Creating Health Series

A lot of clients, when they first come to my office, will say, “I’m supposed to do these lifestyle changes to heal MS, but I’m not exactly sure what that means?” They comment that they’ve done changes in their diet, they’ve detoxed, they’ve worked on their gut health, tried to improve ,their sleep and they are doing everything possible to continue to exercise. And they tell me that it’s making some difference but they are wondering and concerned if there is more to the lifestyle changes necessary to manage multiple sclerosis.

Lifestyle Changes to Heal MS

I would like to explain in this month’s presentation, that it’s not just about what you are doing, but, most importantly, about how you are doing it – the ‘style’ in lifestyle. I want you to explain this with a story. This is called the story of Awakening the Muse.

The Story of Awakening the Muse

Once upon a time, there was a young woman who was very responsible and very dedicated to her work. She always gave it her all. That meant doing 110% everywhere, every day. Quotes that described her way of living would be “Rest is rust.” She was always busy, busy, busy and she was allergic to the word ‘lazy’. Another was “Pull yourself by your own bootstraps”. She was very independent and didn’t like to ask for help because it meant she didn’t know how to do something or wasn’t good enough. If we could describe what she was attracted to in books (though she never had time to read, but they reflected her way of living), they would be books titled “Smarter, Faster, and Better”, “The Art of Working Hard”, and “The Checklist Manifesto“. She loved checking things off her checklist and was always striving to do things even better. Her goal was to be successful and to do things perfectly. She wanted to have a successful looking career, marriage, home. Though she was most focused on career achievement. She was always climbing the ladder at work and expected to get a promotion each year because of her efforts. She wanted to be the perfect picture of success. Because, deep down, her biggest fear was that she was unworthy or not good enough. She was terrified of failure. And these fears motivated her to work even harder, to get even better, and to never ever rest.

Life becomes Unsustainable

And this way of living became very unsustainable for her body. And times of struggle began. And all that the young woman wanted was to return to the lifestyle she had been living. Gut her inner muse wouldn’t permit it. And so for years and years, the young woman and her inner muse faught. Until, one day, she realized that her muse was her soul calling her back.

The Muse – The Inspiration of Artists

Muse comes from Greek mythology.  It is the goddess of poetry, art, and song. Artists are very familiar with the concept Muse – it is the source or spirit that inspires them in their art.

And so when the young woman started listening to her muse, things started changing. She put down her struggles and began to follow what the muse was trying to tell her. And her whole life changed with her muse’s guidance.

Lifestyle Changes to Heal MS

Her Muse completed changes how the, not so young anymore, women lived her life. Instead of this insatiable drive for success, she paces her efforts. She gave 80% of her energy and made sure she was never the sacrifice (if you’ve watched our video on neurphysical therapy, you’ll understand the concept of doing no more than 80%). The quotes that she began living by were that “Every child is an artist. The problem is how to remain an artist once we grow up.” And she also adapted the quote, “If I don’t fit in, then I’m actually doing the right thing” instead of trying and trying to fit in and trying to do things that would make everyone happy. And the books that she started reading, and I recommend these books highly to anyone struggling with their MS, was “The Joy of Not Working” and “The Artist’s Way.”

Inner Muse’s Favorite Books

In “The Joy of Not Working” the author explains this misconception in our society. We think we are supposed to work, work, work, work, work, work. Trying to get as much money as possible during our working years until we’re 65. And then we’re supposed to retire and enjoy ourselves. But the problem is when we get there, we don’t know how! We get restless, and bored and uncomfortable with leisure. So, we start taking volunteer work, and we start making ourselves as busy as we can because that’s all we know how to do. And so in ‘The Joy of Not Working”, talks about learning how to enjoy the time that you are not working. To actually train ourselves to enjoy life. The boo invites the reader to take mini-retirements throughout their careers to really understand what it’s like to not work. It doesn’t invite you to quit your job. But it does help you transform you mindset and invites you to learn to enjoy leisure time and to find hobbies and discover things that you love outside of your work.

In “The Artist’s Way”, Julia Cameron gives us the steps to awaken our inner muse and learn to do things simply for the delight they bring.

And so returning to our not so young any more women’s story – the goal she began to live by was that “It is not selfish to love yourself, to take care of yourself and to make your happiness a priority, it’s necessary” (quote by Mandy Hale).

Multiple Sclerosis is Your Inner Muse

I don’t know if you have figured this out already, but, your MS with all those body symptoms that are keeping you from doing 110% at work, is actually your muse. And when you awakened and listen to your muse; when you actually stop struggling with what the body is trying to tell you, that’s when you begin to heal.

