Multiple Sclerosis (MS) is an autoimmune disease in which the nerves of the eye (optic nerve), brain, and spinal cord lose patches of myelin. MS is a slow and  progressive disease where demyelination occurs to the nerves.

The video below explains how myelin sheath carries out nerve impulses important to our body to produce accurate movement and receive sensory input and how demyelination affects with MS.

Signs and Symptoms usually occur between the ages of 20-50; women are more likely than men to have the disease.

Sensory Symptoms

• Numbness

• Tingling

• Dysesthesias

• Visual disturbances

• Lack of sensation in the Vagina

• Sexual impotence in men

• Dizziness or Vertigo

Motor Symptoms

• Weakness

• Clumsiness

• Difficulty in walking or maintain balance

• Tremor

• Double vision

• Bowel and bladder control, constipation

• Stiffness

• Unusual tiredness

General Principles used in Physical Therapy for Patients who have Multiple Sclerosis:

• Allow maximal use of compensation techniques by strengthening the unaffected muscle groups.

• Use adaptive devices such as, a cane, walker, crutches, to remain ambulatory and maintain strength levels as long as possible.

• Home exercise programs are essential along with patient education on safety awareness. It is important to carry on at home on a daily basis to increase effectiveness.

• Expect a slow progression with strengthening program with frequent rest periods of 1-5 minute throughout the session to increase recovery.

• Stretching should be done first prior to exercise program to decrease spasticity, increase flexibility, and increase circulation to the area.

• Since patients with MS are sensitive to heat a cool atmosphere is important to allow more efficient exercise.

• Emphasis on proximal (close to the trunk) strengthening is important to decrease fatigue and increase energy conservation.

• Light weights may help tremors by increasing stabilization in joints.

Additional Resources

National MS Society

Multiple Sclerosis Association of America (MSAA)

Multiple Sclerosis Foundation (MSF)

Coping with Lupus

I was diagnosed with lupus about two years ago with a lot of joint pain accompanied by inflammation, nausea, abdominal pain, fatigue, and muscle achiness for the past five years. I wanted to share with you how I take care of myself. Don’t get me wrong I have my “good” days and “bad” days and know when it is going to rain better then the weather forecasters. At times I wanted to give up and just crawl into a cave and never be bothered. I also learned that I have no choice other then keep on trying and take control over it before it takes control over me. I am in the physical therapy industry and had many doctors telling me I should look into a different career path. Let me tell you I am not able to be in one position to long without increase symptoms. So sitting in front of a computer desk is out of the question and standing in one spot you can just forget about it.  I have a job that is already best suited for me because I am never in one position too long and I feel great doing it. By moving around (yes in the morning at times I am a bit stiff) I have less pain and stiffness as the day goes. My answer too many doctors about changing career paths…I chuckled and then I asked him “What is it that you think I can do?” I love what I do and I am going to continue being a physical therapist assistant for as long as my body lets me.  Learning to cope with this was difficult and I took some steps along the way to improve my well-being with education. This is what I want to share with you. Everyone is going to have their own way that helps and please do share as we can learn from each other. The more we educate ourselves about varies topics the more tools you have in your bag to use. You could say I give my own dose of physical therapy to myself.

If you don’t know already lupus is a type of rheumatoid arthritis. There are more then 200 different kinds of arthritis. There are four different types of lupus alone. Systemic lupus Erythematosus, Cutaneous Lupus Erythematosus, Drug-induced Lupus Erythematosus, and Neonatal Lupus. To learn more visit Lupus Foundation of America, Inc

I will not discuss about the different types of lupus or the cause but more about how I treat it. There is no cure for lupus so I believe sharing my coping skills may help others place more “tools in their bag” with different options to try to help alleviate symptoms. As I mentioned above lupus is a type of arthritis and may help those suffering from arthritis as well.

Ways I cope:

The most important role with coping is being aware of your flare-ups. Keep a journal of what you eat, how much sleep you get, medications, herbal remedies (as some can make lupus worse), and your daily activity. Place a number of how the pain is which could be done with a 0-10 pain scale with 0 being no pain and 10 being excruciating pain when flare-ups occur. For instance certain foods can make symptoms worse. For me it was foods that contained a lot of carbohydrates and I realized I was more fatigued and achy throughout my body. I cut down by carbohydrate intake (these include white bread, pastas, and cereals…all that good stuff I just love) and replaced them with more fruits and vegetables, fish, and poultry. I noticed a difference with my energy level and the decrease of achiness throughout the day.

