Mobility problems are common among people with multiple sclerosis, but there’s a lot you can do to stay on your feet.
By: Brian P. Dunleavy
Medically Reviewed by: Jason Paul Chua, MD, PhD
Updated on November 14, 2024
Physical therapy, exercise, walking aids, and other strategies can keep you mobile with multiple sclerosis.
Ivan Gener/Stocksy
While everyone living with multiple sclerosis (MS) experiences the condition differently, walking difficulties are a common mobility issue. Other MS symptoms, including weakness, poor balance, spasticity, and fatigue, can also increase your risk of a fall-related injury.
However, that doesn’t mean that people who have MS can’t get around on their own. Many tools and strategies exist to help people with MS maintain their mobility as long as possible.
“While we can’t cure or reverse MS, we can help maintain the function that you do have, use compensatory strategies, and keep you moving for as long as possible,” says Alexius E.G. Sandoval, MD, the medical director of the multiple sclerosis rehabilitation program at Johns Hopkins Medicine in Baltimore.
Here are eight things you can try to improve your ability to walk with MS.
1. Physical Therapy
In physical therapy, therapists evaluate the body’s ability to move and function, then look for strategies to strengthen or compensate for weaknesses or other problems.
Valerie Block, an assistant professor of physical therapy at the UCSF Weill Institute for Neurosciences in San Francisco, says that a physical therapy program for a person with MS might include exercises and stretches, as well as training in using walking aids like canes, crutches, scooters, or wheelchairs. The idea, she says, is to keep you safe while restoring confidence in your legs and balance.
2. Occupational Therapy
Although occupational therapy is a separate discipline from physical therapy, Block says that its goals are essentially the same: increasing independence, safety, and quality of life during daily activities such as personal care, hobbies, family life, and work.
To facilitate walking, Block says that occupational therapists usually work with physical therapists to train people with MS to use assistive devices and to simplify tasks at home.
Ideally, Dr. Sandoval says, therapists visit a patient’s home to perform a home evaluation, then offer advice on what people with MS can do to make their homes safer, more accessible, and compatible with their limitations and needs.
“We may advise people to remove rugs or pieces of furniture they can trip over or to install ramps and grab bars,” he adds.
3. Aerobic Exercise
Historically, Block says, it was thought that exercise was bad for people with MS because it can increase the fatigue they often experience. However, she says, now it’s generally accepted that a customized exercise program tailored to an individual’s needs can help improve energy levels as well as endurance, balance, and strength — all of which can lead to better walking and better overall quality of life.
While the types of exercises recommended differ from person to person, those aimed at improving walking generally focus on maintaining muscle strength in the legs and, if necessary, weight loss, Block notes.
“Maintaining a healthy weight is crucial in MS,” she says. “The less weight you carry around, the less strain on the legs and the better balance you have.”
Studies have found that both aerobic training and resistance training were equally highly effective at improving lower extremity physical function and fatigue in people who have MS.
Other research has found that resistance training led to metabolic changes in people with MS linked to improved hip strength, increased walking distance and speed, and reduced fatigue.
4. Walking Aids for Mobility and Independence
Although the goal of most MS treatment plans is to maintain mobility without the need for assistance as long as possible, many people who have MS use assistive devices, including mobility aids, to help maintain their independence.
Sandoval recommends working with a multidisciplinary team of specialists — including physicians, physical therapists, occupational therapists, and orthotists (specialists who fit orthotic devices or braces) — to choose and learn to use the right device for you.
“People are usually initially resistant to using things like canes to get around,” Block says. “People see reliance on assistive devices as a loss of freedom. But these devices can actually help people maintain their freedom by enabling them to get around safely.”
Research that compared assistive devices used by people with MS found that participants walked faster and better, as well as reported a more positive psychosocial impact, with a single-point cane or trekking pole than with a four-point cane.
5. Working With a Podiatrist
The services of a podiatrist or other foot specialist may be helpful. Foot health can sometimes be a serious issue for people with MS, Sandoval says, and podiatrists can help in a number of ways, from trimming toenails (if you can’t do it yourself) to treating foot ulcers. Podiatrists can also recommend shoe inserts or prescription shoes as needed.
6. Botox to Reduce Spasticity
According to Sandoval, Botox is often used to treat a spastic foot drop, in which certain muscles in the leg and foot abnormally force the foot downward, disrupting the natural gait. If you have this type of foot drop, your doctor may try to correct the problem by injecting Botox into the spastic muscles that force the foot downward.
The injections must be performed by a trained medical professional, and the effects of Botox usually last about three to six months, so injections are repeated when necessary to maintain the effect.
“The side effects are minimal if the injections are performed properly,” Sandoval says.
7. Functional Electrical Nerve Stimulation
A functional electrical stimulation device can help with certain types of mobility issues, according to the National Multiple Sclerosis Society. The device transmits a mild electrical stimulus to a muscle, which helps it move better. This can help some people with issues like foot drop and lower extremity weakness.
The goal, Sandoval says, is to facilitate and retrain muscles to perform their intended function.
“Unfortunately, the device is expensive and often not covered by insurance,” Sandoval says. But for properly selected individuals, it can work really well and can be more convenient to use than a brace.
