily activities safer and more manageable.
• Fatigue, one of the most disabling MS symptoms, can be managed through endurance training and energy conservation strategies.
• Staying consistent with at-home exercises is essential for long-term progress and safety.