Lifestyle Changes are not What you are Doing but How

So as you compare these two lifestyles, its not just about diet, detox, gut health, exercise, and sleep. Because, if you are still living as this woman was originally, when you begin changing your diet, you try to do it perfectly and beat yourself up if you don’t. You don’t detox, you uber detox, giving it your 110%. You don’t improve your exercise, you drive yourself to exercise almost daily, even when so much is a struggle and you are tired.

You can’t improve your body by doing those healthy things in an unhealthy way.

The word pushing is not in the muse’s lifestyle!

What Do You Propose to Do to Really Change the Style in Your Lifestyle?

So when you think about your own lifestyle changes to heal MS, what do you propose? When you think about exercising, check-in, are you doing the exercise as this young adamant go, go, go, way? Or do you do your exercises for the pure pleasure of movement?

Lifestyle Changes – A Story on Exercise

I’ll tell you a second nonfiction story. One of my client’s inner muse (we talked to her inner in hypnosis) asked her to give herself time every day to enjoy a moment to herself. And so every day after she taking her kids to school, she would swing by her local beach and spend 15 minutes taking a nice walk.

The first few days were difficult for her physically though pleasurable mentally. As the weeks passed, it got easier and easier physically as well. She found she could walk farther and farther with no fatigue. And her mind started to get excited. She wondered “perhaps today I can get all the way over there to the stoplight” and then, “perhaps today I can walk one more block…” After three months, she was walking four miles a day briskly. And what happened? The inner muse put her foot down. And suddenly she was back to barely getting a 15-minute walk in with a lot of physical struggle. And when we talked to her body in trance once again, her inner muse and asked the muse why my client had suddenly gotten worse again.  And the inner muse responded, “Because she wasn’t doing the exercise for self-enjoyment and self-care, she was doing it to try to get faster and better. It was now a competitive goal to improve herself.”

Lifestyle Changes is about Nurturing

So the lifestyle changes to heal MS is not about perfecting your diet. It’s about nurturing your inner muse. And I think it is one of the most surprising and unique aspects of multiple sclerosis. Those with MS that truly change their lives around, and with it, their symptoms, start making dates with themselves, some daily, some weekly, to really nurture their inner muse. They write science fiction novels, they start bird watching, they write poetry, journal, create beautiful jewelry, go on nature walks, and truly explore what creates joy in their lives outside of job success.

Lifestyle Changes is about Creating Balance

Your inner muse, your MS, is trying to create more balance in your life. And to create balance, we need to find those things that feed our souls. Those pleasure that are not for anyone else but for our own pleasure.

I invite you to have a date with this inner muse. Explore the things that you used to do as a kid, those things you really loved that you somehow grew out of, bring them back, and nurture them.  And when you do, you will notice a lot of things begin to shift. As counterintuitive as it seems, playing, craft making and stopping to enjoy a beautiful ray of sun, will give you more energy and mental clarity than pushing yourself to do more exercise.

 

If you enjoy this presentation on lifestyle changes to heal MS, consider watching some of our other videos. You can also sign up for the Creating Health Newsletter to receive our videos, as we produce them.

We dedicated this episode of our Creating Health series to the first step on your journey to healing MS. This first step is not only important for those diagnosed with MS but also to move forward from any kind of significant change that was unexpected—such as COVID 19, a loss, getting fired, or going through a breaking up.

Preparation for the Journey

c When we get diagnosed with a scary chronic disease, get laid off, lose our partners, or even need to change our lives because of a pandemic, we grieve. And just as grieving the loss of a loved one has five stages of emotions that we move through, being diagnosed and losing our old lives is no different.

The Five Stages of Grief

The five stages of grief are denial, anger, bargaining, depression, and, ultimately, acceptance. Unfortunately, many of us continue to experience these stages without ever coming to completion. Yet, until we complete the grievance and accept our present state, we cannot fully move forward (instead, we continue to bargain, get angry when what we are doing doesn’t work, get depressed and feel helpless, etc.).

“We cannot change anything unless we accept it.” – Carl Jung

Accepting multiple sclerosis does not mean you like it or agree with it. Accepting it will allow you to see where you are without judgment and move forward.

Getting to Acceptance

In this month’s video, Eva M Clark walks us through a process (adapted from Edith Stauffer Forgiveness Process) to move quickly through the five stages of grief. Do this exercise using a journal to write down your answers if you can. To start, decide what you want to accept so that you can move forward on your healing MS journey (or Coronavirus, a divorce, trauma, etc.).

