Multiple Sclerosis & Exercise
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MS is an autoimmune disease whereby elements of immune function mistakenly attack the body. The disease is characterized by fluctuation and remission or by exacerbation and progression of symptoms. No single laboratory test can diagnose MS. At this time, several procedures are needed to make a clinical diagnosis. These include a complete medical history, assessment of nervous system functioning, MRI scan, evoked potential test (measures how quickly and accurately a person’s nervous responds to certain stimulation), and/or spinal tap.
1. Signs of the disease in different parts of the nervous system.
2. Signs of at least two separate flare-ups of the disease
MS is the most common neuromuscular disease affecting young adults. The onset of symptoms usually occurs between the ages of 20 and 40. The disease is twice as prevalent in woman as in men.
Symptoms of MS
Common presenting symptoms of MS include muscle spasticity, weakness and fatigue. Disturbances of movement, coordination, and balance are also associated with MS. Vision and speech may be compromised. Ms can cause numbness and tingling in extremities, spasticity, tremors, weakness, fatigue, loss of bladder and bowel control. About one third of people with MS experience pronounced pain from their symptoms. Two thirds of people with MS do not experience a great amount of pain.
Secondary Symptoms can include muscle imbalance and weakness that may result in mobility impairment, poor postural alignment, and limited core stabilization.
Exercise cannot strengthen and correct muscle weakness that is caused by neurological impairment that is a direct result of MS. However muscle strengthening can aid in attaining functional physical fitness that can serve to offset the debilitating symptoms of the disease process.
Level 1 – Mild
People with this level of MS may be walking independently but may also walk with a cane. They may have some visual and coordination issues.
Level 2 – Moderate
People with this level of MS may be dependent on a walker or a wheelchair. They may be able to transfer themselves or they may require assistance.
Level 3 – Progressive
People with this level of MS may be paralyzed primarily in the lower extremities. They will spend most of their time in a wheel chair.
MS is a disorder of the central nervous system. For unknown reasons, in MS the myelin sheath, a soft, fatty, protective tissue that insulates the nerve and aids in nerve conductivitiy, is attacked and destroyed. In response to damage to the myelin sheath, the body sends neoroglial cells to attempt to repair it. In the effort to repair damage, scar tissue known as gliotic plaques form. The gliotic plaques cause the development of a tjhick, hard nerve coating. This impedes the communication of neurological messages attempting to pass along nerve pathways. This sclerotic/hardening process occurs at multiple sites throughout the body, hence the name multiple sclerosis.
Types of Multiple Sclerosis (common)
Relapsing-remitting: People with this experience clearly identified episodes of acute worsening of neurological function followed by periods without diseased progression and sometimes nearly complete recovery. In some cases, people experience a residual deficit in function. This form of MS usually begins with symptoms of vertigo (dizziness), numbness in extremities, and changes in vision. Episodes last for several weeks and tend to occur with increasing frequency.
Primary-progressive: (rare) This is indicated by a gradual and worsening onset of symptoms that include spasticity and motor incapacity. People experience nearly continues worsening of symptoms, which are not interrupted by distinct relapses. Despite some steady progression of disability, some people have occasional plateaus and temporary minor improvements
Secondary-progressive: Begins as the relapsing-remitting at onset, followed by progression with or without occasional relapses, minor remissions , and plateaus. It eventually converts to the progressive category. Half of people with relapsing-remitting MS develop secondary-progressive Ms within 10 years of their initial diagnosis.
Progressive-relapsing: (rare) People with this form experience progressive worsening of the disease from onset, with clear, acute relapses that may or may not resolve with full recovery.
- Fatigue: Usually mid-afternoon after waking up feeling reasonably rested
Spasticity: Most common areas of the body to be affected are the legs and postural muscles.
- Weakness: May be present all the time or only during times of acute flare-up. Pain leads to disuse and disuse leads to even greater weakness and los of functional fitness.
- Tremors: These are not predictable as exhibited with Parkinson’s disease. They tend to vary widely in intensity and oscillation.
