10 Powerful Ways To Improve Your Balance When Living With Multiple Sclerosis

1. EXERCISE 4-5 DAYS PER WEEK

• Exercise by itself reduces common symptoms associated with MS including fatigue,^1-5 spasticity,¹ endurance¹, quality of life,^1,5 balance,^1,2 and reduced depression.²
• Exercise will help prevent decline and improve balance in 2 ways
  • Improved mood² to promote living life.^1,5
  • Decreases inflammation, to prevent progress of multiple sclerosis itself.

2. OPTIMIZE YOUR WALKING DEVICE

• Do you need one?
• What do YOU need RIGHT NOW? (Cane, walker, rollator, etc.)
• Correct height? Do you know how to use it? Everything working well?
• Is it realistic and accessible? Do you need modifications for YOU? If you cannot easily use your walking device you will not be well balanced.

3. HAVE YOUR SPECIFIC BALANCE SYSTEMS CHECKED [Inner Ear Balance System (Vestibular System) & Proprioception (Knowing Where Your Legs Are In-Space)].

• It is common to have inner ear balance (vestibular) problems with or without dizziness with multiple sclerosis.⁶
• Proprioception (Knowing where your legs are in-space) is a commonly missed problem in all populations, but so important for our balance.
• Once this information is known, good decisions and treatments can be made.
• The vestibular systems specifically is treatable with multiple sclerosis!^7-9

4. WALK, WALK, WALK

• General exercise is great. If you want to be better balanced, you’ve got to walk.

5. ADDRESS PROBLEMS RELATED TO MULTIPLE SCLEROSIS SPECIFIC TO YOU

• Ankle-Foot Orthosis for drop foot?
• Does spasticity need to be addressed with stretching or botox to help you move better?
• Does one leg need to be strengthened to improve your balance?
• Does depression need to be addressed with exercise, diet, or medication with guidance from your doctor?
• Does cognition and/or memory need to be addressed? (Neurological Psychology, Speech Therapy, Physical Therapy).

6. WALK FASTER

• In general, we are all better balanced when we walk faster.^10-12
• This is due to specific mechanical reasons during the walking cycle.^13,14
• Walking faster will give you confidence, which will then help you balance better.^12,13

7. AVOID FURNITURE OR WALL WALKING

• This trains your body to depend on your hands for balance instead of your legs. If your legs need assistance to be safe, you may need a cane or walker. Check with a Physical Therapist.
• By depending on your legs, your balance will improve because your body will balance itself every day on its own without help.
• Furniture walking will result in physical decline.
• Physical decline¹³ and the perception of physical decline¹⁵  with multiple sclerosis will make your balance worse. Make your balance better by using your body normally to balance itself.

8. CHECK YOUR BONE HEALTH

• Low bone mineral density is associated with, and possibly a cause of the vestibular system (Inner ear balance system) not working correctly.^16,17
• Vitamin D deficiency is associated with getting vertigo^18,19 and treating vitamin D deficiency reduces the risk of getting vertigo again.²⁰

9. IF YOU FALL, SEEK TREATMENT FROM A REHABILITATION PROFESSIONAL

• Half of those with multiple sclerosis will fall over a 6 month period.^21,22
• A very small percentage of those with multiple sclerosis who have fallen will received any type of fall assessment from a rehabilitation professional, even after the fall.²³

10. EDUCATE YOURSELF ABOUT MULTIPLE SCLEROSIS

• You may discover a treatment you didn’t know about that will help you move and balance better.
• You may discover a new organization that can help.
• You may find a different healthcare provider that can help you more for what you need.
• You may eat better, live healthier, decrease inflammation, prevent progression of the disease.
• Educating ourselves gives us a sense of empowerment, which will change the way you strut, which will help your balance.

