The primary cause of MS-related pain is nerve damage. But other factors can contribute to the development of pain, as well as fatigue, when one lives with MS. Pain and fatigue can develop in patients with MS due to orthopedic or musculoskeletal problems caused by overuse of isolated muscle groups, poor posture, or overexertion. In addition, impairment of posture and balance while sitting can affect your ability to perform daily tasks (Lanzetta, 2004).
MS can contribute to poor posture in a number of ways. Muscle weakness or imbalance of muscles in the torso, especially weakness in core body muscles in your back and stomach, can lead to poor posture. When these muscles are weak, it is more difficult to keep your back and pelvis in proper alignment, which may lead to slouching and/or leaning backwards to compensate for the weakness. Improper spinal alignment can cause neck and back strain as smaller muscles must work against gravity to hold the body upright.
Patients who experience weakness in the lower extremities may find standing for extended periods of time difficult, and may also begin to slouch or lean to compensate. Patients who have difficulty walking due to foot drop or weakness in leg or hip muscles may experience poor posture because their muscular imbalance causes them to overcompensate by walking with an exaggerated gait. Each of these circumstances may increase fatigue which itself can contribute to poor posture. It can become a vicious cycle.
Numbness and tingling also are common symptoms of MS. If you have numbness in the legs and/or feet, or have impaired proprioception (sensory awareness of the body in space), you may feel less than sure-footed when walking or climbing stairs. This may cause you to lean forward somewhat to watch your feet as you move, and that puts further strain on your back and neck. With good posture, your head is centered above your spine and your chin is level with the ground. With poor posture, the muscles of your neck, shoulders and lower back must work extra hard to carry the weight of your head.
A less obvious cause of poor posture in persons living with MS could be problems with vision. Poor eyesight may cause a person to lean forward to see computer or TV screens. A combination of poor eyesight and weakness in the arms can lead to excess slouching or bending forward when reading a book, newspaper, or magazine. When at the computer, you can experiment with adjusting text font size or increasing image size on the screen to view them more easily. Using the keys "command" or "control" and the "plus sign" at the same time on the computer keyboard is one way to ‘zoom in’ on web pages or images. Speak with your eye doctor and/or occupational therapist to discuss how eyesight changes may be contributing to poor posture and fatigue.
What can you do to improve posture?
- Strengthen your core/trunk muscles. Exercise programs such as yoga, pilates, or tai chi are particularly helpful.
- Maintain good flexibility. Keep your muscles and joints limber through stretching and gentle exercise. Tight hamstrings and lower back muscles make it more difficult to maintain good posture.
- Be aware of your body position while sitting, standing and walking. Are you slouching, leaning forward when you walk, or jutting your chin forward? Try to keep your hips and pelvis in alignment and let your skeleton support most of your weight.
- Use assistive devices which are adjusted for your height and use them appropriately. Work with a rehabilitative specialist to determine what is best for you.
- Sit in chairs which properly support your body, especially the lower back, and avoid slouching. Use props or pillows as necessary to maintain a relaxed position to reduce leaning and undue muscle strain. Sit with your knees level with your hips and with your feet flat on the floor or resting on a footstool.
- Focus on ergonomics in your work space. The top of the computer screen should be placed at eye level. If using a keyboard, wrists and forearms should be level with the floor.
- Reduce back or neck pain while sleeping by using an appropriately-sized pillow designed for your sleeping style (back-, side-, or stomach-sleeping). Perhaps use a pillow below or between your knees to further reduce strain on joints and allow muscles to fully relax.
- Do not stay in one position for too long. Move around periodically. If you are stiff when you first get up, take time to do some gentle stretches to relax and lengthen your muscles.
Lanzetta D, Cattaneo D, Pellegatta D, Cardini R. Trunk control in unstable sitting posture during functional activities. Arch Phys Med Rehabil 2004 Feb;85(2):279-83. https://www.ncbi.nlm.nih.gov/pubmed/14966714
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Balance for people with multiple sclerosis. © MS Australia, June 2009. ISBN: 978-0-9806637-2-3. Accessed at https://www.msaustralia.org.au/aboutms/documents/MS-Practice/balance.pdf
Managing Pain and Sleep Issues in Multiple Sclerosis. North American Education Program 2012. National Multiple Sclerosis Society and Multiple Sclerosis Society of Canada, 2012. Accessed at https://mssociety.ca/en/pdf/managing-pain-and-sleep-issues-in-ms-EN.pdf
Helen Conyers, Simon Webster. Understanding and improving your posture. © Multiple Sclerosis Trust, 2012. ISBN: 1-904156-27-4. Accessed at https://www.mstrust.org.uk/downloads/understanding-and-improving-your-posture.pdf
Morgan K. Boes. Postural control in persons with multiple sclerosis: An investigation of dual task cost and physical modeling. © Morgan Boes, 2011. Accessed at https://www.ideals.illinois.edu/handle/2142/29697
Lisa Emrich is a patient advocate, accomplished speaker, author of the award-winning blog Brass and Ivory: Life with MS and RA, and founder of the Carnival of MS Bloggers. Lisa uses her experience to educate patients, raise disease awareness, encourage self-advocacy, and support patient-centered research. Lisa frequently works with non-profit organizations and has brought the patient voice to health care conferences and meetings worldwide. Follow Lisa on Facebook, Twitter, and Pinterest.