Stretch and Exercise

This is very imperative to me. Without your muscles being strong and flexible to give you range of motion in your joints, strength, and stability then it will be very difficult to move. Think about it without stretching your muscles become shortened which limits your ability to move through the full range. Flexibility is also important to decrease the pressure to your joints. The strengthening exercises are the “glue” to your joints with stability exercises for mobility. I want you to understand your skeleton is the framework for your muscles. Your muscles need to be functioning and working in order to move. While moving around your joints produce what’s called synovial fluid therefore producing nourishment and lubrication to the joints.

Before I get out of bed I start with my exercises to decrease my stiffness. I also stretch throughout the day. I am no longer able to perform many repetitions on mechanical machines or with resistance as I know this flares me up so I stick to one set of 10 repetitions with moderate weight. I have learned what machines I can use such as the bike and treadmill (but no running).  I also discovered the swimming pool which is a great way to work out because of the bouncy component. This took me over a year to find out what works for me along with a lot of frustration. I thought to myself I used to go to the gym everyday for 2-3 hours without any problems. Then someone once told me “You need to find your baseline and its going to be a trial and error method.” That means find what you can do and then progress from there and when you flare-up then you stick to your baseline. When I get a bad flare-up I can only stretch and do my gentle exercises in bed. Then when my flare-up becomes tolerable I stick to what I call my “gym baseline.”  Be patient and try not to add to many variables at once so you know what to cut out. Find out what your exercise tolerance is. Everyone is different.

Take time to Relax

This is important to calm your mind, body, and soul. Your muscles will relax, your mind will clear, and you will get a good night sleep.

Since lupus is an autoimmune disease getting a good night of sleep is important to boost your immune system. I make sure I get at least 8 hours of sleep. I found that this helps minimize my flare-ups.

The Greatness of water

I also use an electrical heating pad to help alleviate my muscle spasms and tension. Today there are many different and inexpensive heating packs.

I make my own cold packs to decrease my inflammation or swelling. Click here to find out how to make your own cold packs.

I invested in a paraffin bath that uses paraffin wax for my hands  for about $30.00. This really helps soothe my hands after a long day of work.

Relax a Moment

Treat yourself to massage. This could get pricey though. Check out my article on how to self massage the bottom of your foot. There are also many tools out there on the market for self massaging techniques although my personal favorite tool is a tennis ball. I use it on my back by either lying down or leaning against a wall to hit the trigger points. Make sure not to go over the spine when performing this technique.

Meditation is clearing your mind from EVERYTHING and focusing on a specific task such as yoga, a specific object, a mantra or on your breathing.  I find this to be the hardest, especially when the kids are around, and I am still working on mine everyday. Choose a quite location. You want to limit any distractions. So I wait until bed time before I go to sleep or while taking a bath. I also do a little “mini” meditation during my lunch break to feel refreshed. No I don’t sit there with my legs crossed with my hands rested on top; I use a breathing technique and focus purely on my breathing. I take a deep breathe in through my nose and out through my mouth while my eyes are closed. Making sure to relax your shoulders, neck, and chest muscles pick a comfortable spot so when you breathe to use your diaphragm.  This means while breathing in (inhaling) to fill your stomach up with air instead of using your chest, shoulder, and neck muscles.  As you get better at this you can use this technique in stressful situations to decrease stress and tension resulting to decrease muscle spasms.

Vitamins

I grew up with vitamins. My dad used to be a fanatic about it. I used to take all sorts of vitamins. As I got older I kept adding and adding on until I started to feel worse and very nauseas with trouble sleeping. So that’s when I started doing some research and found that it is important to get most of your vitamins from your food intake except that I wasn’t getting enough of what I needed. Vitamins are not a meal replacement but a nutritional aid. Speak to your doctor regarding the use of vitamins and what you are deficient of.

Video regarding vitamin use from the FDA

Be strong and live long. Get to know your body better and avoid triggers that make your symptoms worse. It is not an easy journey but I hope this helps ease your symptoms and improve your strength both physically, mentally, and emotionally. Talk to your doctor of the different treatment options readily available. Please remember that you can’t let lupus or anything else control you…you must control it.

Tennis Ball Massage

Did you know?

When releasing a knot in your muscles your body also releases a metabolic waste (which is a good thing) but you may feel sore for 1-2 days. Make sure to drink plenty of water to flush out the metabolic wastes and to speed up the process a cold pack application may help remove the metabolic wastes.

National Laugh- Friendly Month

Go ahead laugh! Laughing is good for you and contagious. Not only does it bring closeness between others but it also helps with stress, strengthens your immune system, boosts your energy level, and helps diminish your pain. And good news about laughter, it’s free, fun, and easy to use!

How does laughter help with stress?

By laughing it reduces the hormones produced such as cortisone, epinephrine, and adrenaline and increase the production of endorphins and neurotransmitters making the body feel oh-so-good.

