Problems with balance and walking, otherwise known as gait, are common symptoms of multiple sclerosis (MS). Balance and walking problems can be due to several factors such as muscle weakness, muscle tightness or spasticity and a problem coordinating muscle actions known as ataxia.
With the right information and support, these symptoms can be managed to maintain a healthy and active lifestyle.
Many people experience balance problems at some time during the course of MS. This can also be one of the first MS symptoms noticeable to others, for example, if someone starts walking with a limp, or if they begin to stumble or trip.
Balance and walking problems vary considerably depending on the person and may include:
Problems with balance and walking may be the direct result of MS causing damage to parts of the nervous system responsible for mobility or may be caused indirectly by other MS symptoms. It’s important to note that balance and walking are separate issues but may have a direct influence on each other. For instance, lesions in a certain part of the brain responsible for balance (the cerebellum) can lead specifically to a loss of balance, which can then lead to unsteadiness when walking. Or mobility issues caused by muscle weakness in the legs from MS lesions in the spinal cord, can then lead to problems with balance when weight bearing.
Balance problems can be the result of interruptions in communication between the brain and the rest of the body, such that a message coming from the brain to ‘move’ may not actually reach the legs, resulting in a stumble or fall.
Walking problems can be caused by slowed or altered nerve conduction resulting in muscle weakness, spasm or spasticity (muscle stiffness) or extreme fatigue. Sensory changes affecting sensations in the feet and legs can also have an impact. Numbness in the feet, for example, can reduce an individual’s perceptions of their feet touching the ground, whilst over-sensitivity from pins and needles may make someone tentative in the way they walk.
Other MS symptoms that can impact on walking and balance and increase the risk of falling include pain, tremor, dizziness and vertigo and visual problems.
Not all walking and balance problems are caused by MS, so it’s important to seek professional advice. A health professional, such as a neurologist, an MS Nurse, GP or physiotherapist can work with you to determine the cause of your walking and balance problems and advise on managing them. Sudden onset of balance and walking issues requires notification to your MS care team as soon as possible, in case it may be a sign of a new relapse.
Balance and walking issues can be managed well by making some small lifestyle changes to reduce the risk of trips and falls. Consider these options:
There are several different approaches that may improve balance, including exercise, yoga, tai chi and Pilates. Disturbed balance can also be managed to some extent by being aware of factors that make balance worse and that might increase the risk of a fall. Physiotherapists, occupational therapists and rehabilitation specialists are important sources of support, training and resources.
Treatment of walking problems varies depending on the cause. Treatment may involve physiotherapy or medications to alleviate specific underlying symptoms, such as spasticity. Physiotherapists and exercise physiologists can help with individual assessments, particularly of gait, and provide tailored exercise programs, specialised equipment and other action plans to help maintain your safety and keep you active.
There is support available to help you manage your MS.
Your neurologist, MS Nurse or GP should be the first contact for any new and/or persistent balance and walking concerns, so they can perform a detailed assessment and tailor a management plan or referrals if needed.
Contact your state or territory MS organisation to access services such as MS nurses, peer support and other resources.
The following support services may be able to provide lifestyle, wellbeing, or other advice: