The brain will naturally and automatically compensate for a certain amount of damage to the signals it receives for balance, but there can be things people learn to help compensate for changes – sometimes called ‘balance retraining’.  Some people find that working with a physiotherapist or rehabilitation specialist helps them to challenge their current levels of balance and improve their body’s ability to compensate.  This is not a quick solution, but over time it can be beneficial.

For example, a physiotherapist may pick up certain movements when you walk that are affecting your balance.  A relatively common issue for people with MS balance problems is landing on the front of the foot instead of the heel when stepping forwards.  This could be caused by changes in sensation or a weakness in certain muscles.  The result is that the body tips forward when walking, throwing the body off balance.  By improving both muscle strength and awareness of the way they step, people can compensate for the muscle weakness or change in sensation that caused the problem.  With practice, these new techniques become automatic.  

Having assessed what the most likely causes of imbalance are, a physiotherapist might suggest specific exercises to manage the problem.  A carefully designed physiotherapy programme can help improve balance.  There could be a range of different exercises that are useful, including exercises specifically to improve balance.  Physiotherapy might also improve your posture, and the strength and suppleness of your muscles, which in turn could benefit your balance.

Sometimes, a therapist may suggest using equipment such as a balance board, a Swiss ball (sometimes called a yoga ball) or a ‘whole-body vibration’ platform, which some people say help them to balance better.

Before trying any new exercise, or new piece of equipment, consult a health care professional to be sure it is safe and will not cause more problems than it solves.  If you attend group sessions, it is worth considering whether the teacher has experience of people with MS, or knowledge of the condition.  You may want to discuss how MS affects you and if there are aspects of the activity that might be adjusted to suit you better.  Remember, what suits one person may not be ideal for someone else.  Remember also that trying anything might feel difficult at first when your balance is not at its best.  But challenging your balance, safely and gradually, can be a way to develop it.  Finding the right exercises, at the right level for you, can make a real difference to how you feel.

Yoga, Pilates, T'ai chi, and the Alexander Technique are all forms of exercise therapy that people with MS say help them with their balance.  Clinical trials have found some benefits from t’ai chi, including improved walking speed.  Outdoor walking and aerobics may also help with balance.  One very small study in 2007 suggested that some people with MS may see improvements in their balance through hippotherapy – a form of physiotherapy using horse-riding.  As with anything else, seek the advice of a health care professional if you are considering it. The MS Society publications Exercise and physiotherapy and Complementary and alternative medicine have further information about finding activities that are safe, effective and suit your needs.  

Because problems with balance can vary from time to time and place to place, the best tool for the job may also vary. You might find a range of equipment useful.

You may find it helpful to use a cane or stick at times.  Some people find it particularly helpful in open spaces, or in unfamiliar places.  Folding canes/sticks are widely available from high street chemists (pharmacies) and specialist equipment suppliers.  Folding it away into a small bag can be handy, especially if you use it only in certain situations.

Some people also find wheeled walking frames useful – often known simply as a ‘walker’.  These can give not only a point of contact for balance, but also a support if you get tired.  They come in a range of sizes, often with brakes for the wheels, a seat if you need to rest and a place to carry bags.

Your occupational therapist and the Disabled Living Foundation can give you further details about equipment available.  An occupational therapist can also help you find suitable adjustments or adaptations.  To arrange for an assessment of your home, contact your local authority social services department or ask for a referral from your health care team.

Some people find that simply arranging the furniture differently provides a series of ‘balance points’ around the home, which helps them get around.  Small adaptations to the home may be helpful.  For example, hand rails along a garden path or at the entrance to the house, or a second banister on stairs.  The MS Society publication Adaptations and your home has further information about choosing and paying for adaptations.

If you are employed, there may also be useful changes that you and your workplace can make.  Employers have a legal duty to make ‘reasonable adjustments’ to help you do your job.  The MS Society publication Working with MS has further details, for both employers and employees.  

Research is going on in a number of places in the world into using technology to help people with their balance.  ‘Auditory feedback’ uses clicking sounds fed through headphones that respond to the type of footsteps the person takes (the sound changes according to the style of footstep taken).  This feedback of information to the brain appears to help it control the body’s balance for some people with MS.

Visual feedback can make use of ‘virtual reality’ technology – providing feedback to the brain through goggles that show an artificial floor surface.  This stylised image of a surface to walk on helps some people with MS to improve their walking, giving them more confidence and awareness.  These effects may continue for some time after using the goggles, as people remember the image of the ‘virtual floor’ when they walk.

These are both techniques in the early days of development and research, but are adding to researchers’ understanding of balance and coordination difficulties and how they can be managed effectively.  

This article on Balance and MS was adapted from the Multiple Sclerosis Society in the United Kingdom.