Step 1. Begin by Blaming it.

Tell it what you don’t like about it (be specific) and all that that has caused.

Step 2. Now continue with all the “Should have’s…”

Tell it what should have happened instead.

Step 3. Now write about all the negative thoughts you have about it and how it makes you feel.

Tell it how you treat it and yourself because of all the negative thoughts you have about it.

Example: I blame MS for making my life so difficult. It made me lose my job.  My body should have supported my efforts in making this promotion work! Because I wasn’t able to stay in that job and succeed, I feel helpless, and my negative thoughts are that I am not good enough for any job.

A Short Story on Accepting What Is Without Judgement or Negative Thoughts

There is a Taoist story of a farmer who had only one horse. One day, the horse ran away. The neighbors of the farmer quickly come over to console the farmer over his terrible loss. However, they are surprised by his remarks,  “What makes you think it is so terrible?”

A month later, the horse returns home, bringing with it two beautiful wild stallions. The neighbors become excited at the farmer’s good fortune. Yet again, they were surprised when the farmer remarks, “What makes you think this is good fortune?”

Not long after, the farmer’s son is thrown from one of the wild horses and breaks his leg. Again his neighbors quickly exclaim, “Oh, what bad luck!” to which the farmer responds, “What makes you think this is bad luck?”

War erupts in nearby lands, and the young men of the land go into battle. Only the farmer’s son remains due to his broken leg.  The neighbors congratulated the farmer for his luck. “What makes you think this is good luck?” replies the farmer once again.

Releasing the Negative Thoughts Towards Multiple Sclerosis

We are going to become like the farmer – release the negative thoughts or judgments about what has occurred. It is neither good nor bad. It just is.

Step 4. To do so, take a moment, close your eyes, and ask yourself, “How or who would I be without any negative thoughts towards this?” No interpretation or no judgment. Observe it.

“Most of our stress and suffering comes not from events, but from our thoughts (about the events).” – Martha N. Beck

The First Step on Your Healing MS Journey – Acceptance

Now that we have released negative thoughts regarding it, we can begin the acceptance process.

Step 5. In the same journal, look at all the ‘should have’s’ you wrote down. And now for each one, write:

” Even though I would have preferred it _________;it didn’t. So, I cancel my expectations. I accept that I was full of expectations, and I accept what is.”

Example: Even though I would have preferred that my body had kept up with the demands of my new promotion, it didn’t. So, I cancel my expectations. I accept that I was full of expectations, and I accept what is.

Moving Forward

To move forward, we need to know what we truly value and cherish. Many times we think that we want what we lost. We don’t complete the grieving process because we close ourselves to ever getting what we cherish most in other ways. Are you willing to imagine what you truly want and allow life to bring it to you in whatever form is correct for you now?

What do you want to bring forward?

Step 6. Make a list of what you truly valued, the qualities, and the things that were special of that which you lost. What about it did you value?*

Examples: job = having a purpose, being helpful, feeling acknowledged. A partner = kindness, companionship, sharing, and closeness. Life before the pandemic = having a schedule, connection, freedom, touch, etc.

We can get boxed in thinking that there is only one way to have the things we desire: we must be married; have to be physically strong;  and/or need to have a high profile paid job; etc. (or only one way for healing MS). But there are so many more ways to achieve what we truly desire. And when we open up to the possibilities, miracles can happen.

Envision your future

Step 7. Envision a future with all the ways that those things we value can show up. Make the images vague (as we can’t be sure of what the future brings), but very bright and exciting.  Create several different forms that that value/quality can take in your future. You want to engage the subconscious and get it excited.  Once it’s engaged and understands your interests, your subconscious can then find those things for you in an infinite number of ways. That’s its job!

Now close your eyes, if they aren’t already, and imagine your timelines as a path in front of you leading into your future. And now imagine taking all those images you created, duplicate them, and mix them up like playing cards. Now take the cards and toss them onto that timeline path so that they land in different places and different times. Notice them there. The journey of healing has now begun.

*Adaptation from Steve Andreas’s (NLP) grief process.

Click here for more episodes of the Creating Health Series or contact me if you are interested in working individually on healing your MS.

Gut Health and fixing your leaky gut is a key component to address when it comes to multiple sclerosis (MS) and any autoimmune disease. Fortunately there is a lot that you can do to keep it healthy.

“All Disease begins in the Gut”  – Hippocrates

In this video presentation on Multiple Sclerosis (MS) and Leaky Gut, Palmer Kippola discusses gut health, our microbiome, and leaky gut.

