Over the past 15 years we have provided great rehabilitation programs and results for people find solutions to injury and chronic pain by learning how to move better and improve strength and stability. More recently we have attracted people with complex cases of not so much pain, but disability and disease seeking to improve their ability to move in life using exercise. From MS, to spinal cord injury, to cerebral paulsy and stroke, we have multiple different cases we see on a weekly basis all being taught how to improve movement skills and motor programs being driven by the brain and the nervous system (see testimonials for case studies). In this article we are going to look specifically at Multiple sclerosis. Even though this disease has evolved with treatment plans, medication and assistance, there still is a lack of education about the value of exercise and in particular the role of strength training for managing this disease. This article we will share with you some of the methods and principles we use effectively in our program each day. 

What Is Multiple Sclerosis?

Multiple sclerosis (MS) is a condition of the central nervous system, interfering with nerve impulses within the brain, spinal cord and optic nerves. The word sclerosis means scars, and these scars occur within the central nervous system and depending on where they develop, manifest into many different types of symptoms. Most people are diagnosed between the ages of 20-40, but it can affect younger and older people too. I actually have seen a client recently from Port Fairy who is in his late 50's who was diagnosed only a few years ago. This disease has been found to affect over 20,000 people in Australia and more than two million diagnosed worldwide.

There is currently no known cure for MS but there is ever evolving treatments and medications being used with great success. As with all types of disease, and injury for that matter too it is impossible to predict the course of the disease. The condition varies so much from person to person but generally most people with MS can expect 95% of the normal life expectancy.

What is clear though is that use of nutrition and exercise is a great way to manage not just the physical symptoms of MS, but also improve overall confidence and mental ability to move more and encourage the brain to coordinate movements more efficiently.

The knowledge in the medical community has really widened to see the true benefits of exercise. Even as little as twenty years ago people with MS were commonly advised to avoid tiring physical exercise in case it made their symptoms of MS worse! When really what was happening is people were getting worse from doing nothing. The damage to the body from lack of movement and loss of muscle mass only serves to speed up the disability and loss of confidence to move in daily life. Not to mention the side effects of medication and the damage loss of muscle has on the hormonal system, we MUST find a way to constantly move and prevent this from happening.

We have seen the same thing evolve recently with treatment of Cancer, where we now know that exercise and adding muscle during cancer treatment is essential in beating the disease. See our article Why Exercise Is So Important During Cancer Treatment for more information on this.

What Happens When You Lose Muscle

Slowed nerve activity is believed to be due to the plaques (or sclerosis) in the central nervous system (CNS) that causes movements to be slowed and as a result timing and function is often lost. As the disease progresses these plaques begin to block the messages in the nervous system to the muscles resulting in reduced strength recruitment. This results in a reduction in loss of force production by the muscles presenting as a weakness and a steady increase in muscle fatigue from simple everyday tasks.

In older adults we see this happen from lack of activity and lack of resistance to the muscle and nervous system. This is commonly known as sarcopenia. See the picture below of an example of this.

1. The first leg on the left represents a healthy functioning leg and of someone who has regularly taken part in exercise all their life and in particular resistance exercise.
2. The middle leg is someone of the same age who does some form of exercise from time to time, but never remains consistent. They are already starting to show sings of weakness with activities like walking up stairs and have begun to change their lifestyle to accommodate this weakness and instability.
3. The last leg on the right is again of someone the same age but where we see severe loss of function to the point where a walking stick or even a wheel chair must be adopted and most functional tasks are now impossible. This person has avoided exercise and movement most of their life and now has experienced extreme muscle wastage that has led to disability.

There is no medication that can reverse or prevent sarcopenia, only exercise can. And more specifically resistance exercise.

The message here is clear, the more inactive you become, the quicker you end up with muscles like the person on the right.