How does laughter help with immune system?

Humor is bliss! It is amazing how your body responds to something so positive. While laughing, the number of anti-body producing cells increases, which improve the function of the T-cells.

How does laughter boost energy?

By improving you immune system, relaxing your muscles, and increase the production of endorphins all from laughing you produce a lot more energy. A lot of energy is used for pain alone so imagine decreasing your pain level with a dose of humor.

How does laughter help diminish pain?

Laughing decreases tension in your muscles along with your heart allowing increase supply of blood flow throughout the body. Thus, you decrease the chances of a heart attack.

So what does this all mean?

Laugh!

Initiating movement may be one of the most difficult task to accomplish and can be very time consuming. Some feel like they are “stuck” to the ground or there is a magnet pulling them to the floor making walking difficult resulting in a shuffling gait.

Ways to help initiate movement

Moving to the beat of the music helps with continuous walking or place an object to step over like a broom stick to initiate walking. Studies are still being conducted with the correlation of music and Parkinson’s disease. I have tried both methods with my patients and works great. I also use counting or snapping a beat to keep them moving.

Posture

Stretching is important to increase upright posture along with strengthening. Usually the hamstrings, hip flexors,calves, abdominals, and pectorals are tight and should be stretched on a daily basis. Strengthening the extensor group muscles along with the shoulder girdle is going to be ideal to increase endurance to maintain an upright posture.

Knowing what is around you is crucial to avoid falling. Look out for steps, rugs, furniture, and any object obstructing your way. Make sure to pick up your toes when walking to avoid tripping on your feet!

Be on a daily fitness program

Either provided by your physical therapist as a home exercise program or local gym, it is important to stay on a daily fitness program. Afraid to fall? There are many programs out there that provide seated exercises targeting people with Parkinson’s disease.  Can’t find a facility close to home? Is transportation a problem?  The list below includes chair exercise DVDs that can be performed in the convenience of your own home.

Sit and Be Fit

Gentle Fitness DVD

If your doctor clears you there is also aquatic therapy classes so you don’t have to worry about falling while exercises. Make sure the facility provides assistance if needed to get in and out of the pool.

Aerobic Exercise

An aerobic exercise is a great way to increase your endurance by strengthening your heart and lungs by walking, biking, and swimming for 10-30 minutes.

Energy Conservation Techniques

Ways to conserve energy is practicing daily activities such as ambulating with an assistive device correctly. I see so many times when patients use a cane on the wrong side and not adjusted correctly to their height. Your therapist will help you determine all aspects of correct use of an assistive device. Another mistake people do is lean over on the rolling walker! Again another problem is the usage and adjustment of an assistive device along with receiving proper gait training.

Transfer training will also help conserve energy. Examples of this would be getting in and out of bed or a sit to stand transfer. If not done correctly it may take a few tries and before you know it your out of breath, your back hurts, your knees are strained and you are out of energy.

A physical therapist can educate and train you to conserve energy with treatment. You may not be able to do this independently depending on your status but with some ease. Maybe your caregiver, family member, or significant other is taking care of you. It is important to save their back too. Caregiver education is crucial for proper body mechanics to avoid injury on both parties. It would be very difficult for both of you to move around if you are both hurting.

Indication for Physical Therapy

• Balance problems

• Shuffling Gait Pattern

• Incoordination

• Immobility

• Pain

• Fatigue

• Muscle Weakness

Benefits of Exercise

• Improve coordination

• Improve bowel and bladder movement

• Increase range of motion

• Energy conservation techniques

• Maintain or Improve posture

• Increase safety Awareness

• Increase strength and endurance

Additional Resources

American Parkinson’s Disease Association

An organization that focuses on research, patient support, education and raising public awareness for Parkinson’s disease.

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Parkinson’s Hope

This site provides description of exercise program, healthy eating and support system

Physical Therapy

Goals of Physical Therapy:

• Prevention
• Patient Education
• Home exercise program
• Decrease pain and stiffness
• Increase range of motion
• Decrease inflammation
• Improve mobility
• Increase strength and stability

Physical therapy treatments may consist of:

• Therapeutic Exercises: increase strength and stability
• Range of Motion (passive, active assist, active)
• Progressive Resistance Exercise
• Mechanical Machines

Modalities: helps with pain, relaxation, inflammation, and strengthening

• Ultrasound
• Electrical Stimulation
• Laser Therapy
• Thermal Application
• Traction
• Iontophoresis
• Whirlpool

Manual Therapy

• Joint Mobilization
• Massage
• Passive Range of Motion
• Stretching

Prevention/Patient Education

• Home Exercise Program
• Proper Body Mechanics
• Safety Awareness
• Self Care Techniques