- Balance, Coordination, and Gait: Often the first symptom of MS is the great mental effort it takes to perform movements that previously were automatic. They may observe foot dragging and shuffling or a foot that turns in while walking. They may exhibit shaking and jerky movements know as ataxia.
- Muscle Cramps and Spasms: Flexor spasms in muscles that increase flexion of a muscle may occur.
- Numbness and Tingling: Most often sensed toward the periphery of the extremities such as fingers and toes.
- Heat Sensitivity: High ambient temperature and humidity can exacerbate the symptoms and lead to fatigue, loss of balance, visual changes and general worsening of symptoms.
- Vision: people may experience optic neuritis in one eye where vision may be blurred for minutes. Response of the pupils to light is slowed.
- Hearing: Changes in hearing are rare.
- Cognition: 50% of people experience some degree of mild cognitive disfunction.
- Cardiovascular Dysautonomia: Irregular function of the autonomic nervous system leads to blunted heart rate and decreased blood pressure in response to exercise.
Research shows that the proper dose of exercise can provide people with MS with beneficial results. Loss of muscle strength resulting from the onset of neurological damage cannot be improved through exercise. However, muscle atrophy as a result of disuse can be.
Regular exercise can counteract muscle weakness, lower the risk of bone fracture, improve the efficiency of the respiratory system, increase bone density, lower stress, and contribute to a general feeling of well-being.
The benefits of regular exercise and therapeutic fitness training include:
- Maintained optimal health and decreased incidence of secondary health problems related to disuse syndrome
- Increased energy
- Decreased muscle atrophy
- Managed spasticity
- Improved cardiovascular function and blood lipid management
- Reduced risk factors for cardiovascular disease
- Reduced obesity and glucose intolerance
- Depression lessened or eliminated
- Improved sleep
- Enhanced self-esteem
- Improved balance and basic motor skills
- Activities of daily living become easier to perform
Incorporating mild interval training is an effective method to prolong stamina, as it enables people to perform more exercises without fatiguing or overheating.
Activities that necessitate pointing the toes should be avoided as that position might increase spasticity in the legs.
When strength training, focus on areas of muscle imbalance. Coordinate the flexibility portion with strength training static flexibility movements after that focuses on increasing mobility and lengthening of tight areas (chest, calf, and hip flexors).
It’s important to develop strength before endurance and participating in balance activities.
Use eyes to follow movement of a limb. This will increase periphery input and influence adjustments in stability.
Emphasize proper body alignment during all activities. Poor posture hinders controlled and safe movement
Incorporate warm-ups before exercise
Exercise progressions should be gradual and based on response and tolerance
Minimize stress to joints. Be prepared for low impact or non-weight bearing activities if person experiences compromised balance or numbness in their lower extremities, or orthopedic problems
Weight bearing helps to reduce spasticity, therefore, standing exercise are recommended if possible
Incorporate rotational exercise patterns to break up abnormal motor patterns caused by spasticity or rigidity
Do not bend neck forward (cervical flexion) as this type of movement can cause Lhermitte’s sign – a brief stabbing, electric-shock-like sensation that runs from the back of the head down the spine.
Simple movements before complex movements
Static moves before dynamic moves
Slow movements before fast movements
Low weigh loads before high weight loads
Two-arm movements (or two-leg) before single-arm(or single-leg) movements
Stable surfaces before unstable
Quality movements before quantity of movements
Focus on core of trunk as well as stabilizers of each joint
Employ proper use of open kinetic chain moves versus closed kinetic chain exercises.
Focus on proper use of concentric, eccentric, isometric, isokineticand plyometric moves
A comprehensive fitness program should incorporate perceptual-motor skills, visual, auditory, tactile, and proprioceptive senses.
Balance training is important as it underlies nearly every static and dynamic posture that requires the body to be stabilized against the pull of gravity
The goal of cardiovascular exercise is to between 50%-80% of max heart rate