Gut Health MS and Our Microbiome

Gut Health is one of the central factors to health and disease, especially autoimmune diseases such as MS.

“All disease begins in the gut” Hippocrates, father of modern medicine

Important Facts About Your Gut

Your “gut” includes the small and large intestines.  It is like a 25 feet long tube that spread out is 3000 square feet.  There are 100 trillion microbes in your gut, 10x’s the number of cells we have in our body.  Microbiomes help fight pathogens and keeps our immune system in balance.  Most of our immune system resides in our gut.  In fact, about 75% of your immune system is in the lining of your gut.  This linen, only one cell thick, is the interface between the inside world and the outside world.  So maintaining the integrity of your gut helps you maintain the integrity of your immune system.  As MS is an autoimmune condition, to help our immune system we need to focus on the health of the gut.

Apart from its support of the immune system, the microbiome digests dietary fiber.  If we don’t get enough fiber, the microbes will start eating the linen of our gut.  That is how important adequate fiber intake is!  Our ancestors ate many many times more fiber than we do with our modern diets.  They did not have autoimmune conditions. Thus returning to some of their food choices and way of eating would benefit our gut.  If our microbiome is not balanced, our gut is imbalanced.

Multiple Sclerosis (MS) and Leaky Gut

In 2011, Alessio Fasano, a researcher at Harvard University discovered the third factor in the onset and progression of autoimmune disease.  Up to 10% of the cause of autoimmune disorders can be considered genetics. The second factor is environmental (food, infection, hormone imbalance, toxins, and stress). Alessio introduced the third factor –  leaky gut.

The scientific name for leaky gut is hyper intestinal permeability.  Any number of things can cause the linen of our gut to become inflamed and then leaky.  Heavy loads of inflammation will not allow us to take in the nutrients we need and that leads to an imbalanced microbiome.  Gluten, for example, causes some degree of leaky gut.  A person that is healthy and not susceptible to autoimmune disorder might not have any trouble with this.  Someone with MS or other autoimmune disorders must avoid anything that can cause leaky gut.

Anything that causes linen tear or leaky gut will trigger the immune system to attack anything that seems similar to the culprit of the leak thus aggravating, even more, the linen as well as anything in the body that mimics molecularly that culprit.  Myeline sheaths of our nervous system can look suspiciously like gluten.

Restore the Gut and Reverse MS

Thus, according to Alessio Fasano, the way to halt or reverse MS and other autoimmune disorders is to find and remove your environmental triggers and heal your gut.  The implications are well worth making the effort to discover them!

What Harms Your Gut and How to Heal?

The road to health is paved with good intestines.” Sherry Rogers, M.D.

Gluten might not be what effects is harming your gut the most.  You must dig deep and find out what is harming our gut.  Here is a shortlist of the many ways we harm our gut.  All of these, by themselves, can cause leaky gut, including stress.  Be mindful of what you put into your body and mind.

Even if we have decades or a lifetime living this way, we can still flip it around and heal our gut.  First, you must take out what harms your gut.  Then, and only then, begin to add what helps your gut heal.

Paleo template diet seems to have the most research and acceptance in the Functional Medicine community (doing what our ancestors did) but there is no one-size-fits-all.

Creating Health Series

This video is part of our Creating Health Series.  In our series, we hope to cover all aspects that could have influenced the initiation as well as exacerbations and progression of your MS so that you can take back control of your health by addressing the physical and environmental as well as the psychological and social factors.  This video presentation was part of an episode on the effects of the gut on MS.  To learn about how our emotions affect our gut by watching “Minding Your Gut”.

If you enjoyed this video presentation on Multiple Sclerosis (MS) and Leaky Gut and would like to receive these videos on healing multiple sclerosis as they are published directly in your inbox each month, please sign up for our newsletter. Don’t be left behind. There is help.

This series is being recorded at the National MS Society Self-Help MS Group in Santa Cruz, CA. The National MS Society respects the rights of people with MS to obtain any and all information they want related to MS, including information on wellness, medical treatments or complementary therapies, and products or services. The information presented at these meetings does not necessarily reflect the views or official position of the Society, nor carry the endorsement or support of the NMSS.

 

 

¿Existe una personalidad de esclerosis múltiple? ¿Una personalidad de EM? ¿Unos comportamientos, actitudes y formas de ser comunes a las personas diagnosticadas con esclerosis multiple?

Tome la prueba de personalidad

¿Qué es personalidad?

Para comenzar esta discusión, primero debemos entender qué es la personalidad. Porque la personalidad no es ser “tal y como soy”. La personalidad son los comportamientos aprendidos y las metas que nos motivaron en la infancia. Y estos comportamientos y metas se volvieron estables con el tiempo.

