October is National Physical Therapy Month! Many with MS have benefitted from the guidance of a physical therapist and with good reason… they are a very valuable member of the healthcare team! Physical therapy can help to improve many mild challenges and possibly slow down the progression of the symptoms of the disease. Physical therapists may make recommendations about:
The types of exercise that are best for you and those you should avoid.
How long and intense your workouts should be.
The right exercises depend on your symptoms, fitness level, and overall health.
Any physical limitations for your routines
In honor of National Physical Therapy Month, I am delighted to introduce you to Allan Buccola, PT, DPT! Allan is a physical therapist located in Greensboro, NC. He is my go-to resource for questions about exercise and stretching and he has been kind enough to share his thoughts on the importance of exercise and wellness after an MS diagnosis. If you are in the Greensboro, NC area I encourage you to consult Dr. Buccola if you are not local, go here to locate a Physical Therapist near you.
So without further ado, here’s Allan!
Exercise Is Not a Dirty Word
First of all, let’s talk about the pink elephant in the room. Exercise can be a not-so-pleasant word for many, the term alone sometimes a bit misleading. Exercise comes in many different hues and tones and can include things like strength training, aerobic conditioning, stretching, and specific skills development, among others things. As a PT, I find that those who are most successful at staying active and in good shape don’t consider their activities ‘exercise’ so much as leisure or hobbies.
Think about how children play on the playground. When they run are they thinking about aerobic conditioning? When they walk the balance beam, are they thinking about dynamic stability? When they shoot a basketball, are they thinking about fine motor control? The answer is likely a resounding ‘no.’ All they are doing is focusing on having fun.
Consider things that you are passionate about or have been in the past and consider a reboot. You’ll likely be too distracted having fun to realize what a good workout you’re getting. Don’t think of a gym as the gold standard of wellness; most people can remain physically fit, in spite of any mobility limitations outside of a gym. As a matter of fact, my PT practice places a strong emphasis on exercises that can be performed in the home easily with minimal equipment.
Focus on General Wellness at the Very Beginning
For those who have few limitations in mobility or are newly diagnosed, this is the best time to begin to establish a strong foundation of wellness. MS often comes at a time in life that is, for many, stereotypically more focused on career or family than the self. The idea of finding time for personal wellness or exercise is slim to none.
Exercise, in general, can have amazing benefits for those diagnosed with MS, but perhaps most of the benefit lies in the ability to maintain general wellness. As people with MS age and their disease progresses, they may begin to experience some degree of physical decline that is difficult to predict. Unfortunately, I find many who suffer also from other disease complications that are commonly problematic with the general population.
Concurrent diagnoses of problems with blood pressure, obesity, diabetes, heart disease, and many others only make things more difficult for those with MS. All of these things tend to result in fatigue, irritability, and inflammation, which simply adds insult to injury. Also of note, the cocktail of medications required to address all of these begins to take its toll on how people feel. A perfect example of this is how a course of corticosteroids like prednisone create additional problems with blood sugar for those who have diabetes.
The greatest investment you can give yourself is to make a lifestyle change that involves regular physical activity, sound nutritional practices, and some type of mindfulness practice, whether it be prayer, meditation, or daily reflection. It is in this light that no matter the progression of your disease in the future, you will be protected that much more.
Individualized Fitness Programs
The presentation of MS is quite variable among people, but almost all will deal with changes in four key areas related to their physical health: strength, flexibility, mobility, and balance. Although an individualized fitness program won’t completely resolve these changes, it can have a power effect at minimizing these changes. The body is extremely adaptable to training, and this remains the case after MS begins to change the body. I cannot stress this enough with my new patients.
I encourage these patients to pay close attention to daily function, their body, and how they feel from sunup to sundown. As tasks become more difficult, a baseline level of acceptance can be helpful in dealing with those changes, but embrace those individual tasks and continue to work toward improving them. Avoiding them or assuming that they will get worse becomes a self-fulfilling prophecy.
Take time daily to think about any changes you may notice to your strength and flexibility. Daily targeted strengthening and stretching are critical in maintaining ease in mobility and avoiding spastic muscle pain. Do you notice transfers to your wheelchair are becoming more difficult or that your sitting balance is becoming more difficult? Engaging these areas in a targeted method can have powerful results.
Physical Therapists Help in Outlining a Fitness Program
PTs are experts in movement related dysfunction and are critical in helping patients with MS. The big picture often focuses on maintaining quality of life and independence but will start at the ground level to identify specific areas of impairment so that the interventions can be as specific as possible. PTs do this in three ways: remediation, compensation, and strategic planning.
Remediation focuses on improving areas that are either recently or chronically in decline. This may mean improving strength, improving the distance the person is able to walk, or returning an individual to a previous level of independence in a particular task.
Compensation refers to helping a person find new ways to approach an old task. Whereas remediation may be working toward a 3 month goal of being able to walk short distances again, most people still need to find a way to access their living environment in the meantime: this is where compensation might focus on easier ways to perform transfers from a wheelchair to a toilet.
Strategic planning is the last component, a term that I largely have coined. PTs use information generated from the latest research, and the unique story of the patient, and help to create an individualized plan for making daily tasks easier. Sometimes this helps figure out the best time of day to perform errands and save energy for later, or maybe about how to best use community resources to make daily life more seamless.
Whereas PTs typically work with patients for weeks to months at a time to achieve a simple goal, working with patients with neurological conditions can be quite different. Granted the progressive and variable nature of MS, many patients will have very different needs for PT, but likely will benefit from physical therapy a few times over the course of several years.
My practice, Impetus Physical Therapy, is set up for direct pay only, so that insurance plans will never dictate patient access to care. This allows patients to come and go as they see fit, much in the same way they would to their physician. Everyone has the autonomy to say when they don’t feel well and are able to decide when a doctor’s visit is needed, yet many insurance companies in North Carolina don’t offer that same autonomy regarding the need to see a PT. The direct pay model of my practice takes care of that problem and empowers patients to take care of themselves more effectively.
A new diagnosis of MS or even an older one comes with great uncertainty. Every person is different and new advances in medications continue to come out each year. Be forward thinking, invest your time right now, and make physical activity a part of your routine. Many of you know or are still learning about how MS can affect your body, the way it moves and the way you feel. Optimal performance starts today.
Bear in mind that there are a great deal many other diseases related to physical inactivity that are completely avoidable in the first place. Take this time in your life to dedicate yourself to living well and you will find wellness. Find ways to incorporate regular physical activity and exercise in your life and avoid the unnecessary malady that comes with heart disease, diabetes, arthritis, stroke, and even cancer. Be empowered to know that the decisions you make each day have a positive impact on your wellbeing and quality of life.
Dr. Allan Buccola, PT, DPT, is a physical therapist in Greensboro, NC, where he resides with his wife and two children. Allan is the Owner of Impetus Physical Therapy, a practice that strives to simplify access to care and be a leader in preventative medicine and wellness. Allan also works part-time in the hospital setting, and has a wide range clinical interests in everything from sports performance, chronic back pain, injury prevention, running rehab, Parkinson’s Disease, and MS. When Allan isn’t working or with family, you’ll find him running the trails either in Greensboro or at a mountain nearby. Follow him on his blog and Facebook.
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