Beat Pediatric MS Pain With These PT Exercises
Multiple sclerosis (MS) is rare in kids, but that makes it no less painful for the roughly 10,000 children and teens worldwide who have the neurological disease. In MS, pain signals come directly from the central nervous system or from the body’s muscles, says Larissa R. Pavone, M.D., a pediatric physical medicine and rehabilitation specialist at Marianjoy Rehabilitation Hospital in Wheaton, IL. Fortunately, performing physical therapy moves can help reduce muscle tightness, keep joints free of pain, and reduce pressure on sensitive muscles and nerves. We’ll walk you through them so you can help your child.
Get Kids With MS Moving
“The vast majority of pediatric MS cases are relapsing-remitting, with [symptoms] worsening for a few days or weeks and then resolving partially or completely for a while,” says Jaclyn Graff, D.P.T., a pediatric rehabilitation physical therapist at the Hospital for Special Surgery in New York, NY. “Although the child may be free of symptoms during the remission phase, neurological damage can still occur.” That’s why it’s important to make movement a daily habit. Focus on keeping things fun, stop doing anything that causes pain, and always talk to your child’s physician before starting a new exercise routine. Ready? Let’s go.
For kids with MS, tight hamstrings can trigger back pain and, according to Graff, make standing and lying with straight legs uncomfortable. To relax the hamstrings, have your kid lie on his or her back. Wrap a long sheet or belt around one foot, with the child holding the ends. Ask your child to raise a foot toward the ceiling, keeping the knee as straight as possible, to feel a gentle stretch in the back of the leg. If your child needs help, hold and raise the leg for her or him. Do three to five 30 to 45-second holds per leg.
Stretching the calves can make it easier for kids to stand with their feet flat on the floor without pain, Graff says. Have your child sit down with one leg extended, the other relaxed and bent. Wrap a long sheet or belt around the extended foot, with your kid holding the ends. Your child will then pull at the sheet or belt, drawing back the toes for a gentle stretch in the calf. If the child has trouble holding the sheet or belt, gently press back his or her extended foot yourself. Do three to five 30- to 45-second holds per leg.
Doorway Chest Stretch
A common symptom of MS includes chest and rib tightness. Often called the MS hug, it can feel like you're wearing a tight band around your chest, according to the Multiple Sclerosis Trust. In some cases, it can make it feel difficult to take a full, deep inhale. To help relax tightened chest muscles, have your child stand in a doorway and place his or her hands and forearms on the sides of the doorframe. Now, coach your kid to lean forward to gently stretch in the front of the shoulders and chest. Do three to five 30- to 45-second holds.
During flare-ups, your child likely spends more time sitting than usual, which can cause tightness in the hips, as well as increase pressure on their back and bottom to spur on pain there, Graff says. To help relieve excess pressure and relax the hip flexors, have the child to spend up to one hour on their stomach throughout the day. Options for on-stomach activities include drawing, reading, doing puzzles, and playing board games.
Trochanteric bursitis, in which the fluid-filled sacs that pad the hip joint get inflamed, is a common cause of pain with MS, according to research published in Practical Neurology. To reduce pressure on the area, Graff recommends swapping out the child’s desk chair for a stability ball intermittenly throughout the day. Have your kid stand up, heels directly in front of the ball, then sit back down, keeping both feet on the floor at all times. If your child has trouble getting positioned on the ball, hold it in place as he or she sits and finds balance.
Terminal Knee Extension
In multiple sclerosis, the quadriceps often lose muscle mass and strength, contributing to knee pain and painful walking mechanics, according to research published in the Journal of Physical Therapy Science. Strengthening the quadriceps, especially at their end range of motion, can help, Graff says. Have the child sit down with one leg extended on the surface in front of them. Place a rolled-up towel under that knee. Have the child push the back of their knee down into the towel to contract the muscles in the front of the thigh. Do two sets of 10 five-second holds per leg.
The less strength your kid has through the lower body, the greater chance of painful falls, per a 2020 study in Journal of Foot and Ankle Research. To reduce the risk of injury-causing falls, have your child stand, heels directly in front of a chair, and extending arms straight out in front. Tell your kid to sit down on the chair, then stand back up without using their hands. (Make it fun, like a game!) If he or she has trouble balancing, hold your child’s hands for assistance. Do three sets of 10 repetitions. Or, try five reps when sitting at the table for each meal.
Another cause of falls in kids with MS is neurological, Graff says, with the disease attacking the brain and the inner ear’s vestibular system. When the system goes awry, kids feel off-balance, dizzy, or like they’re spinning. To train the system, have your child stand a few feet away, feet together and facing you. Holding a soft, light ball, gently toss it toward the child to catch. Then ask your kid toss it back to you. Once this feels easy, ask your child to balance on one foot, then throw and catch. Do three sets of 10 passes back and forth.
- Pediatric-Onset Multiple Sclerosis: National Multiple Sclerosis Society. (2020). “Pediatric MS.” nationalmssociety.org/What-is-MS/Who-Gets-MS/Pediatric-MS
- MS Hug: Multiple Sclerosis Trust. (2018.) “MS hug.” mstrust.org.uk/a-z/ms-hug
- MS-Related Bursitis: Practical Neurology. (2009). “Greater trochanteric pain syndrome, another cause of hip or thigh pain in multiple sclerosis.” pn.bmj.com/content/9/3/163
- Knee Mechanics and Gait in MS: Journal of Physical Therapy Science. (2015.) “Knee muscle strength in multiple sclerosis: relationship with gait characteristics.” ncbi.nlm.nih.gov/pmc/articles/PMC4395720/
- Lower Extremity Strength and Falls: Journal of Foot and Ankle Research. (2020.) “Research on lower extremity health in patients with multiple sclerosis: a systematic scoping review.” jfootankleres.biomedcentral.com/articles/10.1186/s13047-020-00423-x