Symptom Management

The Symptoms That Can Slow You Down

By Patty Bobryk, MHS, PT, MSCS, ATP

In the world of rehabilitation, mobility is commonly defined as “the quality of moving freely.”  This definition incorporates all movement-related issues when looking at an individual’s mobility, including walking, transferring, moving around in bed, getting in and out of a car, getting up and down from the floor, and the list goes on.

In a survey conducted in 2008 by Harris Interactive, 70 percent of individuals who had difficulty walking said it was their most impactful symptom. A comprehensive MS treatment plan addresses the many symptoms that can affect mobility.


Spasticity is abnormal muscle tone. When mild, it can cause a feeling of stiffness; when severe, moving an extremity can be difficult. Spasticity hinders mobility as the extremity responds slowly or takes on an abnormal position. Energy expenditure when moving with spasticity is higher and may contribute to the overall feeling of fatigue in MS; however, spasticity is not always bad. Many people use their stiffness to stand, transfer, and even walk.

Treatment for mild spasticity is a stretching program which addresses the specific muscles that have become stiff.  While medications to further alleviate the spasticity are sometimes necessary, a regular exercise program that keeps the joints moving is key in preventing joint contractures and assisting in freedom of movement. 


Fatigue, also known as “lassitude,” is one of the most common and often the most disabling symptom in MS.  It is an overwhelming sense of tiredness.  Fatigue may occur when nerve conduction is depleted. A person starts out moving well, but as the nervous system is further taxed, conduction is exhausted, and the activity becomes harder and harder. An activity such as walking in a grocery store may be fine at first, but as the legs fatigue, making it down the last aisle becomes impossible. Fatigue can also be caused by depression, poor nighttime sleep, and unhealthy habits (poor nutrition, lack of exercise, and smoking). 

Fatigue can be managed with careful evaluation by a healthcare professional. Medications are sometimes helpful, but energy management techniques are equally important: taking interspersed rest periods, prioritizing tasks, using assistive devices, and developing good sleep patterns.


Muscle weakness can occur in MS as a result of slowing or loss of nerve impulse conduction. It may also evolve from disuse, especially if lifestyle changes have made an individual more sedentary. Weakness contributes not only to mobility complications, but also to safety hazards.  For instance, foot drop is common in MS and can cause abnormal walking patterns, placing strain on muscles and joints that are not meant for walking. This can result in pain syndromes and create a risk of falling.

There are several treatment options for muscle weakness. One of the most beneficial is an exercise program tailored to an individual’s specific needs. A rehabilitation professional will assist in designing a program that is appropriate for the current strength of the affected muscle. Assistive devices are also helpful in addressing mobility issues. Bracing, canes, walkers, and wheelchairs improve both safety and fatigue. Newer technology that externally stimulates muscles to contract at the right time during the walking cycle is another option.

Sensory Problems

Individuals with MS may experience tingling, numbness, banding, burning, or even the inability to tell where their extremities are positioned. These abnormal sensations can affect mobility; for example, a change or loss of sensation in the legs can affect the way one walks.  When a complete loss of sensation occurs, it is important that the individual looks at the position of their extremities.

Sensory problems can be improved with exercise, massage, and sensory stimulation. Some medications may also help alleviate symptoms.

Other Factors

There are several other additional symptoms that contribute to changes in mobility. Loss of coordination, tremor, and poor balance make movements more difficult and require more energy, thereby affecting how the body moves. Changes in vision can affect how one interprets the environment and how an individual moves within it. Careful assessment by a healthcare team can determine which interventions are most appropriate.

Mobility can be affected by many symptoms in MS. If you are experiencing one or more of these problems, it is important that you have an open discussion with your healthcare team. This will enable them to develop a treatment plan to keep you “moving freely” throughout the course of the disease.

Patty Bobryk, MHS, PT, MSCS, ATP is a physical therapist working with individuals with MS at the MS Comprehensive Care Center of Central Florida, a part of Orlando Health. She is a MS Certified Specialist and serves as the chair of the International Organization of MS Rehabilitation Therapists. She has led educational seminars for patients and professionals nationwide on rehabilitation for individuals with MS.

 (Last reviewed 2/2010)