by: Mariska Breland, Fuse Pilates
Working with clients with multiple sclerosis can be challenging. After all, you’d be hard pressed to find another medical condition with more possible symptoms. Plus, every single case is so different that it’s hard to generalize what an “MS workout” looks like.
In my experience as a Pilates teacher (and someone who has had MS for more than 10 years), I’ve found that there are certain things that should be included in every session if the client is capable of doing them. Note that on top of these tips, you never want to work out in a hot (or very cool) room, which can immediately aggravate symptoms.
Mariska Breland’s Top 10 List for Students with MS:
1. Work the feet and ankles. If you have clients with MS, you probably
see their feet doing some pretty crazy things (they sickle, spasm,
pronate, supinate, drag, etc.).
Feet are one of the first places
for weakness to occur, and
problems such as numbness and
foot drop can make walking
difficult. Moving up the chain,
ankles become increasingly
unstable over time, often
because of spasticity, weakness,
and muscle imbalances that can
all impact a person’s ability to
stand and balance easily. Foot and ankle problems often sneak up on
someone, and walking just slightly “off” can even lead to detrimental
changes in the joints. Work on strengthening and stretching exercises for
feet and ankles in every session, and make sure your students work
barefoot; you have a ton of proprioceptors in the sole of your foot.
2. Safely challenge balance. Balance is affected in an estimated 80%
percent of people with MS at some point. The best way to improve
balance is to work on it. Standing exercises (such as Wunda chair leg
pumps) would be my top choice if the student can do them (after all, we
walk in an upright position). Always be sure to provide support, and
modify if your student seems fearful. Any exercise where a person has
to use their abdominals and back muscles to stabilize their upright
posture is also valuable.
3. Include the reformer if possible. The reformer offers clients a
wonderful opportunity to feel ease of movement. The gliding of the
carriage is therapeutic just by enabling people who have movement
restrictions to feel a little more “free.” Add to that the benefits of
challenging the vestibular system (one of the influencers of balance), and
you have a great reason to try to get your MS clients on a reformer
4. Work the hip stabilizers. I would guess that more than half of my
clients who don’t have MS come in with weak outer hip and glute muscles.
But for people with MS, hip stabilizer strength is critical to maintain
(or achieve) normal gait.
5. Focus on quad endurance and hip extensor isometric strength.
In studies on gait, researchers have found that exercise to improve
quadriceps endurance is important for walking. For hip extensors,
isometric strength was more valuable for improving gait. So, when you’re
doing hip extension exercises, be sure to work in some isometric holds.
6. Strengthen the pelvic floor muscles. Bladder and bowel problems
are common in MS.
Although the pelvic floor
muscles aren’t usually the
ones directly affected,
strengthening those muscles
has been shown to improve
function in MS.
7. Do some upper back
extension. People with
chronic illness tend to
slouch. If you trip, have a fear of falling or bad balance, you tend to
spend a lot of time looking down when you walk. Breathing capacity is
diminished, causing a critical loss of oxygen to the brain and motor
system. With proper posture, everyone breathes better and feels better
and more confident, and yes, more balanced.
8. Give praise. Of course, you already know you should praise your
client. But in terms of neuroplasticity (the ability of the brain to form new
pathways), praise can actually help new motor learning “stick” by
boosting dopamine – a key neurotransmitter, which makes you feel
happy and helps to consolidate brain map changes.
9. Stretch last and stretch long. Stretching is key for people with MS,
whether or not they’re actively experiencing spasticity. But don’t do
stretches in the middle or beginning of a workout. Strength is significantly
reduced (for a time) immediately following stretching, and for clients with
MS, you want to maintain their strength as much as possible. PNF
(proprioceptive neuromuscular facilitation) and long held stretches (think
yin yoga) have been shown to be the most effective when working with
muscle spasticity (which is quite different than “normal” muscle
tightness). To get a spastic muscle to release, you need to stretch it for a
long time. That makes stretching great before-bed “homework” for your
10. Remember, every day is different. Everybody with MS has their
own unique symptom profile. And for everyone with MS, those symptoms
can change day-to-day. Make sure you address your client’s changing
needs, while including the exercises that will help them maintain function
and ease of movement.
Understanding MS and how Pilates can alleviate symptoms is as rewarding as it is challenging. You’ll also find that many of these top10 items are not only beneficial for clients with MS, but also for a variety of students with other neurological disorders and chronic medical conditions.
Mariska Breland is the founder of the Fuse Pilates Method and co-owner of the Fuse Pilates Playground. Possessing a savant-level ability to remember exercises and the anatomy knowledge and creativity to design new ones, Mariska knows why an exercise will work and how to make it and you work better, smarter, or harder.
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