EXERCISES FOR PEOPLE WITH MULTIPLE SCLEROSIS (MS)
 Section 1

 POSTURE
 

Posture is simply the position we hold our bodies in, whether sitting, standing or even lying down.  If we have “good posture”, it will prepare us and allow us to move in the way we want.

If we were asked to define “good” posture we might imagine a ballet dancer, standing erect, body completely aligned, ready to move with the music, or possibly an opera singer, poised and balanced with chest stretched and expanded ready to sing.  You can’t be a good opera singer with poor posture - if the rest of your body isn’t in tune then neither will the voice be!  Dancers and singers alike need to position their bodies to allow them to achieve that flow of graceful movement or control of voice to produce beautiful music.  In common with dancers and singers, we have the potential for free flowing movement and this is best achieved when we start from the right position.

Try this: sit slumped in a chair and shout “hello” Then try: the same again but this time sit up straight and allow your chest to expand.

From an upright position it is much easier to shout.  You are able to get more air into the lungs to force out the volume of noise and the shout is louder.

Look at someone who is angry and raising their voice.  Look at a mother telling off her child.  Even if she’s looking down at the child, she’ll bend from the hips to allow her chest to expand fully!  When you have MS then it can make you feel different - maybe your eyesight has altered or your balance seems a bit less reliable.  Even if there is no muscle weakness, MS can change the way you move and behave, making you feel as if you are more likely to fall over.  When you’re three, it’s not unusual to fall over, be picked up, cuddled and all is well.  However, when you are adult and you fall, then you feel very self-conscious and it’s also likely to hurt more!

Because of this, people tend to drop their centre of gravity and droop from the chest in an effort to get a bit closer to the floor - it doesn’t seem quite so far away!  It’s easy for this changed posture to become a habit which then affects the ability to move fluently.  The movement becomes stiff and stilted, causing the flowing nature of “normal” movement to be lost.  This difficulty is caused mainly by the altered position of the pelvis – which is really important in maintaining and improving the body’s stability and its ability to move and function at optimum level.  It’s also likely to cause back and neck ache and to squash the abdominal contents and lungs, restricting eating, and breathing.  Apart from anything else, it doesn’t look as good!
what to look for if you’re standing…

Don’t forget the position of your head.  Some of us have a tendency to stick our nose in the air when we stand up straight - don’t do it! Keep the head level, the eyes fixed on a window frame or picture and the chin tucked in.  The “chicken position” makes your neck ache!  Being able to hold a good posture takes time, practice and can only be done slowly.  If you can work it into your daily routine, it is much easier and hopefully will become automatic.  Take a few seconds to really look at yourself in the mirror in the morning or watch yourself in a shop window as you walk past.  It can also be helpful to get someone else to help you check your body alignment.

what to look for if you’re sitting…
Wherever you’re sitting, remember to adjust your position to suit you.  The bottom needs to be well back in the seat allowing the knees to bend at a right angle without pressing into the back of the thighs or calves.  Feet should rest on the ground.  If you are a bit on the short side then try a book under your feet; telephone directories are perfect! If you are sitting in a wheelchair make sure your feet are in the right place on the foot-plates and that the foot-plates are adjusted correctly.
As with your standing posture, try to incorporate checking your sitting posture into your daily routine.  Perhaps when you’re watching a TV programme, you could use the time for the theme music or the advert break to check how you are sitting? You may be reading this and thinking, “Why bother? It’s all part of having MS and something you have to put up with.” Some of that may be true.  But the brain is a marvellous organ and will put us into postures that make us feel less vulnerable and, if not checked, that can cause problems further down the line – especially if you have MS.  The way you sit or stand may be causing you to work much harder, making life more difficult.
 your pelvis matters!

a typical scenario…A few years after diagnosis, one leg doesn’t seem to be working as well as the other so you lose trust in it and adopt a posture which favours the “stronger” leg.  The body weight is transferred towards the “good” side.  Then, to further protect the weaker leg, you hitch up the hip of that weaker side, pulling the pelvis up and slightly backwards, and causing the pelvis to tilt away from the horizontal.  If unchecked, over a long period of time, the spine also realigns itself to cope with the tilted pelvis and it feels as if one leg is longer than the other - when in fact the problem all stems from the tilting of the pelvis to take the weight of the so-called “bad” side.  The pattern of movement is changed and becomes one-sided and in extreme cases even “crab-like”.  The hip is pulled up and often slightly backwards.  The foot may then turn outwards and drag on the floor.  This altered posture may also cause back and neck pain.  Although there may be some weakness around the ankles, walking can still be dramatically improved if the alignment of the pelvis is changed.

so, what can you do to improve things?

where do you start?

LookUse a mirror to look at how you stand, perhaps in your underwear so that you can see the bony points of your hips.  Check that both bony points are at the same level and pointing forward.  Feel
If you have no mirror, stand with your tummy against the kitchen sink [or somewhere similar] to check your hip bones are level and pointing in the right direction.

 In particular do the exercises which will make the pelvis move both forward and back and then from side to side. 

If at first the exercises seem hard, just do a few at a time and persevere; they will help in the long run.  The important thing is to start gently and gradually build up what you can do.  Half the battle is knowing what the problems are, then gradually try to change things.  If your posture has altered over a period of time, then, logically, it will take time to change it again.  It may not be possible to reverse all the changes that may have occurred but it is important to remember that there is progress in not allowing things to get any worse.  If you stay the same, you’re doing OK.  However, there are very few people who do not notice some improvement once they start an exercise programme.

The position and alignment of the pelvis is crucial.  Get it right and everything else becomes easier - sitting, standing, walking and, of course, exercising.