The importance to us though, is that MS can mean that balance can become problematic; research shows that as many as seven out of ten people with MS (PwMS) experience balance problems at some point during the course of the condition, with around one in five people reporting balance problems as one of their first symptoms of MS.
It may sound silly, but why is balance important?
Balance is important primarily to prevent falls, but also (as we all probably already know!) in day to day living; no-one wants to trip down the stairs (or up as I did recently) or to fall over nothing.
How can MS be responsible for balance issues?Do you remember the 'tangled wires' analogy from the site? This is where messages sent from the brain to the muscle to perform a specific action get jumbled up and don't necessarily reach the desired destination, get misinterpreted along the way or are too weak to elicit the required action; it maybe that the brain orders the foot to be lifted in order to clear a kerb, but if the message doesn't get through, you'll trip up the step.
Many of our MS symptoms can bring about unsteadiness and balance problems, increasing the chance of tripping or falling, including:
- Muscle stiffness/weakness causing unsteadiness
- Muscle spasms/spasticity/tremor putting us off-balance
- Numbness interfering with how we walk
- Vertigo affecting perception
- Pain affecting mobility
- Visual problems affecting how we perceive obstacles
First cautionary note...
...not all balance problems are a result of your MS, if things change or are different to your 'normal' consult your medical team for advice.
What is the core and what does it have to do with balance?
The core musculature can be visualised as a non-compressible cylinder with the diaphragm at the top, the pelvic floor at the bottom; the transverse abdominis (which compresses the abdominal contents and maintains pressure to protect the spine) wrapped around the sides, all zipped up by the intricate muscles surrounding the spine.
There are many muscles involved in core stability, some major ones include:
Deep muscle layer
- Series of intricate muscles surrounding the spine
Middle muscle layer
- cylinder image above
Outer muscle layer
- Abdominal ,muscles
- Oblique muscles (internal and external) which allow spinal rotation and a degree of forwards and backward bending
- Gross spinal muscles
The core's function is primarily to support and protect the spine while we do activities with the attached limbs eg walking etc in an attempt to throw it off balance!
What can I do to strengthen my core?Now we've covered what the core actually is and the importance of using movements which work on all three muscle layers, you can hopefully see that a core training plan isn't just a load of abdominal crunches/sit-ups each day - although, with proper form these can play a role...
...and this is always the challenge of writing about exercise but not providing a training plan for you to follow; it is very difficult to provide personalised training through a blog post or even through an online video (remember my rotator cuff injury of a few years ago?!). Personal Training is by nature 'personalised'; what works for me isn't necessarily suitable for anyone else. I could provide links to a video of core exercises but without knowing you personally I can't find out if they are suitable or whether they will aggravate existing conditions; some core exercises are tricky and need coaching into position, difficult from behind an email. For example, the plank is a traditional core exercise, but unless you have been shown the correct way to perform it, it can give you dreadful back-pain and provide little benefit.
What I can do though is add a link to core and balance exercises provided by the MS Trust; these have been shown helpful for many abilities and are promoted within their site. If I can work out how to create the little moving figures perhaps next time I can add some of my own!
Exercises for core stability
Please consult a physiotherapist or book a session with a PT to assess which exercises are most suitable and give you a step-by-step guide. As always, safety when exercising is paramount.
Active IQ (2016) Personal training manual. London: Active IQ
Cash M (1999) Pocket atlas of the moving body. London: Ebury press
Freeman, J.A Et al., (2010) ‘The effect of core stability training on balance and mobility in ambulant individuals with multiple sclerosis: a multi-centre series of single case-studies’, Multiple Sclerosis 0(00): 1-8. Doi: 10.1177/1352458510378126
Kanis, J. A., McCloskey, E. V., Johansson, H., Cooper, C., Rizzoli, R. and Reginster, J. Y. (2013) 'European guidance for the diagnosis and management of osteoporosis in postmenopausal women', Osteoporosis International, 24(1), pp. 23-57. doi: 10.1007/s00198-012-2074-y.
MS Society (2016) Balance and MS (booklet). Available online at: https://www.mssociety.org.uk/ms-resources/balance-and-ms-booklet
MS Trust (2016) A-Z of MS: Balance. Available online at: https://www.mstrust.org.uk/a-z/balance