MS Exercise Modifications 7 Physical Therapy Strategies for Better Results - Podcast
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Dr. Gretchen Hawley: When you have multiple sclerosis, you need to make sure that the exercises you're doing are doable for you, because the more doable they are, the more you're going to get out of them. Oftentimes, people think that modifying an exercise or making it easier for isn't a good thing, but I'm here to tell you that making an exercise easier is not a bad thing.
[00:00:23] Why you should mondify exercises
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Dr. Gretchen Hawley: In fact, it's a really smart thing to do. And here's why. If an exercise is easier for you to do, you can likely do more repetitions of that exercise. And the more repetitions you do, the more opportunities you have to increase neuroplasticity, meaning finding a way to strengthen the neural pathway, which is the connection from your brain all the way down to whichever muscles you're using.
Dr. Gretchen Hawley: So modifying is always encouraged here over at The MSing Link. And I want to give you six ways to modify any exercise. You don't have to do all of these. I would recommend picking just one or maybe two, but hear them all out and then see which feels most appropriate for you.
[00:02:13] Modification - Change Position
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Dr. Gretchen Hawley: These modifications are not mentioned in any specific order. All of them are going to be equally great. see which one feels good for you,
Dr. Gretchen Hawley: the first one that I want to mention is to change the position that you're in. For today, I'm going to be showing you how to modify the specific exercise called marching, which from a seated position looks like this. It's one of the most effective exercises to help with improving your walking because as we're walking, we need to lift our leg.
Dr. Gretchen Hawley: forward like this, which is the standing version of a march, regardless of what position you're in. You're strengthening your hip flexors, these muscles on the front of your hip. So we're going to work through all of these ways to modify specifically for the marching exercise, but you can apply everything we're talking about today to any exercise.
Dr. Gretchen Hawley: So I mentioned that changing the position is one way that you can modify an exercise. What I mean by that is one way that you can march is sitting up tall like this. However, this is actually one of the hardest positions to march in because your hip muscles are already flexed. They're already bent at this 90 degree angle.
[00:03:28] Recline in a Chair
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Dr. Gretchen Hawley: And one way we can make it easier is by Opening up that angle so that it's not at 90 degrees anymore. So one way that we can do it is reclined. So now we're not as bent. This version of the exercise might feel easier. Or you could even do this exercise standing. Now there's no bend in our hip flexors.
Dr. Gretchen Hawley: They're straight and we're bending from there. So this position Might be easier. Other position options could be lying on your side.
[00:04:02] Laying on the floor
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Dr. Gretchen Hawley: And when you're lying on your side, you can bend one hip. So this is still the marching exercise or both legs at the same time, whichever feels easier. Just make sure to flip over and do the other side as well.
Dr. Gretchen Hawley: And you could also do this marching exercise lying on your back, if that's easier for you. So find a position that feels like it's easiest, so that you can do more repetitions with good quality.
[00:04:28] Move Faster
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Dr. Gretchen Hawley: Another way that you can modify is to go faster. Typically, the slower you go, so if I were to do a standing march really slow, the harder it is, because it requires that I'm standing on this leg, And it requires that I use these muscles on this leg longer for more time. If I'm going slow, I might have to use my hip flexors for five, six, seven seconds.
Dr. Gretchen Hawley: But if I'm going faster, I only have to use them for maybe one second. So going faster, With an exercise is another modification that you could take.
[00:05:04] Use less Effort
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Dr. Gretchen Hawley: The third modification is to put less effort in. Another way to think about this could be to not lift as high or go for less movement. So instead of aiming for lifting your leg this high or however The highest you can lift is maybe only aim for this high, you're still working your hip flexors.
Dr. Gretchen Hawley: It's just that you're not lifting as high. So it should feel a little bit easier and you should feel a little more successful.
[00:05:36] Fewer Repetitions
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Dr. Gretchen Hawley: Next up is to do fewer repetitions. So if you are normally doing maybe some alternating marching one side than the other side, and you're aiming for 10 repetitions, but you notice that by the sixth repetition or seventh, it's just extra hard to lift your leg. Maybe spasticity is kicking in, or it's just not good form, or you're not sure if this is what it's supposed to look like.
Dr. Gretchen Hawley: Stop at five, do fewer repetitions. And that way it should feel a little bit easier.
[00:06:10] Take more rest breaks
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Dr. Gretchen Hawley: Which brings me to my next tip on how to modify an exercise, which is more rest breaks. So if you're only doing five repetitions after five, you would stop and rest. And your rest breaks can be anywhere from 10 seconds to 30 seconds or a minute or five minutes, however much you need, but take a rest break.
