Multiple sclerosis (MS) is a neurological condition that affects the central nervous system. The nerves of the body are coated with a covering called the myelin sheath, in MS this sheath starts to break down effecting the messages carried from the brain. As a result symptoms can present in any part of the body.
There are many symptoms of MS and no two people present the same. Therefore when using Pilates with MS clients it is essential that they are treated individually so a specific programme can be devised for them to get the best care.
Symptoms of MS can be:
- decreased balance & problems walking
- spasm & stiffness in muscles
- altered sensation
- difficultly with speech & swallowing
- difficultly with memory recall , planning etc
- bladder & bowel problems
- visual problems
The majority of people are diagnosed in their 20ʼs & 30ʼs after being refereed to a Neurologist. There are 4 main groups of MS:
- Relapsing remitting MS – this is the most common form, where symptoms flare up aggressively then settle down again, this is known as a relapse.
- Secondary progressive MS – after a relapse the presenting symptoms worsen and the disabilities can increase.
- Primary progressive MS – disability with this form develops very quickly from onset of diagnosis.
- Benign MS – infrequent mild attacks that are interspersed by long periods with no symptoms.
There is no cure for MS but there are a number of drugs that are prescribed to help manage the condition. It is also important for the individual with MS to have a holistic treatment plan combining diet, Physiotherapy, exercise and alternative therapies that can help manage their symptoms.
I have personally found that a Pilates based exercise programme introduced early on in the condition can help to reduce contractures in the muscles and help with balance and pelvic floor control. As the symptoms of MS are different from person to person it is essential that the client is assessed on an individual basis to begin with so all symptoms and function problems can be noted and a plan to address them is devised.
One of common presentations of MS is muscle hypertonia in which there is increased muscle tension, or tone as it is often known, which reduces the muscles ability to stretch.
This is the result of damage to the motor pathways in the central nervous system, which over time can result in a joints inability to function through range and cause joint pain.
In the early stages of MS increased muscle tone may not be present, if a Pilates based exercise programme is introduced at this stage it could help maintain muscle length & joint range. Often in Pilates we are encouraged to use touch to help stimulate a muscles function. However, with MS touch of a high tone muscle group would produce negative results. It is more affective to stimulate length in a tight muscle group from a distal point. For example if you were trying to open the hip flexors focusing on grounding the clients heel and creating a sense of space in the hip would be of more beneficial. Also passive positioning and using the breath to aid relaxation would be helpful.
On the other extreme is hypotonia where the tone of the muscle is reduced. In this case the muscle would benefit from tactile stimulus to help facilitate activation of the muscle group. stroking of the low-toned muscle from the insertion to origin is advised. This is where a strong understanding of functional anatomy is required to get the desired results.
If an MS client has an altered gait due to hypertonia or hypotonia they may benefit from a walking aid to prevent falls but also to reduce imbalances occurring. However, if they do have altered gait sometimes our role is to help them undo these imbalances during their session by positioning to prevent contractures occurring. In the lying position we can help place their limbs in a more symmetrical alignment that will assist with the rebalancing of the muscular skeletal system.
Challenging posture in different postural sets is also advised to help maintain balance perception. Getting the clients to work outside their base of support i.e. reaching forward and to the side while sitting is a very basic but functional exercise. The general education of postural positioning that we use in Pilates in different postural sets plays an important role in helping to maintain the MS clients proprioception & body awareness.
People with MS experience relapses which means that the disease is going through a period of flare up. It is important the Pilates teacher does not push their clients through these periods, but instead encouraged them to rest. After the relapse the client may present with worsening symptoms, its is therefore very important to review your exercise plan at this stage and to adapt accordingly. Working with this condition is challenging but also very rewarding.