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Physiotherapy, exercise and neuroplasticity

Apologies for the anon.

I have had a revelation this week. In the midst of a relapse, which affected my legs, I sought physiotherapy to see if it might be helpful. Physio has not been offered to me as a treatment option to date.

The things I have learned through the physio session have changed the way I think about my treatment options with MS. I was diagnosed 5 years ago, and in that time, no one has clearly pointed out to me, or somehow I have not realised, the role that exercise and physiotherapy can play in the treatment of MS: now, I must stress that I fully understand that some people with MS are not able to exercise, and I very much hope that these are the people who have access to physiotherapy.

My MS has not been too bad until this point, and I’m thinking this is why I have not been offered physio after relapses. I’m guessing it’s reserved for people whose lives are affected much more severely on a daily basis.

But it seems that exercise could help before and when relapses happen - so why isn’t this flagged up to people with MS who can exercise as absolutely critical and fundamental from the day they are diagnosed? Some exercise and stretching is completely cost free and many people might be able to do some form of stretching or exercise that is suitable for them in their own homes.

Until the physiotherapist explained, I realise I did not fully understand how the nervous system worked and how stimulating it through exercise or physiotherapy can be beneficial for MS.

I had no idea that exercising and stretching can not only improve the outcomes for recovery from a relapse, especially in the early stages of recovery where the nervous system is still in healing mode and may respond better, but I also didn’t fully understand that by strengthening my body through exercise, which not only is good for stress (which seems to be the the main trigger of my relapses) that I can strengthen the way my nervous system and muscles work together so that they are in the best possible state to cope with further relapses.

I’m not trying to imply that exercise or physiotherapy is a miracle cure, particularly as some people with MS are not able to exercise, but for something that is far less expensive than drugs, it seems very puzzling that this is not promoted more as part of treatment options for MS.

I would be interested to know if physiotherapy is generally part of treatment options for people with more severe MS, particularly types where there is currently no drug treatment available?

There is some evidence that certain stretches and exercising moves stimulate parts of the nervous system and brain that might be working more slowly due to damage and that this can help. It seems that by exercising we are increasing our potential to stay mobile, as well as the overall health benefits of exercising.

For those who can exercise, I think the first thing that they should be told on diagnoses is to develop an exercise and stretching programe suitable for them, that they can do every day.

I feel so empowered by this new exercise programme. I feel that I am doing something else that could help me to stay well with MS.

The other thing I have discovered is the concept of neuroplasticity - the brain’s capacity to rewire itself after damage. Again, I’m not suggesting that this is some kind of miracle but it gives me hope and I think that understanding the immense power of the brain is very interesting as someone with MS.

Wikipedia neuroplasticity ’ refers to changes in neural pathways and synapses which are due to changes in behaviour, environment and neural processes, as well as changes resulting from bodily injury.’ This is a really interesting article - I recommend. http://www.time.com/time/magazine/article/0,9171,1580438,00.html

Hi Anon

I’m curious as to how long it took you to see a physio after your relapse? I relapsed in March and again was not offered physio so requested a referral in May. What a palava that was! My GP wanted to give me more steroids and in the end my nurse at the hospital gave me the number to self refer. I am still waiting to hear when I reach the top of the list … I have been offered gabapentin for pain relief but have declined as I really don’t want to take any more medication unless I get desperate.

In the meantime I am doing basic yoga stretches as I don’t think I can cope with a full yoga class yet and I’m loathe to waste money on a class when I cannot benefit from it fully. My yoga instructor agrees that it sounds like a full yoga class would be too much for me just now. However I do find that the basic warm up stretches that we do at the start of a class have really helped my legs and I’m eagerly waiting for the physio to show me some other exercises I can do particularly some that would help with my balance as that seems to be the main problem.

I looked at the MSS fact sheet re exercise and physio and it states that the earlier you have to start problems the more benefit physio is likely to be as it can prevent problems becoming permanent. I took it to mean that if someone points out that your gait is making things worse you can do something about it rather than compounding the problem.

However, when I was diagnosed 4 years ago, the hospital were happy to discharge me when I was only just able to walk again with no mention of physio. At the time I wasn’t even aware physio was available to MS patients and it is only by discussing such things on here that I am now aware of ‘my rights’ and I fight a bit more for access to these things. If I had been discharged with a compound fracture of the leg for instance, I am quite sure I would have been referred for physio as a matter of course so why are we treated with such disregard? I’m sure it comes down to funding (again!) as there seems to be just one physio in my area and there are a huge number of MS patients for her to cover. So we have to wait until she gets to us. My fear is that now I have waited so long and I have done my best to help myself I will be dismissed as not needing her help as she has so many more severe patients on her books when what I am trying to do is stop myself becoming that severe in the first place!

I have to say that I discovered yoga as a powerful tool quite by accident too. I was determined to do something to help myself and my legs were so achy and painful 4 years ago that I thought I would give yoga a try even though it was the last thing I felt like doing with achy legs. To my surprise I found it helped and it was also relaxing and enjoyable. My neuro and nurses seemed pleased I had taken up yoga but they do not recommend any form of exercise to anyone; we are left to our own devices to find out what works for us.

In fact, I think I have found out most things about MS for myself. I have been given the chance to ask questions but as I had already been told likely MS at an earlier date without any explanation I had already done some research beforehand. The only questions I have ever had are the ones they cannot answer; what is my future likely to be and what causes it?