Dr. Gretchen Hawley: And then when you're ready, get back right into the exercise. After you've done five or whatever lower number you've determined to be good for you, stop and rest again. So you'll have more frequent rest breaks. This also coincides with my next tip, which is longer rest breaks. If you normally do take rest breaks, that's amazing, but maybe instead of only resting for 30 seconds, try resting for 60 seconds or 2 minutes or 5 minutes.
Dr. Gretchen Hawley: Not only that, if you're resting in a standing position, Maybe you try resting in a seated position, especially if you're doing standing exercises like this, and then you're just resting in the standing position, your muscles are still working. You would be giving your muscles more of a break if you sat down while you were resting.
Dr. Gretchen Hawley: Now, if you're normally doing a seated exercise, let's just say the seated marching, you do a few repetitions, then you're going to give yourself a break. Again, if you're resting. up like this unsupported from the back of your chair, your muscles are still working. You'd be doing a better service to your body by resting fully relaxed and reclined. Consider how many rest breaks you're taking and if you're looking to modify, take more rest breaks. What is the time of your rest break? Maybe rest for longer and rest in a more relaxing position. That was basically three rest tips, even though I only mentioned it was two, but there's an extra bonus for you.
Dr. Gretchen Hawley: Now I mentioned that I had six ways to modify. I've already mentioned those six, but I did just want to mention a seventh. If you are someone who does use weights or resistance bands or something external to add to your exercises, then you can consider modifying by dropping weight, maybe using no weight or much less weight.
Dr. Gretchen Hawley: Or if you normally use a. blue or black resistance band, which is typically the hardest ones. Maybe use a yellow, which is a lighter resistance. I typically don't use weights or resistance bands with my exercises, because when you're doing MS specific functional exercises, more often than not, they're not effective.
Dr. Gretchen Hawley: necessary. You can add them in if you want to, but they're not necessary. But I do know that some people just love using weights and resistance bands. So if you are, go ahead and drop the weight or drop the resistance to modify.
Dr. Gretchen Hawley: Okay. So I feel like that was a lot all at once. And if you weren't taking notes, I just want to quickly recap my favorite ways to modify. And again, you don't have to do all of these, just pick one way to modify or maybe two, but you don't have to do all of them. And once you pick one, If it didn't feel that much easier for you or more relaxing, then pick a different one next time.
Dr. Gretchen Hawley: It's all about listening to your body and making sure that it feels good and easier for you. Even if it's not feeling easy, I keep using the word, it should feel easier. It's not going to feel easy. It should just feel easier, if that makes any sense. So if an exercise is already really challenging for you, modifying in any of these ways likely won't make it feel easy, but it should feel like you can be at least a little bit more successful. And what that might look like is You attempting a movement and it going from not moving at all to maybe moving a little bit, moving an inch or a few centimeters.
Dr. Gretchen Hawley: That is improvement. And maybe the reason it's moving is because you modified based on changing your position or you're adding more rest breaks or fewer repetitions, whatever it is.
Dr. Gretchen Hawley: So let's recap these modifications. Number one, change the position to make it feel easier. Maybe that means changing from a seated to standing, or standing to seated, or lying on your side. And I do just want to point out, when I was lying on my side earlier, I demonstrated it on my floor. You can do that on your bed or a couch.
Dr. Gretchen Hawley: Do not get down to the floor if you don't feel safe and able to stand up with confidence and with strength. Number two was to go faster. Change the speed of your exercises. The faster you're moving, typically, the easier it is. Number three was to not put as much effort in. Don't aim for big movements with each of your exercises.
Dr. Gretchen Hawley: Just aim for smaller movement. Don't put as much effort in. Number four, don't do as many repetitions. Number five, have more rest breaks. And number six was have a longer rest break. The sneaky one that I put in there as well was to make sure you're resting in a more comfortable position. And number seven was to drop weight or resistance.
Dr. Gretchen Hawley: Lessen the weight or resistance. If you are using weights or resistance,
Dr. Gretchen Hawley: All of these strategies are things that we discuss in my online MS wellness program, The MSing Link. And furthermore, the last Wednesday of every month, we have a live Q and a call on zoom. So all of my missing link members hop on zoom and you're able to ask me your specific questions.
Dr. Gretchen Hawley: And this question comes up frequently of this exercise is hard. How do I make it easier? Or how do I modify this exercise? And that is what we get to do together. We get to brainstorm and troubleshoot so that your exercises are doable for you because if they're doable, you're more likely to succeed. See an improvement in real life situations like walking, climbing stairs, better stamina, standing longer, you name it.
Dr. Gretchen Hawley: If you haven't heard of The MSing Link, Check the description and I'll put the link there where you can learn all about it and see if it's a good fit for you and the goals that you're working towards.
Dr. Gretchen Hawley: And if you're listening on the podcast and you want to get a visual of the different positions that I was talking about, I actually recorded this in video format as well. And it's posted over on YouTube. So check it out there.
