One of the most fearsome consequences of multiple sclerosis is immobility. People with MS may grow increasingly worried about walking unsteadily; needing to use a cane, arm crutches, or wheelchair; or a reduced ability to be safe while moving from one place to another. Living with MS also means an increased risk of falling, which is more likely to happen at home, during the day, or in the midst of normal activities like turning, walking, climbing stairs, or while transitioning between body postures (Gunn et al, 2014).
Early in my time of living with MS, I remember a day when our family went out to eat at an unfamiliar restaurant. Lunch was excellent and we had leftovers to take home. As we left the restaurant and made our way back to the car, I suddenly found myself face-down in the main entrance to the parking lot, with our leftovers a couple of feet away on the ground. I had stepped off the curb and “tried to walk on air, apparently,” I told my neurologist. I had not become fully aware before this incident that I couldn’t feel my feet, nor the ground beneath them. The lack of sensation significantly increased my risk of falling.
Factors contributing to the risk of falling
Physical symptoms of MS — such as weakness, spasticity, loss of balance, dizziness, sensory deficits, and tremors — can contribute to falls. Fatigue, heat intolerance, vision problems, and cognitive changes can increase fall risk, as well. Behavioral risk factors include deconditioning and inactivity. It is important to stay physically active so that you can remain physically active. (That sounds obvious, I know.) Finally, environmental conditions can contribute to falls, including poor lighting, uneven or unsteady surfaces, clutter and obstacles, and even your choice of clothing. And in a bitter kind of irony, both overconfidence and the fear of falling increase the risk of falls.
Reduce your risk of falling
One of the easiest ways to reduce your risk of falling is to make simple changes to your environment in the home, workplace, or community in order to limit possible contributing factors. The National MS Society’s booklet. Minimizing Your Risk of Falls: A Guide for People with MS (pdf), offers 49 tips for fall-proofing your home and 17 tips for staying safe in your community. Examples of suggestions include:
- Install railings on both sides of your stairs which extend beyond the first and last step.
- Avoid throw rugs or tack them down securely with double-sided tape, and never place them at the top or bottom of stairs.
- Make sure that the light by your bed is within easy reach, or keep a flashlight handy.
- If you have a vision problem, use contrasting color tape on the border of countertops to avoid bumping into them.
- Avoid walking near the edge of the sidewalk so that you don’t fall off if bumped or if you lose your balance.
Improve your balance
Exercises aimed at improving mobility and stability will be those that focus on balance, core strength, posture, and gait. It is particularly important to work on movements and activities that focus on dynamic balance as people with MS are more prone to falls during activities that involve transitioning between postures and walking, rather than during quiet standing and sitting (Cattaneo et al, 2014).
Exercises that challenge dynamic balance may not seem complicated or complex, but they're very important. These exercises might be as small and simple as standing in a particular posture (feet in tandem, for example) and slowly moving your head and eyes from side to side, or up and down.
Carrying on a conversation while you are engaged in activities during physical therapy might not seem significant, either, but doing so also helps to challenge your dynamic balance control. Dual tasks, such as walking on a treadmill and engaging in cognitive activities (such as counting down by certain increments, or carrying on a conversation), can help improve your reflexes and prepare your body for everyday activities.
See more helpful articles:
Cattaneo D, Jonsdottir J, Coote S. Targeting Dynamic Balance in Falls-Prevention Interventions in Multiple Sclerosis: Recommendations from the International MS Falls Prevention Research Network. Int J MS Care. 2014 Winter;16(4):198-202. doi: 10.7224/1537-2073.2014-062.
Gunn H, Creanor S, Haas B, Marsden J, Freeman J. Frequency, characteristics, and consequences of falls in multiple sclerosis: findings from a cohort study. Arch Phys Med Rehabil. 2014;95:538–545.