The question of whether a person with Multiple Sclerosis (MS) can walk is answered with a clear “yes,” particularly in the early stages of the condition. MS is a disease where the immune system attacks the central nervous system (CNS), including the brain and spinal cord, leading to varying degrees of disability. The disease’s effect on mobility is highly personal and can fluctuate significantly. Challenges to walking stem from damage to the communication pathways that control movement.
Neurological Basis of MS-Related Gait Issues
Walking difficulties in MS are caused by damage to nerve fibers within the central nervous system (CNS). These fibers are protected by myelin, a fatty insulating layer that ensures electrical signals travel quickly and efficiently. MS causes inflammation that strips away this myelin sheath, a process called demyelination.
When myelin is damaged, nerve signals are slowed, distorted, or blocked, preventing the precise commands required for coordinated walking from reaching the leg muscles correctly. MS also causes progressive damage to the underlying nerve fibers (axons), which is linked to long-term disability.
Damage to the motor pathways in the brain or spinal cord directly impairs movement, interrupting the neural drive needed for muscle strength and timing. This structural damage is a reason why walking speed and endurance are often diminished in people with MS.
Specific Mobility Impairments
CNS damage results in distinct symptoms that interfere with normal walking patterns. MS fatigue is a pervasive symptom that severely impacts the stamina required to sustain walking. This debilitating tiredness often leads to a noticeable drop in function after minimal activity or as the day progresses.
Another common issue is spasticity, involving muscle stiffness and involuntary spasms, particularly in the legs. This stiffness restricts the smooth, fluid movement needed for a natural stride and forces individuals to exert more energy with every step.
Muscle weakness can manifest as foot drop, making it difficult to lift the front of the foot while walking. This condition causes the toes to drag, increasing the risk of tripping and falling. To compensate, a person may lift their knee higher than normal in an inefficient movement called vaulting.
MS lesions can also affect the cerebellum and sensory pathways, leading to issues with balance and coordination. Damage to the cerebellum, the brain’s coordination center, results in ataxia, an unsteady, swaying gait. Sensory deficits, such as numbness in the feet, also contribute by preventing the brain from knowing precisely where the feet are in space (sensory ataxia).
Strategies for Maintaining and Improving Ambulation
Interventions focusing on rehabilitation and compensatory strategies are effective in managing MS-related walking difficulties. Physical Therapy (PT) is central, offering tailored exercise regimens that include strengthening, balance training, and gait retraining. Resistance training increases muscle strength and neural drive, correlating with improved walking speed.
Occupational Therapy (OT) works alongside PT to increase safety and independence in daily activities. Both disciplines provide training on the proper use of assistive devices, which improve stability and conserve energy. These devices include:
- Canes and walkers
- Orthotics like Ankle-Foot Orthoses (AFOs), used to manage foot drop by supporting the ankle and lifting the foot
- Functional Electrical Stimulation (FES), which uses a mild electrical impulse to facilitate muscle movement for foot drop
Medication management improves ambulation by targeting specific symptoms. Certain medications, such as baclofen, are prescribed to reduce spasticity, relieving muscle stiffness and improving range of motion. Other medications manage MS-related fatigue, which directly improves walking endurance.
Energy conservation techniques are practical self-management strategies that benefit walking ability. This involves pacing activities throughout the day, balancing activity and rest to avoid exhaustion. Since heat sensitivity can temporarily worsen MS symptoms, using cooling vests or regulating ambient temperature helps sustain energy and maintain function.
Variability and Disease Progression
The course of MS is highly variable, meaning the impact on walking ability differs widely among individuals. The majority of people with MS maintain their ability to walk over the long term, and only about one-third eventually require a walking aid. The timeline for mobility loss relates directly to the disease type and its activity.
Relapsing-remitting MS (RRMS), the most common form, involves periods of new or worsening symptoms followed by recovery. Disability accumulates primarily from incomplete recovery after these relapses. In contrast, progressive forms, such as Primary Progressive MS (PPMS), feature a steady worsening of symptoms from the onset without clear remissions, often leading to earlier walking difficulties.
The Expanded Disability Status Scale (EDSS) is the standard tool used to quantify disability progression, with scores reflecting mobility function. For example, a score of 4.0 indicates limited ambulation without an aid. A score of 6.0 signifies the need for an intermittent or unilateral walking support. Progression to these milestones can be delayed by several years with the use of disease-modifying therapies.