Stretching Techniques: to improve range of motion

Gait Training: regain or improve proper ambulation

• With or without use of an assistive device

Transfer Training: transitioning from different positions to improve energy conservation and prevent injury

• Sit to stand
• Supine (on your back) to sit

Balance Activities: improve proprioception (where the body is in space) to prevent falls

Prosthetic Training:

• Skin, scar, and stump management
• Regain function
• Care of prosthesis

Wound Care: to avoid infection and increase healing

• Debridement
• Dressing

Aquatic Therapy: to increase flexibility, strength, and stability

• Characteristics in water include bouncy, resistance, and hydrostatic pressure (helps with swelling)

If you enjoyed this article you may also like this one:

What is the difference between Physical Therapist (PTs) and Physical Therapy Assistant (PTAs)?

Apply cold and hot pack to painful areas for approximately 10-15 minutes.

You could also try to alternate the cold and hot pack for example:

-> Cold pack for 10 min followed by

->Hot pack for 10 minutes

->Then cold pack for 10 min and so on…by alternating hot and cold every 10 minutes

Did you know?

This creates the blood vessels to constrict (get smaller) with the cold pack and dilate (become enlarged) with the hot pack acting like a pump to get rid of metabolic wastes so “fresh” blood can enter to nourish the cells.

What is the difference between Physical Therapist (PTs) and Physical Therapy Assistant (PTAs)?

You Can Be Me — A Career in Physical Therapy (APTA)

The list below is in alphabetical order with a brief description of most common used medical specialist. To learn more click on the specialty.

Anesthesiologist: administer anesthesia

Cardiologist: specialist in the heart

Dermatologist: specializes in skin, hair, and nails

Diabetologist: specializes in diabetes

Endocrinologist: specialize in hormones produced by the glands.

Gastroenterologist: specialize in disorders in the gastrointestinal tract, including esophagus, small and large intestine, stomach, liver, and biliary system which include gallbladder, bile, and bile ducts.

Gynecologist: specializing in the female reproductive system, including, uterus, vagina, and ovaries.

Hematologist: specializing in blood disorders

Immunologist: specializes in the immune system

Internist: focus on adult medicine

Nephrologist: specializes in kidney diseases, transplantation, and dialysis therapy.

Neurologist: diagnose and treat disorders of the nervous system. The nervous system includes the brain, spinal cord, nerves, and muscles.

Neurosurgeon: specializes in surgery of the nervous system.

Obstetrician: surgical specialty along with care with pregnancy, labor, and puerperium, the time immediately after delivery.

Oncologist: specialists that diagnose and treat cancer.

Ophthalmologist: eye specialist concerning medical and surgical problems.

Orthopaedist: specializes in skeletal deformities that include bones, joints, ligaments, and muscles.

Osteopathic physicians: diagnose and treat all illnesses and injuries as a whole.

Otolaryngologist: specialize in the ear, nose, and throat.

Pathologist: study the cause and development of diseases.

Pediatrician: specialize in children from birth to early adulthood.

Podiatrist: specializes in the foot, ankle, and leg.

Psychiatrist: specializes in mental disorders.

Pulmonologist: specialist in lungs, and the respiratory tract.

Radiologist: specializes to interpret medical images such as MRI, X-rays, CT scans, and ultrasound and trained to use radioactive materials.

Rheumatologist: specialist in diagnosing and treating rheumatic illness such as, arthritis (inflammation of the joint) and other diseases that involve bones, joints, and muscles.

Urologist: specialist in the male and female urinary tract.

Take 1 cup of rubbing alcohol to 3 cups of water ( 1:3 ratio) and place into a big Ziploc bag (preferably 2 by double bagging it so it doesn’t leak out) and place in freezer until slushy. The alcohol keeps the water from hardening creating a slushy cold pack.

You can also try using liquid dish soap and place the desired amount into a ziplock bag. Place it in the freezer and it becomes very pliable and great for contour areas like the knees.

For the bottom of your foot

Take a plastic water bottle (about 20 ounce) with water and place in freezer until frozen. This is great for the bottom surface of the foot and can be used seated while performing an ice massage! An ice massage should last for 5-10 minutes until the area is numb.

For small areas

Take a Styrofoam cup and fill it up with ¾ water. Place in freezer until frozen and then peel the top off with the bottom acting as a handle.

This is great ice application for small areas such is tendonitis of a specific muscle and should be used in a constant circular motion until the area is numb.

Did you know?

There are four stages of sensation your body feels with cold application.

Stage 1 Cold

Stage 2 Burning

Stage 3 Achy

Stage 4 Numb

These are all normal to experience while applying a Cold application with end result to be numb. After the numb stage the cold application should be removed.

Do caution for frostbite!