Multiple sclerosis

What it is

Multiple sclerosis is an autoimmune condition in which the myelin insulating nerve fibres in the brain and spinal cord is damaged, slowing or blocking signals. The consequences depend on where the damage is: weakness, spasticity, balance problems, visual disturbance, bladder symptoms and fatigue.

Fatigue is the most commonly reported and most limiting symptom. Heat sensitivity is the other feature that shapes exercise: raised body temperature temporarily worsens symptoms in a large proportion of people, which for decades led to exercise being discouraged. It is now clear that this effect is temporary and harmless, and that exercise improves fatigue, walking and strength.

What it feels like

• Fatigue that is out of proportion and unrelated to how much you have done
• Weakness, often worse on one side, and heaviness in the legs
• Stiffness and spasticity, particularly in the legs
• Balance problems and unsteady walking
• Symptoms noticeably worse in heat - a hot bath, hot weather, a fever

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Demyelination slowing nerve conduction

Damage to the myelin sheath slows or blocks signals along nerve fibres. The location of the damage determines the symptom, which is why presentations vary so much between people.

Heat sensitivity

Raised body temperature further slows conduction in demyelinated fibres, temporarily worsening symptoms. It is reversible and harmless, and it is the reason exercise was wrongly discouraged for decades.

Central fatigue

Fatigue in MS is not simply muscle tiredness - it involves altered central drive and is the most limiting symptom for a majority of people. It responds to exercise more than to rest.

Spasticity

Loss of inhibitory control produces increased muscle tone, which makes movement effortful and contributes to stiffness, cramping and altered gait.

Deconditioning

Reduced activity from fatigue and weakness produces muscle loss and cardiovascular decline, which then produce more fatigue. It is a large and modifiable share of the disability.

Balance and proprioceptive loss

Damage to the pathways carrying position sense produces unsteadiness that is worse in the dark and on uneven ground, and raises fall risk substantially.

Vitamin D and geography

MS is more common further from the equator, and low vitamin D is associated with risk and possibly with disease activity. It is routinely checked and supplemented.

Smoking

Associated with higher risk and with faster progression. Stopping is one of the clearest modifiable factors.

Sex and age

Two to three times more common in women, with onset typically between twenty and forty.

The old advice to avoid exercise

Based on the temporary heat effect and now clearly wrong. It cost a generation of people with MS the strength, fitness and fatigue benefits that exercise provides.

Who tends to get it

• Women, in whom it is two to three times more common
• People living further from the equator
• Anyone with a family history, which raises risk
• Smokers, in whom risk and progression are both higher
• Adults between twenty and forty, when onset peaks

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineMovement for Neurological Conditions

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

New or worsening neurological symptoms may be a relapse - medical review

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Exercise improves fatigue, muscle strength, walking capacity and quality of life in MS, with benefits over eight to twelve weeks, and it does not worsen the disease. The temporary heat-related worsening during exercise is uncomfortable and harmless, and cooling strategies largely manage it. Symptoms and capacity vary considerably between people and over time, which makes an individualised programme with a physiotherapist experienced in neurological conditions the best starting point.

Prevalence basis: Neurology epidemiology

Others the same routine covers

These share the Movement for Neurological Conditions routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.