You can read more about this in the article Strength Training For Older Adults

The Value Of Exercise For MS

There are many forms of exercise that people with MS can take part in and all forms of exercise will provide some benefit. Cardio training for most people is very over rated and while it provides great benefit to heart and lungs, blood circulation and fitness levels it does very little to improve how you move. Most cardio exercises are very repetitive and require little coordination and skill to complete. They also require little in the way of strength and stability to complete which are two factors that most people with MS lack the most. This does not mean to say they are a waste of time, you can still take part in this activity but you must incorporate some form of strength training in order to really combat the disease and prevent the damage of muscle loss and movement function.

However not all strength training is equal!

What do I mean by this? When most people think of strength training the first thing they think of is someone like Arnie on the bench press trying to lift massive weights. This is body building training, and this will do very little to improve how you move for the purpose of body building is to look good in a mirror, not to move better. Sure some exercises may be of use, but most will not, for we need exercises that provide a much more complex task for the brain and the body in order to improve movement function. We need exercises that improve strength in the way we are designed to move.

Good articles to read on this are How To Become Stronger By Challenging Your Brain & Nervous System & Why Isolated Strength Training Fails & Movement Skills Succeeds

Is Strength Training Safe?

Okay we have made a very strong point about strength training but is it safe for MS?

As we mentioned earlier many years ago it was still regarded as unsafe. Concern has focused on the possibility of exacerbating MS symptoms, such as fatigue and weakness which could compromise the treatment and medication. However, there is now strong evidence indicating that exercise does not cause prolonged or permanent worsening of MS symptoms. Actually the opposite has been found to be true that exercise can often provides an improvement in a range of MS symptoms. In some cases clients training with us with MS have reported that exercise sometimes preceded some elevation of symptoms, but this was mainly working out on hot days and more in the early stages of starting their exercise program. As time went on this ceased to become a problem. Also there has been no studies able to identify exercise as the cause of elevated symptoms.

It should be noted that exercise can result in a temporary increase in existing symptoms or onset of new previously silent symptoms in people with MS. This is probably related to a heat-induced reduction in nerve conduction velocity. Such symptoms tend to resolve within thirty minutes of rest.

What Type Of Strength Training Exercise Is Best?

This is a difficult question to give you a black and white answer for it all depends on the person.

The key is to assess the person across fundamental patterns of movement. A strong focus on stability, coordination is paramount. The instincts of most trainers would be to place people on machines or lie them down on benches and perform body building type movements for they are safer. Sure they may be adding muscle and maybe preventing sarcropenia to some degree, but you will not be enhancing movement.

Very, very rarely to muscles work in complete isolation or anywhere close to it. When we move some muscles contract, others stretch and elongate to while some muscles provide stability, and all of this is done within a split second without you having to think about it. This is what is known as a pattern of movement and these patterns are like groups of movements linked together in a big chunk of information. The chunk of information is known as a motor program (like software on a computer). These motor programs link many movements together all at once to complete a specific task. When you train against this principle by using isolated exercises that do not require this "chunking" you are basically making the system slower, inefficient and dumb! The brain does not understand or recognize how to use any of this information for movement.

Remember MS already has a slowing of the conduction speed within the nervous system, the last thing you want to do is make it slower.

So where do we start? Well we look at various key foundation patterns of movement being:

1. Squat
2. Bend
3. Lunge
4. Twist
5. Push
6. Pull
7. Gait

And based on the findings of our assessment across these key foundational movements we determine where to start with each person. Often with MS we find that there is good coordination with arm movements of push and pull, the movement of squat is okay, but we see tremendous instability and dysfunction surrounding lunge, bend and gait (walking). Very similar findings to what we see with older adults with muscle loss and balance problems. Again this is not always the case, but in majority of cases it is what we find. You will find great detail about functional patterns in our free report on Functional Training you can get at the bottom of the page.

Below is a great video on how each of these patterns works and how we assess each one.

The most complex of all and the one many MS people will find hardest is GAIT otherwise known as walking.

