Balance and Walking

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:

• Tripping, stumbling or falling
• Unsteadiness when walking or turning
• Needing support from walls, furniture or other people
• A heavy feeling in the legs when stepping forward
• Leg weakness when weight bearing
• Difficulty placing the foot squarely on the ground
• Taking slower, shorter steps
• Loss of confidence when walking
• Difficulty in feeling secure when moving about and a sense of location in space (known as “proprioception”)

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: 

Footwear 

• Suitable and well-fitting footwear can help support your foot and lessen the dragging along the floor. 
• Shoes with laces or adjustable velcro fastenings, may be safer than slip-ons that can become loose with wear.
• Boots can be helpful as they provide ankle support.
• Avoid cumbersome or heavy shoes that quickly tire your muscles. 

Awareness

• Be aware of your surroundings when moving about, concentrate and be alert: assess your location and environment for tripping hazards. 
• Plan your movement, consider which route offers the least potential risk or fewest obstacles. If an obstacle does exist, can this be either safely moved or negotiated? 

Remove hazards

• Some clutter is inevitable, but try to keep the main routes you use to move around the house free from obstacles. 
• Tape down or use non-slip mats under rugs particularly in the bathroom and bedroom, or consider removing them completely.
• With electrical items, try to keep wires and cables covered or taped down in walking areas to prevent trips or falls. An extension lead can help to reroute cables away from places where they might be a tripping hazard.
• When out and about, use walking ramps and lifts where possible instead of stairs and escalators.

Balance:

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.  

Walking:

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.