                                                                                  References

1. Tarakci E, Yeldan I, Huseyinsinoglu, BE, Zeenginler Y, Eraksoy M. Group exercise training for balance, functional status, spasticity, fatigue, and quality of life in multiple sclerosis: a randomized controlled trial. Clinical Rehabilitation. 2013;27:813-822
2. Ahmadi A, Arastoo AA, Nikbakht M, Zahednejad S, Rajabpour M. Comparison of the Effect of 8 weeks Aerobic and Yoga Training on Ambulatory Function, Fatigue and Mood Status in MS Patients, Iranian Red Crescent Medical Journal. 2013;15:449-454
3. Heine M, van de Port I, Rietberg MB, van Wegen EE, Kwakkel G. Exercise therapy for fatigue in multiple sclerosis. Cochrane Database Syst Rev. 2015;11(9).
4. Asano M, Finlayson ML. Meta-Analysis of Three Different Types of Fatigue Management Interventions for People with Multiple Sclerosis: Exercise, Education, and Medication, Multiple Sclerosis International. 2014.
5. Dalgas U, Stenager E, Jakobsen J, Petersen T, Hansen HJ, Knudsen C., et al. Fatigue, mood and quality of life improve in ms patients after progressive resistance training, Multiple Sclerosis.2010;16:480-490.
6. Zeigelboim BS, Arruda WO, Mangabeira-Albernaz PL, Iorio MC, Jurkiewica AL, Martins-Bassetto J, et al. Vestibular findings in relapsing, remitting multipole sclerosis: a study of thirty patients. Int Tinnitus 2008;14(2):139-145.
7. Frohman EM, Zang H, Dewey RB, Hawker KS, Racke MK, Frohman TC. Vertigo in MS: Utility of positional and particle repositioning maneuvers. Neurology. 2000;55:1566-1568.
8. Ozgen G, Karapolat H, Akkoc Y, Yuceyar N. Is customized vestibular rehabilitation effective in patients with multiple sclerosis? A randomized controlled trial. European Journal of Physical and Rehabilitation Medicine. 2016;52(4):466-478.
9. Hebert JR, Corboy JR, Manago MM, Schenkman M. Effects of Vestibular Rehabilitation on Multiple Sclerosis-Related Fatigue and Upright Postural Control: A Randomized Controlled Trial. Phys Ther. 2011;91:1166-1183
10. Callisaya ML, Blizzard L, Schmidt MD. A population-based study of sensorimotor factors affecting gait in older people. Age Ageing. 2009; 38:290-5.
11. Rodacki ALF, Souza RM, Uginowitsch C, Cristopoliski F, Fowler NE. Transient effects of stretching exercises on gait parameters of elderly women. Manual Ther. 2009;14:167-72.
12. Gianni C, Prosperini L, Jonsdottir J, Cattaneo D. A systematic review of factors associated with accidental falls in people with multiple sclerosis: a meta-analytic approach. Clin Rehabil. 2014;28(7):704-716.
13. Kirkwood RN, Souza Moreira B, Vallone MLDC, et al. Step length appears to be a strong discriminate gait parameter for elderly females highly concerned about falls: a cross-sectional observational study. Physiotherapy. 2011; 97:126-31.
14. Verghese J, Holtzer R, Lipton RB, Wang, C. Quantitative Gait Markers and Incident Fall Risk in Older Adults. J Gerontol A Biol Sci Med Sci. 2009 64A:896-901.
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16. Bigelow RT, Semenov YR, Trevino C, Ferrucci L, Resnick SM, Simonsick EM, Xue QL, Agrawal Y. Association Between Visuospatial Ability and Vestibular Function in the Baltimore Longitudinal Study of Aging. J Am Geriatr Soc. 2015;63(9):1837-1844.
17. Singh NK, Jha RH, Gargeshwari A, Kumar P. Altered auditory and vestibular functioning in individuals with low bone mineral density: a systematic review. Eur Arch Otorhinolaryngol. 2018;275:1-10
18. Han W, Fan Z, Zhou M, Guo X, Yan W, Lu X, Chen C, Wu Y. Low 25-hydroxyvitamin D levels in postmenopausal female patients with benign paroxysmal positional vertigo. Acta Oto-Laryngologica. 2018;138:5,443-446
19. Jeong SH, Kim JS, Shin JW, Kim S, Lee H, Lee AY, Kim JM, Jo H, Song J, Ghim Y (2013) Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol. 2013;260(3):832–838.
20. Talaat HS, Kabel AMH, Khaliel LH, Abuhadied G, El-Rehem HA, El-Naga A. Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency. Auris Nasus Larynx. 2016; 43: 237-241
21. Gunn HJ, Newell P, Haas B, Marsden JF, Freeman JA. Identification of Risk Factors for Falls in Multiple Sclerosis: A Systematic Review and Meta-Analysis. Phys Ther. 2013;93:1-31.
22. Finlayson ML, Peterson EW, Cho CC. Risk factors for falling among people aged 45 to 90 years with multiple sclerosis. Arch Phys Med Rehabil. 2006;87(9):1274-1279.
23. Fritz NE, Eloyan A, Baynes M, Newsome SD, Calabresi PA, Zackowski KM. Distinguishing among multiple sclerosis fallers, near-fallers and non-fallers. Multiple Sclerosis and Related Disorders. 2018;19:99-104.