I’m transitioning to SPMS and my confidence in walking is poor. What might help with my mobility?

In this video Peter interviews Nicola Hatton who is a Neurological Physiotherapist. The interview was filmed by Emily

Video transcript

Peter: I’ve been advised that I’m moving to secondary progressive MS. I’m still very stiff and my confidence in walking is low. I realise regular exercise may help this, what might help with my mobility?

Nicola Hatton, Neurological Physiotherapist: Again, if you’re in contact with a physiotherapist at that time and you’ve got a chance to have an assessment, it’s worth having a detailed assessment of your core stability and your hip function, because sometimes people’s legs present very heavily. You can hear people walking, they’re stomping around, so maybe walking with a wide-based gait. And they may just describe themselves as feeling it difficult to sort of stand upright and so they start to sag after a period of time. And that’s often due to a lot of control in the middle and quite often you can have therapy or home exercises or advice that can really help with that. So it’s very tempting to think, oh it’s my legs that are the problem, but you’ve also got to look a little bit higher up. And quite often, even the influence of your head and your arms as well can take you out of line a little bit and if you don’t stand up fully and if you don’t extend through your feet and through your legs, what happens centrally gets very switched off and you become very sluggish. So there’s quite a few reasons as to why you might be feeling that, whether you’ve got secondary progressive MS or not and it’s something you need to keep an eye on. The best thing really to help maintain that extension, to maintain that control is to keep moving, keep walking, and not necessarily just pottering around where you’re perhaps furniture walking or you’re only walking short distances, that actually deactivates your core quite a bit. If you can walk in an upright fashion for a good couple of minutes at a time, if you can manage that, that helps to engage the muscles in the middle.

So yeah, in answer to the original question, I would advise an assessment of the whole thing again just to check if anything additional can be done. It could be that as part of the disease progression, that despite doing all those things you still have the heavy legs, you still have the weakness, and then we’d discuss things like pacing and grading of activity so that you’re keeping as mobile as you can, sort of in the best way so that you’re not absolutely exhausting yourself but you’re also working to your maximum potential. And there may be a time when you then need to discuss walking aids, wheelchairs for longer distances, all that kind of stuff so that you’re actually maximising your walking capabilities sort of in the best way so that you’re effective throughout the whole of the day and not just for, say, an hour in the morning. But I would never encourage anybody just to randomly get their own set of crutches or sticks without having an assessment, because how you use those walking aids can influence your posture and there’s a good way of using them and a bad way of using them.

Peter: I was going to say, imagine if you just grab yourself a walking stick without any interaction with a physio, you could actually be doing damage.

Nicola Hatton: You can do, in terms of the positioning of your arms influences how switched on your hip muscles are and just by placing your arms in a certain way or using the sticks or crutches in a certain way can engage or switch off your muscles accordingly, so just having somebody keeping an eye on that and just advising you can be useful. And it’s almost as well just having that assessment to say yeah, this is a time when you need to be using it, because quite often people will battle on and actually end up walking really badly when they could actually walk quite well with a walking aid. So it’s not always a negative thing, but having somebody to have that conversation with can be quite useful.

Peter: So it’s all about good communication with your physiotherapist?

Nicola Hatton: Yeah, yes. And again, it’s not always that you need to be coming in for weeks on end, it can often be just a quick chat or a quick pop in to have a once over and if you’re lucky enough to have a physio that’s known you for a while they can often pick up those things before the patient may even be aware of them as well.

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