Ataxia in MS: Physical Therapist Guide to Restoring Independence

Today on the blog, I want to talk about one of the most common symptoms of MS - ataxia. While the word choice "common" might make this symptom sound manageable, the lack of balance and coordination from ataxia leads to both physical and emotional difficulties that are difficult to overcome. Although it can be overwhelming - pause. You are not alone. I'm here to help.

Without further introduction, let's break down what exactly ataxia in MS is, and more importantly, how you can manage your symptoms and take back control.

What Is Ataxia In Multiple Sclerosis?

Ataxia is a symptom of MS, affecting coordination and balance while walking. It occurs when the nerves responsible for muscle control are damaged, leading to a lack of muscle control and difficulty in maintaining a steady gait. I know what you’re thinking - what is gait? Although we don’t use this word very often, gait refers to the rhythm in which we walk. 

For someone experiencing ataxia, the best comparison is trying to go down a wobbly bridge. This is due to walking with a wider stance, uneven footsteps, or different step lengths. This can lead to a lot of tripping concerns, along with a lack of confidence in one’s own balance.

What Are The Challenges of Ataxia?

Ataxia can pose significant challenges to daily life. Tasks like walking, standing, and the simple movements of completing tasks can become difficult and exhausting. In my practice, I focus on not just the physical challenges, but the emotional as well. Many of my clients, although working through our programs quite diligently, have a fear of falling and losing their independence. This can lead to an increase in social isolation of discomfort going into different environments.

Although it can feel overwhelming (and at times exhausting) trying to manage ataxia symptoms in MS, I want to make it clear you are in control. There are many treatment approaches available to not just help with the physical condition of your body, but the emotional difficulty of trusting yourself to walk smoothly.

Guidelines For Movement With Ataxia

Before I get into the exercises I recommend for managing ataxia, there are three main guidelines to follow when regaining some sense of control over your daily mobility. 

1. Do one thing at a time. We all like to multitask as much as possible, but this can often lead to distractions and a lack of focus on balance. As a practice not just for managing ataxia, but everyday life, slow down and take it one task at a time.
2. Check you are stable before continuing movement. A lot like slowing down and taking one task at a time, a lot of balance issues come from moving too quickly after standing up. I advise my clients to stand up, sense that stability, then continue moving forward.
3. Focus on quality over speed. We have a tendency to tend and do things a little too fast, which unfortunately makes ataxia worse. Place an emphasis on the quality of each movement (even steps and correct weight distribution) over rushing to where you’re trying to go.

Ataxia Exercises

There are seven exercises I recommend specifically for managing the difficulty walking due to ataxia in MS. Depending on your level of comfort, there are three sitting and four standing exercises that will strengthen your muscles and improve balance. For each of these exercises, repeat as many times as possible with good quality. To see an even larger list of exercises you can utilize for ataxia, MS symptoms, and support, check out my Youtube channel: Dr. Gretchen Hawley. 

Seated Exercises

• Heel lift and lower. Sitting in your chair, lift one heel up as high as you can, then lower it to the floor. Repeat on the other side. Focus on keeping your core strong and going slow and steady.

• Lift knee and tap with opposite hand. This is a great exercise for coordination when walking. Like the previous exercise, lift the leg up as high as you can, then tap with an alternate hand. Lift. Tap. Repeat.

• Lift knee and pump opposite arm. Just like the previous two exercises, lifting the leg improves balance, but with the opposite arm swing, you'll mimic how we naturally walk. Repeat on the other side with an alternate arm pump. Make sure you’re utilizing the opposite motion, even if you have to stop and regroup.

Standing Exercises

• Stand up, get stable, then sit back down. Sit at the edge of your chair, keep your stance nice and wide with your feet planted firmly on the floor. The goal of this exercise is to really feel yourself be in control when you stand up, then sit down when you feel solid.
• Step forward and back. For this exercise, I recommend standing in a corner to get stability on either side of your body. Shift your weight, step forward, then back. Repeat on the other side.
• Use a small step and put a foot up to balance. You can use anything as small as a book to place your foot on. Keep posture and your core in mind.
• Use a small step and tap your foot up and down. Slowly shift your weight from either side as you pull your foot up, then slowly bring it to the floor.

Practical Tips for Daily Living

In addition to formal rehabilitation sessions, there are many practical tips that can help manage ataxia in everyday life. Simple modifications to the home environment, such as removing tripping hazards and installing handrails, can make all the difference in feeling confident to maneuver around your home. 

Using assistive devices, like grab bars or a shower chair, can provide added support in areas where balance is challenged. Who hasn’t slipped in the shower before? It’s happened to me plenty of times. This is a huge recommendation I have for my clients just for peace of mind above all.

Lastly, a cane or walking device can be a huge help with outings in new environments. It’s essential to not let your MS symptoms control your life, so utilizing tools made specifically for stability can be huge confidence boosters to leave the house with less anxiety.

Ready To Feel Empowered?

As a physical therapist specializing in MS, my goal is to support anyone experiencing the symptoms of MS on their journey to reclaiming independence. If you're looking to receive a wealth of information from myself (plus many other MS specialists!) read my book: The MSing Link. This guide is specifically meant to make the symptoms of MS feel more manageable, allowing you to take back control and live life to the fullest.