Physiotherapy and exercises

Movement, through physiotherapy and exercises, is an important way to manage muscle stiffness, whether it is mild or severe.

Whatever exercise or stretching plans you agree with your physiotherapist, doctor or MS nurse, they need to be ones that you can continue to do yourself at home, either on your own or with help from family or carers.  Therapies like this are most effective when they are done regularly.  Always consult a health care professional before starting new exercise plans or trying out different therapies.  They can help you be confident the therapy will not be dangerous, or do more harm than good.

If you are unable to actively move the affected part of your body, it can be useful if a carer helps with what is known as 'passive movement' – where the arm or leg is moved by someone else, to stretch the muscle and keep the joint supple.  A physiotherapist can help you and your carers learn appropriate techniques.

'Range-of-motion' describes the amount of movement you have in each joint.  Good range of motion describes a joint which can move very widely.  Poor range of motion is where a joint can only move to a limited extent.  Exercises designed to help you keep maximum movement can bring benefits in two ways: they may reduce muscle stiffness and can also prevent knock-on problems like stiff joints from lack of use.  In severe cases, joints can become locked in one position, leading to postural and hygiene problems. A physiotherapist can show you active or passive exercises that match your abilities and help you avoid these problems.  If you have muscle stiffness, it is important to begin these kinds of exercises as soon as possible, to minimise the risk of problems later. 

Along with range-of-motion exercises, stretching muscles can also help prevent long-term complications.  When muscles are working normally, they stretch and contract, getting longer and shorter as the body moves about.  Stiff or spasming muscles can be stuck for long periods of time in a shortened state.  In the long term, this can lead to pain in the muscles, or in the tendons that connect them to the bone. Daily stretching, to lengthen affected muscles can help avoid this. 

Sometimes, applying gentle pressure or lightly stroking a muscle can help get more out of range-of-motion and stretching exercises. Touching the muscle like this may calm the message pathways and relax the muscle, allowing you to stretch or move a little further. 

If muscles do not get much use – perhaps because of stiffness, spasms, or other MS symptoms – they will get weaker over time. This can make daily activities and moving about more difficult.  Strengthening exercises, sometimes involving lifting or moving weights, can help prevent this, by making the muscles stronger. 

Some people find that relaxation techniques and deep breathing, such as those used in yoga or t'ai chi, for example, help them relax when exercising.  These kind of techniques can be learned with books or tapes, or through classes.  If you join a class, you might want to explain your needs to the teacher beforehand so that they are aware of any adjustments you might want.  It is important to take any exercise at a pace that suits you.
 

Not everyone with MS is affected by heat, but some are particularly sensitive.  Hot weather, an over-heated room and exercise can all make MS symptoms worse.  This is a temporary effect – when the body cools down again, symptoms return to the level they were before.

If you are sensitive to heat, keeping cool during or shortly before exercise may help you exercise for longer, or more strenuously, without bringing on heat-related symptoms.  This could be done with ice drinks, cooling garments, or with regular breaks to prevent overheating.

Research showing benefits for these cooling techniques is not conclusive, and they may not help everyone, but they are unlikely to be harmful.  With the support of a health professional, you may find a cooling method that works for you.

Lowering the body’s temperature, with cold baths or cooling garments, might also reduce some people’s muscle stiffness temporarily. Applying cold packs or cold towels directly to affected muscles may give temporary relief for spasms or stiffness.  Again, research is not conclusive, but you may find such cooling techniques help your symptoms.

In contrast, some people with MS find that cool temperatures make their spasms or stiffness worse.  For these people, exercising in a warm swimming pool may help with stretching and relaxing muscles.

Be careful with hot and cold therapies.  When applying cold directly to the skin, or when using cooling garments or cold water to cool the body, care should be taken not to damage the skin.  MS can cause changes to the way you experience temperature, distorting the feeling that would normally tell you when something is too hot or too cold. It is sensible to consult your doctor, MS nurse or physiotherapist if you are thinking of using such techniques. 

Only a physiotherapist can instruct you on the proper way to exercise.