Y una vez que se llegaron a ser estables, se volvieron inconscientes. Igual que conducir un automóvil. Una vez que uno aprende y lo ha hecho suficientes veces, se puede volver habitual, y se conduce sin mucha conciencia de que se está haciendo. Del mismo modo, aprendemos estos patrones de conducta y se convierten en nuestra respuesta automática a la vida. No es su identidad. Son adaptaciones a los factores estresantes de la niñez.

“Las adaptaciones que le ayudan a sobrevivir el estrés inmediato en la niñez se convierten más tarde en fuentes de patología. Son inconscientes.  Nadie elige comportarse de esta forma”  ~Gabor Maté, “Cuando el cuerpo dice no”

Y a menos que reciba un llamado de atención de algún tipo, como la esclerosis múltiple, continuará respondiendo de esa manera.

¿Existe una personalidad de EM?

¿Hay hábitos, creencias y comportamientos comunes entre las personas diagnosticadas con EM?  Tome la prueba siguiente y luego continúe leyendo o viendo la presentación.

Nota: A medida que tome la prueba, considere cómo era usted antes de empezar a tener los síntomas de EM, ya que hay comportamientos que ya no puede realizar debido a los síntomas (y hay una razón para ello que discutiremos en breve) –

Tome la prueba de personalidad

¿Cómo se forma la personalidad de la esclerosis múltiple en la niñez?

Curiosamente, los rasgos de la personalidad  que más se admiraban y alentaban en la niñez son los que luego se convierten en esclerosis múltiple. ¿Por qué? Porque a medida que se siguen desarrollando y adquieren una importancia increíble en nuestra vida, se vuelven insostenibles. El cuerpo humano no puede mantener esos rasgos casi sobrehumanos.

 

Los rasgos como ser un buen estudiante, la hija favorita o una persona trabajadora o atleta, a medida que continúan motivándonos y su importancia aumenta, se convierten en un esfuerzo interminable por lograr el éxito, destacar y hacer listas. Las cosas siempre se pueden hacer incluso mejor… Hasta preocuparse por otros se convierte en la imposibilidad de decir “no”, incluso cuando estamos exhaustos. Ayudar se convierte en una forma de ser automática, apresurándose a hacerlo en cuanto alguien lo pide, mientras que ser ayudado es inconcebible. ¿Emociones?  Las emociones son para el resto de las personas, ya que desde la niñez hasta la edad adulta hemos aprendido que no está bien sentirlas, por lo tanto las reprimimos.

Estos son algunos ejemplos de cómo se desarrollan algunos de los rasgos de personalidad de la esclerosis múltiple. Todo está bien hasta que estos comportamientos y creencias toman las riendas de nuestras vidas. Debemos desarrollar los recursos para crear equilibrio en nuestros comportamientos.

Crear un equilibrio de la personalidad de esclerosis múltiple mediante la PNL

La programación neurolingüística (PNL) puede ayudar a crear el equilibrio de estos comportamientos que se convirtieron en rasgos de personalidad extremos. No existe un juicio sobre estos comportamientos. Por el contrario, existe una curiosidad sobre qué creó este comportamiento y lo mantuvo por tantos años. La PNL presupone lo siguiente:

“Cada comportamiento es útil en algún contexto.”

“Detrás de cada comportamiento hay una intención positiva.”

Al entender la intención positiva detrás del comportamiento y cuándo es útil, podemos empezar a comprender maneras más saludables de lograr esa intención.

Además, de acuerdo a los presupuestos de la PNL, los síntomas de la EM no son una ‘falla del sistema inmunitario’.

“No existe tal cosa como una falla, solo retroalimentación”

“Los síntomas son un comunicado sobre las medidas necesarias.” 

Los síntomas solo son retroalimentación. El organismo está diciendo: ‘esta forma de comportamiento no es sostenible.’  Está pidiendo que se tomen medidas. Una vez que se tome la medida detrás del síntoma, el síntoma ya no será necesario.

