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Multiple Sclerosis

Multiple Sclerosis (MS) is a disorder of the central nervous system which cannot be cured but is managed through a combination of medication and symptom therapy.

MS is an auto-immune disorder which means that the body?s immune system attacks its own healthy tissue in error. In MS, the immune system damages areas of the CNS ? the Central Nervous System - which means that normal nerve impulses which control the body?s functions are disrupted or even blocked.

Specialist neurological physiotherapists are trained to assess and treat the physical symptoms of MS which vary greatly. Your physiotherapist will work with you to create a tailored treatment plan to help maintain your quality of life and your function.


What is MS?



MS is a neurological condition that affects approximately 100,000 people in the UK. It is a disorder that is two times more likely to occur in women as it is men and is commonly diagnosed between the ages of 20 and 40 although it can occur at any age.

The central nervous system is made up of all the nerve fibres in the brain and spinal cord. Each of these nerve fibres plays a part in controlling the body and all of its functions including areas such as the muscles, skin, eyes and organs. Each nerve fibre is coated in a fatty substance called myelin which insulates the fibre to ensure that messages can travel smoothly and quickly between the brain and the body. Myelin also makes up the white matter of the brain.

In MS, your immune system mistakes myelin for an intruder in the body and attacks it, causing areas of damage to the myelin at any area along the nerve fibre. These areas of damage then leave scars on the nerve fibres which are commonly referred to as plaques or lesions. This process causes an accumulation of disability over time as the scarring prevents the affected nerves from transmitting their signals properly.

Symptoms of MS are very varied due to the fact that damage to the myelin and nerve can occur anywhere in the central nervous system.





A patient being treated for multiple sclerosis from our neurological physiotherapists.Above: A patient being treated for multiple sclerosis from our neurological physiotherapists.



Types of MS



There are a number of different types of MS:

Relapsing Remitting (RRMS)

Relapsing remitting MS is the most common type of MS. Approximately 85% of those with MS has RRMS.

This type of MS means that you will have periods of good health (remission) followed by sudden flare ups (relapses). Remission can last for any length of time and the flare ups can affect you for anything from a day up to a few months. It is not known what triggers a relapse but it?s thought that stress and infections are major factors.?

Primary Progressive (PPMS)

Primary progressive MS only affects around 10-15% of people affected by MS. PPMS is characterised by symptoms that start off fairly mild and get worse over time instead of occurring as sudden relapses.

The speed of deterioration varies greatly between different individuals but the symptoms generally begin with subtle problems walking and this worsens over time.

People who are diagnosed with PPMS are usually between 40 and 60 and there are equal numbers of men and women with PPMS unlike in relapsing remitting MS.

Secondary Progressive (SPMS)

Secondary Progressive MS most often follows Relapsing Remitting MS (RRMS). It is thought that approximately 65% of people with RRMS will develop SPMS 15 years after the original diagnosis.

SPMS is characterised by a developing disability with no or few periods of relapse and recovery. If a relapse occurs, the period of recovery may be much longer in SPMS and it can be difficult to distinguish between progression of the disease and the effects of a relapse which is difficult to recover from.

Benign MS

Benign MS is characterised by very long periods of good health with very few relapses in between. It is therefore generally only diagnosed retrospectively after an individual has experienced a number of relapses followed by full recovery with little or no disability for a number of years; usually up to 15.


What causes MS?



MS does not yet have any known specific cause. Research into the causes of MS is being carried out and it is believed that a combination of genetic and environmental factors lead to a diagnosis of MS.

It is not possible to purely inherit MS but it is thought that having a specific combination of genes may increase the risk of the disease.

MS is virtually unheard of in countries surrounding the equator but much more common in those further away; including Great Britain. It is therefore being researched to ascertain whether a lack of vitamin D may potentially be a contributing factor. There is a growing evidence base for this but it is still being researched.

Ultimately, a specific cause of developing MS has not yet been discovered.


How is MS diagnosed?



MS does not have one specific diagnostic test so a number of different examinations may be carried out to diagnose MS.

