Physical Therapy for MS: What to Expect
When you have multiple sclerosis (MS), your doctors may recommend physical therapy to help you better manage your symptoms. “I would say that at least 30% of MS patients can absolutely benefit from physical therapy,” says Patricia Coyle, M.D., a board-certified neurologist and director of the Multiple Sclerosis Comprehensive Care Center at Stony Brook Medicine, in New York.
And that number could be double or even higher when people are given a good set of exercises that they can perform at home, Coyle says.
If your doctor has recommended physical therapy for your MS symptoms, especially those related to mobility, strength, pain, and fatigue, here’s what to know to help get the most out of the first and subsequent visits with your therapist.
What to Expect at Your MS Physical Therapy Session
Upon meeting you, your physical therapist (PT) will discuss your specific goals and perform measurements to establish your baseline functional ability, says Palak Shah, a physical therapist and head of clinical services for Luna physical therapy in Rocklin, California.
As part of these measurements, your PT may use their hands to feel areas of concern. The PT also may ask you to:
- Walk so they can assess your gait
- Get up from a lying position or get in and out of a chair so they can assess your functional abilities
- Bend or lift so they can assess how you use your body for certain activities
Your PT will also likely use questions or observation to evaluate your:
- Pain levels
- Cognitive abilities
- Ability to do your job or activities around the house
The PT may also ask questions about whether you have an adequate support system, including family, friends, and co-workers, and any ways that your abilities may interfere with maintaining a meaningful social life.
With this information, your PT can formulate a treatment plan that is likely to include stretching, home exercises, controlled position changes, and energy management techniques, Shah says. The treatment plan your PT devises for you is meant to reduce your symptoms and improve your functioning over time.
Everyone’s MS is different, and your symptoms can change, Shah says. Your PT will tailor and adjust your treatment plan to address your specific needs as you work together.
In addition to physical exercises designed to improve areas that need help, your PT also may recommend that you see a speech pathologist, neuropsychologist, and/or occupational therapist, if necessary, based on the results of your assessment. The PT will also evaluate your need for assistive devices, such as a cane, crutches, or a rolling walker, and make recommendations for using them, Coyle says.
Tips to Make the Most of Physical Therapy for MS
Certain strategies can help you get the most benefit out of your time in physical therapy.
1. Look for a PT Who Has Experience with Multiple Sclerosis
You want someone who understands and has experience working with MS, Coyle says, so they can address its unique challenges. When looking for a physical therapist, be sure to ask how many people with MS they treat. If you’re being treated at a comprehensive MS center, its staff may be able to recommend PTs the center works well with, Coyle says.
“You need to find the best fit for you,” says Karl Burris, physical therapist, board-certified orthopedic clinical specialist, and founder and CEO of Live Life Physiotherapy in the San Diego area. “If you are lucky to live in the right city, there might be specific outpatient clinics dedicated to neurological impairments,” Burris says. “These clinics tend to spend more one-on-one time with the individual, which will likely make therapy for a person with MS much more meaningful and beneficial.”
Some PTs also offer online physical therapy, so if you have trouble getting to in-person appointments, telehealth may be a good option for finding specialized care.
If you’re a member of an MS support group, whether online or in person, ask for recommendations, Burris says. People often have stories they’re willing to share and are happy to recommend therapists who helped them achieve their goals.
The American Physical Therapy Association also has a searchable online directory in which you can filter the results by specialty so you can find someone who works with neurologic conditions such as MS.
2. Plan Ahead for Your Visit
“Nothing makes a physical therapist happier than seeing someone who is engaged in their treatment,” Burris says, and planning ahead for your visit means you can reap the most benefit, too. Here are some tips to help you take a proactive role in physical therapy for your MS:
- Keep a journal of your symptoms and any limitations. Then, bring it to your evaluation. “Your journal can best paint your picture of your life and how MS has affected it,” Burris says. While your PT will perform some objective tests to measure your physical limitations and areas that need to be addressed, as Burris says, “They are not nearly as important as your story.”
- Review your medical history. That first visit, your PT will do a medical history, so think ahead. “You should be prepared to answer questions about the timeline of your diagnosis and disease progression,” says Katelyn Palazzolo, a traveling physical therapist based in New Hampshire.
- Determine your goals and expectations for your visits. Doing so beforehand can make your time together more productive, Burris says.
- Check your insurance benefits. Your insurance may limit the number of visits you can receive, the frequency of the visits, and sometimes the type of care you receive, Burris says. It’s best to check in with your insurance provider and to be aware of your benefits ahead of time.
3. Gather Relevant Medical Reports
You should be sure your physical therapist has access to any lab testing results, imaging studies, or reports that can provide relevant information about your medical history and current condition.
Today, many healthcare providers use electronic records to communicate with one another. If yours do, then your PT may be able to partner with your other providers more easily to coordinate your overall treatment. Be sure to have the names and contacts of the members of your health team that you may want your PT to notify of your progress.
4. Ask a Friend or Family Member to Go with You
Your companion can be a second set of ears and eyes and help you remember what the PT tells you during your visit. While this tip goes for anyone, the additional support may be especially helpful if you have cognitive impairments, brain fog, or issues with your sight or hearing that could make it more difficult for you to keep track of instructions and feedback.
5. Understand It’s a Long-Term Partnership
You may not need regular, lifelong physical therapy for multiple sclerosis, but as Palazzolo says, “It may be a resource [you use] at various times to help you achieve specific, functional goals.”
For example, Palazzolo says, one of her patients with MS wanted to walk down the aisle at her son’s wedding without using a cane. “This required several weeks of foundational strength and balance training under direct therapist supervision,” she says. “Once she achieved that goal, she continued with her exercise program independently for six more months, only to return to therapy with a new goal of walking a 5K distance.”
Your goals and results may be different, so talk to your PT about what’s achievable and on what timeline.
6. Do Your Homework
Going to physical therapy for your MS is an important step, but progress is made through consistency. It’s important to remember that physical therapy works best when you do the recommended exercises and training at home in between visits with your PT. Be sure to make time in your schedule to do your exercises, and it may also help to enlist the support of loved ones who can help keep you accountable to your routine.
Physical Therapy as a Valuable Resource
A primary goal of physical therapy for MS is to maintain your ability to do your daily activities, especially when it comes to mobility, strength, balance, posture, fatigue, and pain, says the National Multiple Sclerosis Society. In this way, having a rehab professional like a PT on your side gives you an added edge over multiple sclerosis.
“I hope everyone living with MS knows that physical therapy is a powerful resource,” Palazollo says.
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