What Causes Walking Problems with Multiple Sclerosis?
Two-thirds of people diagnosed with multiple sclerosis (MS) eventually need some kind of mobility device — such as a cane, walker, or scooter — to help them be as active as they want to be. In other words, walking may be impaired, but mobility doesn't have to be.
When you have MS, many different factors can affect your ability to walk easily and safely, so the first step is to identify the sources of the problem. Following is an overview of some things that can trip you up.
Lassitude and fatigue resulting from overexertion or deconditioning can make it difficult for you to do the things you want to do — including walking. Activities like climbing the stairs or walking around the block, which used to feel easy, may begin feeling like marathons. So, it's important to remember that managing your fatigue will also help your walking.
Spasticity or stiffness in your limbs, which is the result of increased muscle tone caused by demyelination, can interfere with walking. Limbs that are stiffened by spasticity are more difficult — and therefore more tiring — to move. The most common sites for spasticity are the muscles of the calf, thigh, buttock, groin, and sometimes the back. The stiffness can range from mild and barely noticeable to severe and painful.
Here's the tricky thing about spasticity: If you have any weakness in your legs, a little bit of stiffness can help you stand and walk. Too much stiffness, on the other hand, is uncomfortable and tiring. So, here are some tips for managing your spasticity in such a way that you have just the right amount:
Treat the problems that are known to increase spasticity. These problems include a distended bladder or bowel, urinary tract or other types of infections, pain of any kind, and pressure sores.
Ask your physical therapist to recommend a stretching plan. The plan should include both active stretching (that you do on your own) and passive stretching (that you do with a helper who stretches some muscles for you). Take a look at the National MS Society's stretching booklets.
Ask your doctor about medications to treat your spasticity. The most commonly used medications are baclofen and Zanaflex (tizanidine). Just remember that too little medication won't provide relief and too much will make you tired and weak. The best plan is to start low and work up gradually until you have just the right amount of spasticity. Be patient — it may take some time to reach this optimal point.
Severe spasticity that doesn't respond adequately to these oral medications is best managed with a surgically implanted pump that delivers Lioresal (liquid baclofen) directly to the spinal cord. Because the medication goes straight to the spinal cord, this miracle of modern medicine relieves spasticity with a much lower dose of medication — thereby avoiding the unpleasant side effects of fatigue and weakness.
Dizziness and vertigo
Although dizziness (a sensation of light-headedness or inability to maintain balance) and vertigo (a sensation that you're spinning or the world is spinning around you) don't directly affect walking ability, they sure can make it uncomfortable to move around.
These conditions generally occur with MS because of demyelination in areas of the brain stem that control balance, or because of demyelination that interferes with messages from the inner ear to the brain. Because other conditions can cause both of these problems, ruling out other causes is important before assuming that MS is the culprit.
Here are some tips that may help get you back on your feet:
If the sensations are worse when you change position, a physical therapist can give you exercises that help build your tolerance to motion.
Niacin, a component of the vitamin B complex that dilates blood vessels, sometimes provides relief.
Antihistamines, such as Benadryl (diphenhydramine), Antivert (meclizine), or Dramamine (dimenhydrinate), may relieve mild dizziness or vertigo.
Medications in the benzodiazepine family such as Valium (diazepam), Klonopin (clonazepam), Ativan (lorazepam), and Xanax (alprazolam) may suppress the workings of the inner ear that can cause dizziness.
The dilemma you face in trying to manage dizziness and vertigo is that the medications that provide the best relief — the antihistamines and benzodiazepines — are also known to cause drowsiness. So work with your doctor to find the lowest possible dose that relieves your symptoms.
Sensory changes such as numbness and pins-and-needles sensations in your legs and feet can also interfere with walking. For example, it's difficult to walk comfortably and safely when you can't feel the ground. Unfortunately, no medications specifically deal with numbness. However, pins and needles may respond to a medication like Neurontin (gabapentin) or Lyrica (pregabalin).
The best strategy is to wear whatever shoes provide you with the most comfort and the best "feel" for the ground. You also need to closely watch where you're going in order to avoid stubbing or stepping on surfaces that are too hot or too sharp. If the sensory changes in your feet cause you to feel less secure, a cane will provide greater stability.
Many problems with balance are caused by lesions in the cerebellum. Like numbness, there are no medications to improve your balance. However, if you find yourself stumbling, contact a physical therapist. He or she can recommend exercises to help improve balance, as well as mobility aids to increase your stability. And be sure to check out the National MS Society's Free from Falls video.
Mobility aids are definitely the tools of choice for more severe balance problems. The specific tool depends on how much support you need to be safe on your feet. A cane, which provides support on one side of your body, may be sufficient. But, if one-sided support isn't enough for you, you can increase the support by using two canes, crutches, or a walker. Each has its particular charm — a physical therapist can help you identify the best tool for you and teach you how to use it effectively.