Melissa Pei, DPT, MSCS
, was the guest speaker at the June conference call for the MS/Cancer teleconference support group. Pei works at the Evergreen Healthcare Rehabilitation Department in Seattle with MS patients and patients who have other neurological diseases like Parkinson's disease, stroke and head injury. Pei discussed the importance of exercise and answered questions from call participants.
Q: What about spasms and stiffness?
As a physical therapist, I get questioned a lot about spasms, which are involuntary muscle contractions. I recommend that you let them run their course, which can be a couple of seconds up to a minute. People with MS often feel a stiffness all over their bodies and throughout their range of motion for the entire arm, leg or knee. Stretching can reduce the tight feeling.
Q: When tremors occur, should you let them pass before exercising or do you push through?
Many tremors occur in hands and wrists and can come on suddenly. Tremors in legs often shake a little and usually go away. I recommend letting them pass before you continue exercising.
Q: Is a tremor the same thing as spasm?
A spasm is a muscle contraction, and a tremor is a continuous movement, not contraction. Let the tremor pass. The muscle should be in prime optimal state to reduce or stop a tremor. You can apply deep pressure to the muscle or joint. Find a position that makes the tremor go away. If you have a tremor in your foot, push your toe down so it is pointed. And then start straightening.
Q: What is a charley horse?
A charley horse is more like a spasm. It is a strong contraction usually in the calf and often is painful.
Q: How do you get rid of a charley horse?
It is best to try to prevent a charley horse. Stretch before you lay down in bed for a long period of time. If you experience a charley horse when in bed or when you are transferring, push your ankle or foot into a position opposite of where the spasm is occurring. Also, you can push hard on the heel tendon to break the spasm. If you can't bend your leg because of a spasm, put pressure on back of knee.
Q: What is the downside of not exercising?
People with MS often are tired or fatigued and don't want to exercise. However, you will experience so many benefits including improving your heart, you will sleep better and your moods may improve. Also exercise increases bone density that can result in greater independence and help you manage your weight.
Exercise gets your blood flowing and improves your overall sense of well being. Your exercise program doesn't have to be hard core. You can exercise while lying in bed or sitting in a wheelchair. When you start an exercise program, it may take a while to build up endurance. Do it slowly and don't over do it, which can set you back. My job as a therapist is to train patients to not attempt too much too fast.
Q: How much should I exercise?
You should do moderate exercise for 20 to 45 minutes a day. You can split it up for shorter session, but you should exercise every day. Your activity level should be based on your symptoms. Take it easy if you are really tired. Watch your fatigue level or you won't be able do anything else the rest of the day. You will see benefits if you exercise five or six days a week.
If you have to stay in bed, you can still exercise to build endurance and strength. Start slowly and build up to 30 or 45 minutes of activity. Watch for out for heat. When it is hot outside, don't over do it. Find a time of day when you can exercise perhaps late morning when it is still cool. Fit it into your day wherever you can. You can't go wrong, but you can overdo it. Exercise should be fun.
Q: What are some good exercises?
A good leg exercise is the straight bridge. When you are on your back, one leg is straight and one is bent. Lift your straight leg in the air and hold for ten seconds. Another leg exercise is trunk rotation. Lie on your bed, knees bent together, feet flat on the bed. Move your legs slowly from side to side.
A good arm exercise is wall pushups. Put your arms or hands flat against the wall and push back and forth. Also do simple shoulder rolls, which open up the chest for good breathing and improved posture. Doing overhead punches improves range of motion and strength. When watching television, you can do hand exercise such as squeezing a ball, practice writing or simply play with your fingers.
Q: What about the theory: No pain, no gain?
This exercise theory applies more to athletes. If you have pain, you are causing injury because pain signals that something is wrong. When you exercise you may feel uncomfortable, but you should not hurt.
Q: Should I alter my walk for exercising such as walking sideways?
Walking helps prevent osteoporosis, which is weakening of the bones. Sideways walking can improve balance but the most important thing is to walk.
Q: What about swimming?
Swimming exercises are great for MS patients and for people who can't walk for a long period of time. Swimming takes pressure off your legs and you get to exercise a little more. Water is a good medium for resistance because you can push through the water. Make sure the water is not too hot. Some MS patients are heat sensitive. If the water temperature is too warm, you may have a hard time walking afterward. MS patients should not swim or exercise in water temperature higher than 80 degrees.
Q: Should I try to stimulate my brain in new ways?
You can create new brain paths to help brain activity. Wear your watch on the opposite arm, fasten your belt the opposite way or eat with your non-dominant hand. These activities can help develop new pathways from the brain to the muscles so if one goes down, you have another pathway. You exercise to work on building another pathway. For example, you may have a lesion on your brain or spinal cord, but other nerves get to that muscle. So you exercise or stimulate these pathways.
Q: Is horseback riding good exercise?
Yes, horseback riding is good exercise. Hippotherapy uses the multidimensional movement of the horse and can help with balance and trunk strength. It works the non-core muscles to help you stay upright. The movement of the horse makes your hips move in a way similar to walking and is great for your heart.
Q: What about Nintendo Wii?
Nintendo Wii games can help work hand/eye coordination and on balance as you shift your weight back and forth for games like tennis. Caution: make sure you have enough space around you. If you have balance problem, have a walker or table nearby in case you lose your balance. I encourage you to use technology for exercise.
Q: What is the difference between an occupational and physical therapist?
Even though it sounds as though it is, OT is not job related. Occupational therapy treats your life as though it is your job. An occupational therapist teaches you how to cook, clean, dress and manage daily living activities. If you have trouble dressing, an OT can introduce aids to help you. OTs can help with memories issues as well as help you plan out your day.
Physical therapists deal more with movement, how to move in a safe manner and to keep moving as well as you can. PT works on your fine motor skills. OT and PT often work as a team to help you be as independent as possible.
Q: Once an OT and PT has devised exercises, how do you recommend keeping up the pace at home?
Because I need people to help me move my arms and legs, it's difficult to maintain a program. Tailor a program for when you have help. Perhaps they can exercise with you. It can be hard to exercise at home by yourself, so find a family member or friend because it is more fun to exercise with somebody. Also, consider group exercise classes. The MS society offers free classes in all states (www.nationalmssociety.org).
Q: Does massage therapy come under the auspices of PT?
Physical therapists can do massages not full sessions. PTs usually work on manual therapy skills and would refer you to a massage therapist who focuses on patients with back pain or a muscle imbalance. A massage for relaxation purposes is not part of physical therapy.
by Carol Smith