This such a complex movement pattern to teach anyone for there is so many pieces of the puzzle all needing to be sequenced and timed just right in order to make this efficient. It is not so much a loss of strength that affects this, but more the lack of stability and coordination to move. Use of tools like the Sensa Mat or the Line Drill (see videos below) to challenge the brain about how to coordinate better is usually required if you want to improve walking efficiency. There is many exercises we might try here, again it all depends on the person in front of us and what they are capable of. Use of crawling and infant development if walking impairment is significantly loss can be a great stepping stone to eventually standing up and walking.

Great article to read about improving walking with several examples of not just MS but also spinal cord injury and cerebral paulsy are mentioned here - 6 Ways To Improve Your Walking Ability

We like to adopt what we call the success formula for improving the movement skill and strength of each of these patterns of movement. This is where we focus more on mobility and stability prior to strengthening. An example of several exercises we might use to improve the gait pattern is shown in the video below. 

A Real Life Case Study Of How Functional Movement Works

If you are still not sure that strength training is the key then read the story below of Steve a young guy with severe case of MS that has forced him into a wheelchair who has been training with us for about 18 months now.

"When I was around 16 years old I was really into going to the gym. I'd go 6 days a week with my mates and always reach new heights in strength and muscle size. One day when I came home from gym I felt numbness in my face and I could barely walk. I didn't think it was anything serious, as my mates and I would joke about it after a heavy gym session.

Then, a few months before my 18th birthday I was diagnosed with MS and the specialists said it was an unknown cause. From then on I was getting medicated for my condition as the neuro-specialists were saying it was the best thing for MS, however, I felt it was making things worse. I was losing mobility in my legs and losing some strength in my arms, then, about 7 years later I couldn't walk. From then on I have been doing some rehabilitation with occupational therapists and physio's who have helped me gain function with certain tasks and getting around places in everyday life, although, there were some stages where I felt like I wasn't getting pushed hard enough, having my typical gym mentality haha.

Now that I have found No Regrets I feel like I am getting pushed to my limits. Since I have been here I have had two operations on my toe that they had to take the toenail off from the ongoing MS symptoms, however, that isn't stopping me from trying to get back into things that I need my toes to help me walk and work my leg shard. Nathan has been getting me to walk with my walking frames, doing squats up and down the chair holding on sticks instead of using the frame, and now to the point of standing up without holding on! (see picture) I wish I would have found these guys earlier as I feel like I am getting closer to achieving my goal to being able to walk again. " 

Steven Nikolovski.

Here is a picture of Steve standing completely unassisted for the first time in years!

Summary

Multiple sclerosis is a very tough condition to work with and can really cause a lot of problems with daily living. It is clear exercise can help, in particular the use of Functional Strength Training methods that enhance how we move. In people with MS weakness, poor endurance and functional impairment can be a result of loss of muscle activation or muscle control. This is due to the disease process of MS or possibly from prolonged disuse just as we see in older adults. These secondary effects of disuse can be prevented or reversed in some people with MS, just as they can with older adults. The earlier you get started the better. Remember exercise does not make MS worse, if prescribed carefully and with an intelligent method of exercise selection based on your capability. But you must start and never stop.

For more information on Functional Movement Skills you can get a copy of our Free Report below by clicking on the image.

And if you live in Melbourne and would like to know more about our programs for MS and schedule a free consultation by clicking the image below and we will be in touch within 24 hours.

About The Author

Nick Jack is owner of No Regrets Personal Training and has over 15 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.

References:

• Multiple Slerosis Australia
• Functional Anatomy of the Pelvis and the Sacroiliac Joint - By John Gibbons
• The Vital Glutes - By John Gibbons
• Movement - By Gray Cook
• Corrective Exercise Solutions - by Evan Osar
• Back Pain Mechanic - by Dr Stuart McGill
• Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
• Low Back Disorders - by Dr Stuart McGill
• Ultimate Back Fitness & Performance - by Dr Stuart McGill
• Core Stability - by Peak Performance
• Anatomy Trains - by Thomas Meyers
• Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
• Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
• How To Eat, Move & Be Healthy by Paul Chek
• Scientific Core Conditioning Correspondence Course - By Paul Chek