The effect of exercise on ankle stiffness in MS

Dr Phu Hoang

NeuRa, The University of NSW

| Better treatments | Social And Applied Research | Project | 2017 | Investigator Led Research |


Around 20% of people with early stage MS have joint stiffness, which increases to 80% in the later stages of the disease. More than 40% of joint stiffness in MS occurs in the ankle. Ankle joint stiffness is particularly debilitating because it prevents normal movements of the ankle, which impedes standing up and walking or causes tripping and falls. It is thought that ankle stiffness contributes to nearly half of all falls in MS. Traditional passive stretching methods have not been effective for ankle stiffness in MS.

This project will determine the effect of a specifically designed exercise-training program on ankle joint stiffness in people with MS. This project will investigate a new approach to treatment of ankle stiffness, known as eccentric exercise. Eccentric exercise works via inducing growth and remodelling of muscle fibres. This new exercise program aims to improve ankle joint stiffness, thus reducing difficulties with mobility and the risk of falls in people with MS. This in turn would improve the level of participation in activities of daily living, as well as work and productivity.

The research will also generate new knowledge about mechanisms underlying joint stiffness. While changes to the muscle and other structures within the ankle could all contribute to the loss of movements of the joint, it is not known with certainty the processes that lead to ankle stiffness in MS.

This study is recruiting participants within NSW. For more information visit the MS Trials website here.

Progress to Date

In the first year of this grant, Dr Hoang completed a pilot study of this clinical trial with five participants with MS. Based on the preliminary data of the first 5 participants who underwent eccentric exercises, Dr Hoang and his team are confident that this specific exercise training is feasible and may be effective in improving ankle joint stiffness in people with MS. The team have learnt that most people with MS who have developed ankle joint contracture also developed a certain degree of knee hyperextension to compensate for the loss of movements in the ankle. So, knee hyperextension needs to be controlled during the training to ensure it is effective.

In the clinic, Dr Hoang has also applied this type of training in those people with MS who have developed ankle joint contracture and stiffness, consequently affecting their mobility, but could not participate in the study. All clients improved their ankle joint stiffness and mobility after five sessions. These results provide corroborative evidence that the eccentric exercise training would work in a larger group.

Dr Hoang has formed a collaboration with Australian Catholic University for this project and is supervising a PhD student to undertake this work. Dr Hoang is now recruiting for the full group of participants and expect full recruitment by the end of 2019.


  • Psarakis M, Greene D, Moresi M, Baker M, Stubbs P, Brodie M, Lord S, Hoang P. Impaired heel to toe progression during gait is related to reduced ankle range of motion in people with Multiple Sclerosis. Clin Biomech (Bristol, Avon). 2017 49:96-100.
  • Psarakis M, Greene DA, Cole MH, Lord SR, Hoang P, Brodie M. Wearable technology reveals gait compensations, unstable walking patterns and fatigue in people with multiple sclerosis. Physiol Meas. 2018 39(7):075004.
  • Hoang P. Safety and Feasibility of an Eccentric Exercise Intervention in People with Multiple Sclerosis with ankle contractures – A Case Series of five subjects. In preparation.

Updated: 20 April 2018

Updated: 04 March, 2017



Grant Awarded

  • Project Grant

Total Funding

  • $160,000


  • 3 years over 2017 - 2019

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The effect of exercise on ankle stiffness in MS