Tracey x

Oops, para 3 should say ‘the earlier you start to have problems’

All physio referrals should come with a simple warning: Don’t hold your breath waiting.

I was referred at the end of Jan. As of now, I have not even been offered an appointment.

Geoff

Interesting thread, thanks Anon. If I recall correctly there was information on this website suggesting exercise should be short and vigorous to get the best results. I had physio following a stay in hospital, I think I was given 6 free sessions, it definitely helped me recover (to a degree). Went swimming yesterday for the first time in 2 years since I was hospitalised, shocked myself that having learnt to swim over 40 years ago my legs were all over the place and I ended up floundering around in the deep end!. I am interested in neuro pathways. What I have never been able to work out is my legs don’t work properly because of damage done to the myelin sheath, which effects messages being transferred along the central nervous system.The article on neuroplasticity suggests that new routes can be found for pathways that dont work, this is clear but if they are damaged how can we re-route them?. If there a way of shutting down the damaged routes for better ones?. Be nice if we could. All the best, Peter

I managed to finally get on the Physio list after my worst relapse 3 months ago but that was after making numerous calls and pestering the hospital, have had 2 sessions so far due for the next in 3 weeks time, can’t say I’m feeling the benefit as yet but at least it’s something positive. Don’t hold your breath though as the waiting list is pretty long but keep badgering them as much as possible.

Yes I’m also going to start swimming again as every little helps.

I am seeing my neuro on Friday and I know the hospital was hoping I would have had some physio by then so he could assess what damage the last relapse did. I shall make a point of telling him that I am still waiting and hope that the hospital offer to chase it up for me as my mobility is really restricted at the moment compared to how I was before the relapse. The longer I carry on like this, the more I think that this is going to be permanent. Whilst I can accept this, it doesn’t mean that I don’t want whatever help is available especially if there is a chance that my walking could improve.

Tracey x

The brain has numerous pathways to signal different parts of the body. When one gets damaged you can retrain it to reprogramme to another nerve pathway that isn’t damaged. This is possible to retrain the brain after every relapse to find different pathways round the problem and will continue to work until too much damage has been done. Think of it like an electricity board - once one fuse short circuits it shuts them all down but once you replace the new fuse all the other circuits start working again. Does that make sense?! Yoga and Pilates are both good at reprogramming the brain as they both stretch the nerve pathways as does swimming - also the cooksey cawthorne exercises are good for the brain and if you continue with the exercises and do them on a regular basis the brain retrains itself

I asked for physio as I was a fitness instructor myself, so this barely able to walk situation is making me a little crazy.

It’s been just over 2 months since I saw my neuro but I notice the last letter I received was CC’d to neuro-rehabilitation :slight_smile:

I am excited about it as my dignosis was largely on the basis of my osteo writing to my GP to say I needed an MRI, she was magic, I went to see her after a fall. Sadly I can’t afford to keep paying for treatment tho so will see what happens.

Sonia x

Hi

Neuroplasticity is something I’ve recently become interested in. I know stroke victims have been able to retrain their brains so that new pathways are found round the damaged bits, so in theory I don’t see why the same thing could happen with us.

I heard that people who are left handed have a better chance of recoverng from a stroke. A theory for this is that, as they live in a right-handed world, they are constantly having to learn new ways of doing things, forming new neural pathways. So if they have a stroke, their brains are already used to forming new pathways. As a result of this, I’ve started trying to do things with my left hand - brushing my teeth, using a computer mouse, things like that, as well as just trying to learn new things. Who knows whether it will make any difference, but even if it doesn’t, it’s fun to learn new things anyway.

Dan

I used to love swimming, but on my last holiday (and verified by a trip to my local pool) I have completely lost the ability to swim.

I can’t consistently coordinate enough to do ANY stroke and I can’t even float properly - I end up turning on my side like a goldfish that has lost use of its swim bladder

I have just started a series of appointments with a new neuro-physio. My neuro referred me as part of her action plan on my last appointment at the end of May.

I am quite hopeful because when I was referred in 2010/11 prior to diagnosis the lady I saw then was really helpful. I couldn’t even walk down stairs at the time and I fell over trying to negotiate flat floors (tricky b****** that they are). They aren’t miracle workers but after some intense work (but not exhaustingly intense) she got me functioning a lot better.

For me, one of the best things about it was I felt that I had a lot of involvement and control over my treatments as opposed to just being the patient who was having things done TO me.

I have only had 1 appointment with my new neuro-physio and she seems really clued up about MS and really nice to.

The only (tiny) downside is that the location where I see her is at the local hospital that does 90%+ of its work with elderly stroke patients. Lovely new facilities in the day hospital (new extension to the old cottage hospital which was the old workhouse!) but because of the usual patient demographic there I was the youngest patient we saw there by a long way. We felt that staff and patients were pointing me and my OH out as a bit of a novelty. “Ooooh. Look at her. She’s got a husband! And he’s still alive!!!”

Hi all,

New to the forum and MS.

I have found exercise to be my saving grace - especially pilates. Going to the gym i would push it too far and be shaky and dizzy after. But after pilates i walk better, I stand straighter and generally feel well balanced. Hope it continues.

I was offered physio when i could barely walk when pregnant and being diagnoised. They were great but didn’t feel i needed any further appoinments because i exercise.

Mich