Commonly, a Magnetic Resonance Imaging (MRI) scan is used to obtain a detailed image of the brain and spinal cord in order to detect areas of plaques or lesions in the nervous system. Evidence of this type of scarring indicates MS. More than 90% of people with MS are diagnosed following an MRI scan.

Another common investigation is an Evoked Potentials test. This involves using electrodes placed on the head to monitor how quickly your brain responds to things you see or hear. If the brain is taking longer than what is considered normal to receive this information it may indicate damage to the myelin or nerve itself.

Alongside these tests you will also take part in a neurological assessment with a neurologist who will look for any alterations in your co-ordination, balance, speech and reflexes to determine whether or not any of your nerves are damaged.

Blood tests are also routinely taken to rule out other causes of your symptoms.


What problems caused by Multiple Sclerosis can physiotherapy help with?



Physiotherapy can help with a number of problems causes by MS. The symptoms of MS differ greatly from person to person depending upon which nerves have been attacked and scarred.




Our physiotherpaist work closely with you to help you achieve your individual goals.Above: Our physiotherpaist work closely with you to help you achieve your individual goals.



Some of symptoms that Liverpool Physio can help with are:
  • Fatigue
  • Muscle weakness
  • Muscle imbalance
  • Stiffness and spasm
  • Reduced balance and co-ordination
  • Pain
Specialist physiotherapy can help to manage these symptoms at any particular stage of the disease and can also help to reduce the impact of these symptoms during a flare up through education around a healthy and active lifestyle.

Multiple Sclerosis leaves individuals with a wide range of symptoms and disabilities so it is important that you are treated by a professional that specialises in neurological conditions. A neurological physiotherapist is specifically trained to assess and treat conditions of the nervous system including MS.


How does physiotherapy help MS?



Our specialist physiotherapists are able to assess and treat your MS at any stage of the disease. As MS is a lifelong condition it is important that physiotherapy is used initially to educate around management of the disease to maintain a good level of daily function and then to treat any flare ups or disabilities going forward.
In general, physiotherapy will help to:
  • Educate you about self-management of MS
  • Maintain or increase mobility
  • Increase your independence
  • Increase your quality of life
  • Delay the progression of disability
  • Increase your self confidence
  • Achieve functional goals
In order to achieve all this, treatment will normally use a combination of education, hands on therapy techniques and a personalised exercise programme to complete between appointments to maximise your day to day function.

Physiotherapists are movement experts and aim to help you to move in the most energy efficient way you can to conserve energy and reduce wear and tear of muscles and joints.


What would physiotherapy treatment for MS involve?



Treatments for MS vary greatly dependent upon the stage of the disease and the disabilities concerned.

Initially, our specialist physiotherapists will carry out a full assessment to determine how you feel your MS is most affecting your day to day function and then evaluate how the disease is affecting you physically in order to develop an effective treatment strategy.

You should expect treatments with our physiotherapists to include some or all of the following:
  • Assessment
  • Manual therapy
  • Clinic visits
  • Home visits
  • Hydrotherapy
  • Home exercise programmes
  • Medical Reports
Our physiotherapists have the expertise to create a tailored therapy programme to best suit your needs whether you?re recently diagnosed or have been living with the condition for many years.

Our highly experienced physiotherapists may also identify benefit of adaptive equipment to improve your quality of life, such as by provision of splints, orthotics or equipment for your home.


How do I arrange a physiotherapy appointment for MS?



If you would like to see how we can help you please email us at office@liverpoolphysio.co.uk or call us on 0151 558 0077 to arrange an appointment with one of our physiotherapists.


Summary



Multiple Sclerosis is a lifelong condition which affects individuals differently dependent upon the type of MS diagnosed and the areas of the nervous system damaged.
Physiotherapy is extremely important throughout the lifetime of the disease to maintain your day to day function and reduce the impact of your flare ups. We can help you to self-manage your condition and improve your quality of life.

To book a neurological assessment for Multiple Sclerosis call Liverpool Physio on 0151 558 0077 or e-mail office@liverpoolphysio.co.uk

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