M.S is an inflammatory disorder of the brain and spinal cord (central nervous system). It is predominantly a disease of the white matter tissue, which includes the nerve fibres that transmit signals around the body to and from the brain and spinal cord.

Each nerve fibre is surrounded by a protective sheath made up of a substance called myelin. In M.S the disease causes plaques to appear on the myelin sheaths which leads to interruption of the nerve transmissions of those nerve fibres affected.

This block of transmission causes symptoms to occur, such as visual problems, muscle spasms, muscle weakness, limb tremors, pain, numbness, tingling, reduced balance, urinary symptoms and fatigue.

What causes M.S?

About 1 in 1000 people in the UK develop M.S. It can affect any age and any individual but is very rare in young children. Common disease onset is around the age of 30, more common in women than men.

It is thought that M.S is an autoimmune disease, which means that an individual’s immune cells, normally designed to attack viruses and bacteria, start to attack the body instead. The trigger for this to occur is unclear but one theory is that a virus or environmental factor initiates this autoimmune response in individuals with certain genetic makeup – i.e. some people may therefore be more prone to developing such a disease due to the way their bodies are programmed. It is also thought that there may be a possible geographical link to the disease.

Diagnosis: firm diagnosis is not often made following the first symptom, as many of the initial symptoms such as short periods of blurred vision, leg tingling and numbness can be one-off problems linked to other conditions. Often the diagnosis is made after 2 or more relapses have occurred, as symptom presentation then becomes more obvious. It is confirmed often by MRI scan but in conjunction with examination and history taking by a GP / specialist, and occasionally by performing a lumbar puncture.

How does the disease progress?

M.S is usually a slow progressive disease, and symptoms vary hugely between individuals depending upon severity of the damage and areas of the central nervous system affected. Some people can show few or occasional symptoms, and others are affected more significantly with widespread symptoms and severely impaired function.

Once the disease is triggered, it normally follows one of the following patterns:

Relapsing-remitting (R&R) Characterised by relapses (exacerbations) which cause new symptoms to occur. Symptoms may last for a few days to 6 weeks but can also last for months. Symptoms then remit (go away) and during the periods of remission, a person can fully or partially recover from the deficits of the remittance. Further relapses and remissions then occur over time – one to two every two years if common. Consistent cycles or R&R over time cause more permanent scarring to the myelin of the nerve fibres which can result in reduced recovery following each relapse. Relapses can flare older symptoms or may result in new ones. After several years of R&R, some symptoms become permanent as the damage to the nerve fibres themselves occurs.

Secondary Progressive M.S (SPMS) This phase of M.S happens a number of years after R&R M.S has occurred and is characterised by a gradual worsening of the disease between relapses. The periods of remission become shorter and slowly the relapses merge into a general progression of deterioration. Some individuals in this phase may experience good and bad days / weeks but no real symptom recovery occurs.

Primary Progressive M.S (PPMS) This occurs in about 1 in 10 people with M.S. It is characterised by a gradual progression of the disease from the onset with no initial R&R course. Symptoms gradually worsen from the outset and do not recover. As with SPMS, there may be good and bad periods of time. Damage is confined more to the spinal cord than the brain therefore symptoms are less often cognitive with PPMS, and more physical.

Benign M.S (BMS) Affects less than 1 in 10 M.S suffers and is characterised by only a few relapses in a lifetime where no symptoms remain permanent.

Physiotherapy for M.S

The interruption of normal nerve signals from the brain to the limb muscles often means that movement becomes more difficult, balance and sense of position is affected and in turn functional ability is compromised.

Research clearly shows that physiotherapy input is vital in containing the effects of MS. This is achieved through muscle pattern retraining, stability and strengthening work and various manual therapies to reduce pain, improve movement and co-ordination, and restore function. Regular physiotherapy is an important way of managing the disease and its progression.

Through individual assessment of the individual and analysis of particular areas of difficulty a specific treatment and rehabilitation programme can be established to tackle the presenting symptoms and functional problems. The individual's progress can thereafter be monitored and his/her programme adjusted to suit any changes in condition as soon as they become detected. The aims of physiotherapy are to:

• Improve and maintain joint mobility.
• Improve and maintain balance and co-ordination.
• Reduce muscle spasms.
• Maintain normal patterns of movement.
• Maintain and restore function
• Improve general fitness
• Optimise independence and quality of life.

These in turn will help limb control, reduce spasticity, improve strength, aid walking and act against further secondary complications.

Following a relapse, physiotherapy may need to be provided in intense and focused bursts of sessions, to tackle any newly presenting symptoms and optimise recovery. Exercises and rehabilitation may then be required on a maintenance basis during remissions, but continued independent home exercises are strongly encouraged to ensure full potential is continuously achieved and maintained.

At PEAK Physiotherapy, home-based sessions can be arranged and inclusion of carers and relatives in the physiotherapy process when required by the individual, is considered an important part of maximising rehabilitation.

We also have a designated neurorehabilitation clinic (Iveridge Hall), with a bobath treatment couch for physiotherapy purposes as required.

For all enquiries or to arrange an appointment, please click here, or telephone Cathy Preston on 07908 684440 or Sarah Joice on 07908 684441

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