Trabajar a través de la personalidad de EM para sanar de la esclerosis múltiple

“Las personas diagnosticadas con EM tienen patrones de hábitos arraigados de la mente que son específicos a sus síntomas. Cuando esos patrones de hábitos se transforman utilizando una combinación de métodos que (1) ayudan a entender los patrones de los hábitos de una persona y  (2) aportan recursos para modificar esos patrones, los síntomas se reducen y frecuentemente desaparecen.”  – Eva M Clark “The Effectiveness of Hypnotherapy in Treating MS” [La efectividad de la hipnoterapia en la esclerosis múltiple]  

Al trabajar a través de los rasgos de personalidad de la EM que se han convertido en problemas significativos en la edad adulta, podría reducir eficazmente los síntomas de la EM.  Un ejemplo del trabajo que haría usando hipnoterapia médica en el Programa para la curación de la esclerosis múltiple sería:

— Entender la causa y el significado detrás de la EM y cada síntoma específico

— Eliminar el crítico interno y crear el instructor interno.

— Hacer las paces con la perfección.

— Crear un equilibrio y congruencia internos. Librarse de los conflictos.

— Dominar ansiedad.

— Crear límites bien definidos alrededor de otras personas.

— Deshacerse de la creencia “No soy suficientemente bueno / digno” de una vez por todas.

— Satisfacer sus necesidades. Anteponer sus necesidades a ayudar a los demás.

— Comprender y potenciar su relación con control.

— Deshacerse de la culpa y la vergüenza.

— Explorar cualquier obstáculo inconsciente interno para la curación. ¿La EM le está sirviendo más de lo que usted piensa?

— Liberarse del trauma de un diagnóstico negativo y las expectativas de que va a empeorar.

— Crear un futuro gratificante,  imperioso y estimulante.

Rasgos de personalidad saludables

A medida que estos rasgos de personalidad comienzan a transformarse en patrones mentales más saludables, se vuelven sostenibles y gratificantes, y el organismo se ve aliviado de su carga y puede empezar a sanar.

Los resultados de las personas que han trabajado conmigo son testimonio de los increíbles cambios que pueden producirse.

No haga esto solo. Existe ayuda. Su personalidad de EM no es quien usted realmente es; es quien ha aprendido que tenía que ser.

Si desea recibir estos vídeos sobre curación de la esclerosis múltiple todos los meses directamente en su buzón a medida que se publiquen, inscríbase para recibir nuestro boletín.

Most people associate physical therapy with the recovery from an injury or a stroke but what is less known is its use with symptoms of chronic and neurological disease such as the symptoms of MS.  As no two people with multiple sclerosis experience the same set of symptoms, physical therapy for MS does not have a single solution but can tailer and address your particular combination and struggles at all stages of the disease.

In the video of this episode Dr. Poorva Kulkarni, PT DPT MHS explains to us in this episode how physical therapy can help you with your symptoms.

Physical Therapy for MS

Dr. Poorva: Thank you so much for giving me this opportunity to be here. It is heartfelt to hear all your stories and what you guys have been going through. It definitely helps me to be a better physical therapist knowing what struggles you go through. So I hope this will help explain the role of what physical therapy is and when it can help.

No Two MS patients are the same

So, basically what is MS? I’m not going to spend a lot of time on this because a lot of you already know. But what I do want to say is that it affects everyone differently depending on which part of your brain and which nerves are damaged. And thus it will present itself in a different way for each of you. If you do a Google research on MS, it can be overwhelming to see that there are so many symptoms out there. Know you will not experience all of them. Everybody is going to go to a different level of progression and have a different evolution.

The only thing I do want to mention is how physical therapy (PT) can help.

The Role of PT for MS

So when does PT come in? What will help to improve your strength, your endurance, your balance, and decreasing spasticity? Things such as managing it in a better way. For example, having a stretching program will make sure that your spasticity is much more under control and easier deal with it. Another example is coping with fatigue.

Because coping with fatigue is vital. There’s a lot of research out there about fatigue induced weakness. So what if you push yourself to a limit?  It is too much. The next day you’re going to feel it and you’re going to feel that weakness. And so just being aware of your limits, which could change, is important. Knowing your limits and not reaching them.  I always tell my patients to imagine a zero-to-ten scale. Zero being you’re not tired, 10 being you’re very tired. You don’t want to reach ten. You want to keep yourself at a solid five to six range. If you feel like you are do something, pushing it into an eight or nine, you’re going to feel that weakness may be that day or next. And most times, that is not worth it, so always try watching your thresholds.

Apart from stretching and watching your fatigue levels, PT for MS supports you with exercises. It’s hard to generalize what can really benefit as each of you presents symptoms differently. But, some things that help are endurance training, walking, and biking. These are especially good in the morning. If you feel like you know you’re tight and it’s hard for you to get going – the bike definitely helps to relief that muscle tightness that you feel.

As for balance and coordination training, PT works a lot with those issues. If you’re noticing that you have fallen two or three times and are having a little trouble with balance, we can definitely help you with that.

