Although it is a common condition with multiple sclerosis (MS), weakness is a tricky thing to manage. Like fatigue, you have to figure out what's causing it in order to manage it effectively. Weakness can be caused by the following:
Deconditioning: This type of weakness, which results from lack of use or couch potato-itis, can be improved with progressive resistive exercise with weights.
Demyelination of the nerve fibers that stimulate the muscles: With this kind of weakness, the muscles are fine but the nerves that transmit signals to them are damaged. Without those signals, the muscles can't do their thing.
Even though it's important to keep these muscles toned with appropriate exercise, lifting weights won't improve their strength because the nerves providing signals to those muscles aren't working. The good news is that exercise can strengthen the surrounding muscles that are being used to compensate for the weakened ones.
Managing weakness involves a balancing act: In order to minimize weakness, you first have to make sure that your fatigue and spasticity are under control. Then you have to figure out which exercises will be beneficial and which may make things worse. A physical therapist can work with you to develop an exercise program to meet your needs. For example:
An aerobic program tailored to your level of ability can improve your overall strength and conditioning.
Weight-resistance training can strengthen muscle groups that are weak from a lack of use.
Passive range-of-motion exercises performed by the physical therapist can help keep all of your muscles flexible and toned even if they aren't receiving adequate messages from impaired nerves.
To manage your weakness most effectively, you also need to take advantage of tools and mobility aids to enhance your safety and conserve your energy.
For example, if weakness in your foot and ankle is causing your toes to drag, not only will you trip a lot, but you'll also use a lot of valuable energy trying to keep those toes up. An ankle-foot orthosis (AFO) is a lightweight brace that keeps your foot and toes at the appropriate angle so that you don't have to work so hard.
An AFO is made-to-order for you by an orthotist (a person who designs, fabricates, and fits braces and other orthopedic devices prescribed by your physician). Even though an AFO may not seem all that appealing at first, you'll pretty quickly find that its pros outweigh its cons.
Functional electrical stimulation (FES) devices, which manage foot drop by stimulating the weakened muscles with mild electrical impulses, are also available. However, these devices aren't appropriate for everyone, are quite expensive, and generally aren't covered by insurance.
Mobility aids such as canes, crutches, walkers, and motorized scooters also help compensate for weakness. No one likes to think about needing these kinds of aids, but they're valuable tools for anyone who's experiencing a lot of weakness because they help you conserve your energy for the big stuff. And, besides, walking isn't always the smartest or safest way to get where you want to go.
