Multiple sclerosis (MS) is a disease of the central nervous system, interfering with nerve impulses within the brain, spinal cord and optic nerves.

HISTORY

34 year old mother (RP) of two young children diagnosed with relapsing remitting Multiple Sclerosis 14 years prior. Remains independent and active riding her bike with her children to and from school each day. RP works full time and is very aware of conserving her energy levels to maintain her work and family life balance. More recently troubled by mild weakness in her legs – left greater than right, and a loss of rhythm with fast movements, making running difficult. RP also experiences pain in her legs from knees to feet, after prolonged standing or walking for more than 20 minutes.

EXAMINATION

RP walks independently, manages dual task gait activities and can take 3-4 jogging steps. Balance in standing is compromised with eyes closed and high level skills such as Single Leg Stance are maintained for 3-4 seconds (normative aged matched data = 30 seconds). Sensation is reduced to light touch, there is good selective active movement with mild generalised weakness, but tightness throughout both leg musculature, particularly hamstrings and calves, with unsustained clonus (tonal response) left foot. 

TREATMENT

Home program of feet mobilisation and desensitisation techniques, with muscle/neural stretching exercises and balance activities. Discussion re self-management strategies including hydrotherapy and yoga to assist flexibility, strength and rhythmical activity, to help towards her goal of jogging, bearing in mind fatigue levels to avoid compromising lifestyle independence.

OUTCOME

RP keen to continue home program to fit in with work and home demands, and will come back for reassessment in three months to review and upgrade home program. Ongoing reviews are planned, with short bursts of more intensive treatment if new issues arise.