Again, something that I want to stress so much because it is so important is to learn to gauge your fatigue. And I stress this because I know it is hard for you to gauge how much is too much. You need to learn your limits. In physical therapy, I offer my patients an activity log. That way you can plan ahead. Sometimes the log will work and you might have days, that it might not. But even if it works 90% of the time, it’s still a good thing. So if you feel like you have to do A, B, C, and D things, just plan ahead. Plan taking little rest breaks in the middle so you’re not pushing yourself to the limit where you’re going to be so tired the next day.  That has really worked well with patients – having that activity log as a reminder.

Also, split your activities out during the week, or delegate it. Getting an idea of your fatigue is key. It will definitely help. Also, if you go to a gym on your own, just be aware to exercise within that fatigue level too. Have somebody initially give you a guided exercise program so you know your limit and how to progress.

Aquatic exercise is another option of physical therapy for multiple sclerosis. There is new research that shows that pool therapy is really good for patients with MS. It helps to relax the muscles. The biology of the water basically helps you. And it is nice to not be afraid that you’re gonna fall. It’s a good place to stretch out. Also, physical therapy in a pool can put you in positions that would be hard for you to do on the table or a mat.

The thing that you want to remember is you are not going into a heated pool. You want it at 80 degrees, which is a therapeutic temperature that is important with MS. So you want it to be at 80 to 85, a good therapeutic range that relaxes the muscles and makes it easier out. So much more so than on land.

When can Physical Therapy for MS help?

Everyone with MS goes through many different stages and PT can help in all of them. It could be at the time of diagnosis, when you are in remission, and during a relapse or progression. Know that PT can help with MS at each of these stages.

1. At the Time of Diagnosis

So, to begin, at the time of diagnosis, it can help educate you on what is out there. And that is key. It’s definitely scary because it’s new and overwhelming to just have the diagnosis. And if you don’t have enough information, you could be misled, as there is so much out there on the internet. And PT has a treatment for each of the symptoms that present themselves at the onset. The earlier you start, the better you’re able to deal and cope with it. One of the basics, which is most important from the beginning, is teaching you the energy conservation techniques. What I kind of explained to you with making sure that you’re planning your activities, you’re taking rest breaks, etc. And that’s the key. If you start sooner and if you know what this is, it’s easier to get in the routine and help stabilize you.

2. In remission / stability

Then your PT can check up on you at 6 months. You would review your home exercise program. See if everything fine. Is there a change? The idea behind that is that you’re catching the problem before it happens. If you’re kind of slowly noticing that maybe you’re having a little issue with your foot or you’re dragging it, we can work with that. It can be fixed.

Even when you are in a stable phase, you can come in for a tune-up, do a reassessment, and overall see where you are at.

3. During or after a relapse

During a relapse, working on things that are affecting you and getting the treatments to address the symptoms. Is there a need for assistance advice at that point? We are assessing your balance and seeing if that relapse has done anything that might make you more susceptible to falling or things like that.

4. Disease Progression

And then with the progression, if you are in that phase, we might assess if you need a standing frame if it’s hard for you to stand for too long.

We evaluate the need for each stage. Whether we need to use any device just to make sure you’re safer or if we need to brace. Things like that will help you live that much better.

Questions on Using PT for MS

Question: If we did start needing an aid, even temporarily, would we be able to come to you with that aid and you could show us how to use it physically, therapeutically and make sure we’re using it right?

Dr. Poorva: Yeah, totally. Because it’s the technique we use. It could be a walking stick. We assess what might be best for you? It could be a cane or you could do better with a walking stick or a walker if you need to. A physical therapist can show you which device could work best for you at that point. Aids require technique and it can be hard if you haven’t used it.

We have mobility clinics that can help out if you need a wheelchair or things like that. Know that you can get a customized wheelchair if need be, which is way better than getting a rental one which is not your size. You don’t want to get pressure sores. So things like that. So just knowing that you have that source out there too, which is a mobility clinic where they evaluate you, they customize a wheelchair or a standing frame based on you.
There are definitely options out there for you to know that if you are in that phase as well.

And then again managing your symptoms at that point too. If there are things that are getting harder for you, we can definitely address those changes. So some things, when you’re aware of them through the activity log, we can address things like using an ice vest. If you’re a person who gets overheated too much and then your symptoms get really hard to manage, especially with the heatwave that we had, there’s an ice vest that you could get which helps you not get overheated.

