Multiple Sclerosis

Multiple sclerosis damages the insulating sheath around nerve fibres in the brain and spinal cord, and later the fibres themselves. Signals slow, scatter or fail. Which functions are affected depends on where the damage is, which is why no two people with MS have the same problems.

Rehabilitation does not treat the disease. Disease-modifying therapy is your neurologist's work, and nothing in this programme replaces it or slows the underlying process. What rehabilitation treats is the consequence: walking, balance, strength, fatigue, bladder function, and the daily tasks these make difficult.

That distinction matters when you are choosing where to spend money. A centre implying that intensive therapy alters the disease course is describing something rehabilitation does not do.

For decades people with MS were told to avoid exertion, on the reasoning that heat and fatigue make symptoms worse. That advice is now known to have been wrong, and it produced a generation of patients who were deconditioned on medical instruction.

The evidence now shows exercise improving cardiorespiratory fitness, muscle strength, balance, fatigue, cognition and quality of life in MS. Low to moderate intensity aerobic training is safe and tolerable for most people with an EDSS below 7, and physical fitness appears to help rather than hinder 1.

If you were told years ago to rest and have followed that advice since, this is probably the single most important paragraph on this page.

Raising body temperature — through exercise, a hot bath, fever or hot weather — can temporarily worsen MS symptoms. Vision blurs, a leg becomes weaker, fatigue deepens. This is Uhthoff's phenomenon and it frightens people into stopping.

It is temporary and it is reversible. It reflects nerve conduction being slowed by heat, not new damage being done. When the body cools, function returns to where it was. It is not a relapse and it is not a reason to stop exercising.

It is managed rather than avoided: exercising in a cooler environment, in water, in shorter bouts, with cooling before and during. Cooling the room has been shown to reduce the loss of central drive during exercise in heat-sensitive people. That is why aquatic work features heavily in this programme — the water is cool and it unloads the joints at the same time.

MS fatigue is not ordinary tiredness and it does not respond to willpower. It is one of the symptoms patients rate as most disabling, and a programme that ignores it produces a person who improves at first and then collapses.

So the schedule is built with it: shorter sessions, planned rest, the hardest work early in the day, and energy conservation taught as a skill — how to sequence a day so the important things happen when the capacity exists.

Aquatic exercise and low-impact aerobic work have both been shown to reduce fatigue, which is one of the few interventions that improves the symptom rather than working around it.

Walking difficulty in MS usually combines weakness, spasticity, poor balance and reduced sensation from the feet. Each is treated differently, which is why the assessment separates them rather than treating "walking" as one problem.

Robotic gait work delivers a volume of correctly patterned stepping that fatigue would otherwise cut short. Balance and posture analysis identifies whether the instability is coming from the ankle, the trunk or the vestibular system — and the answer changes the training.

Bladder symptoms are common in MS and are among the least discussed. They are treatable, they respond to assessment and training, and they are asked about here rather than waited for.

Cognitive change — processing speed, attention, word finding — is also common and often missed because it is subtle and because people compensate. It is screened, and where present it is worked on rather than mentioned.

MS is a long-term condition with a variable course. A block of rehabilitation raises function; without maintenance it drifts back. Blocks are usually planned every one to two years, with a home programme between them.

Timing matters too. Rehabilitation during an acute relapse is different from rehabilitation in a stable phase, and a block booked in the middle of a relapse often achieves less than the same block once the relapse has settled. Tell us where you are in the disease and the reply will address timing directly.

Three to six weeks, three to five hours a day, adjusted continuously to fatigue. Aerobic and strength training at controlled intensity, aquatic sessions, robotic gait work where walking is a goal, balance training, spasticity management, energy conservation, and assessment of bladder and cognitive symptoms.

The programme is coordinated with your neurologist rather than around them, and the discharge document is written to be usable by the team that manages your disease-modifying treatment at home.