Many of the patients will describe tingling or numbness in the hand. And if you’re cooking, you don’t want to cut yourself with a knife. That could happen if you’re not feeling your hand. So there are these weighted spoons would you can get even on Amazon and things like that. The idea with that is that the weight helps you to realize that you have something in your hand so it helps your brain. What we called proprioception. Even with the tremors, it helps. I use weights a lot for patients who don’t know where their feet are. It gives your brain extra feedback. And it will help you not cut to the finger too.

Question: I know the cold season’s coming and I know we’re all basically just like Goldilocks is, we need perfect temperatures. If we are going to exercise outside, should I be wearing like warmer stuff even though I get hot? I guess the temperature thing has been a bit concerned. Should I be going out for long walks? Or should I be going to the pool where it’s warmer, where I can stretch?

Dr. Poorva: Definitely. Again, it depends on every individual, but usually, if you walk in extreme heat, those symptoms trigger. Like you might feel like you’re getting fatigued a lot. So choose the time when you go for walks.

Question:  As I mentioned earlier, my shoulders are really starting to hurt.  It feels like I don’t really even have the strength to build them up at this point. So is that something that you think would be better?

Dr. Poorva: If there is pain, we need to address that pain first. We’d definitely show you some techniques on how to spread and transfer your weight. And then if at that point, if we determine that you are having trouble with your daily activities, I refer you to OT. Occupational therapy can help you learn about the cool devices out there for you. And there are so many now that can make your life easier. We always tag team with other therapists, splitting the sessions so that you get the support you need. You don’t have to be concerned with knowing what kind of physical therapy you need.

Audience member:  We have a real advantage in this community because there aren’t a lot of outpatient neuro PT clinics in the country and she (Dr. Poorva) has a lot of really specific things that will help you adapt and help you. Whatever stage you’re at. I mean you can, it doesn’t really matter whether you’re primary progressive relapsing, remitting or secondary progressive there you can make changes at any stage.

Dr. Poorva: After you have completed your physical therapy, I usually like my patients to go to the classes offered at the clinic. We can always talk about which one you might benefit from.

There are these PEP classes that take place or you could be going off into the community doing senior fitness classes or going into the pool doing one of their programs. The idea behind that is that you’re doing something once a week where you are having somebody there for you. And they can catch things, notice changes, and refer you back to PT. So you can stay in the loop that way. It’s quicker to catch things that way.

Question: Do we need to ask our doctor to refer us? I feel like, every time I go see my doctor, I ask but then they don’t send through a referral.

Dr. Poorva: I would follow up and see if they have. They don’t always call you. Sometimes they say that if they don’t call by such and such date, call them. If they say no, you get back to your doctor and say I didn’t get my referral. Exactly. Yeah, that’s pretty much it. I can also check in our files if your doctor sent us a referral for you.

Member of the audience:  I just wanted to say, I didn’t think I would benefit from physical therapy because I was operating on a basic level, but you showed me stuff that I didn’t even realize! The brain is amazing, and some of the stuff that my body was doing in order to protect me was actually causing me longer-term damage. For instance, I didn’t realize that I wasn’t really looking left and right when I was walking because it made me dizzy. And, and then, getting more confident in being able to look around.  That has helped me feel safer going on walks at night. There was a point there where I was feeling really uncomfortable because I go if you’re coming on my left I was like Zoo Lander…couldn’t turn left!

I’m now a big advocate. Thanks. Thanks to your work. I didn’t realize. I didn’t understand all of the stuff I was doing. Like, I wasn’t even using my knees right. I’ve had these for 32 years! I just didn’t know. It really has helped. And, for example, the pools that they use. Just that light bit of compression that you get from being in the water. Cause I’m always pressing on myself, and the pressure of laying in the pool makes my arms feel so much better. I just didn’t know. The water is amazing, it really is. It definitely helps. So you might not realize that you might be compensating by training your body when you are looking and not turning your head at the onset of that dizziness. PT for MS helps you to learn that. And, Dr. Poorva, you made me sit up straighter!. I’ve been sitting up straight and it makes me look skinny (laugh)!

Dr. Poorva: Thank you.

References

Dr. Poorva Kulkarni, Physical Therapist specialized in neuro, Dominican Hospital Rehabilitation and Therapy Services, Santa Cruz, CA.

Rohrig, mandy. (2018). Physical Therapy in Multiple Sclerosis. National Multiple Sclerosis Society.

Creating Health Series

This video was recorded at the National MS Society Self-Help MS Group in Santa Cruz, CA. It is part of our series “Creating Health in Multiple Sclerosis”. If you would like to receive these videos in your inbox each month, please sign up for our newsletter.  Don’t be left behind. There is help.