Dr. Gretchen Hawley is a physical therapist and MS specialist. She’s the author of The MSing Link: The Essential Guide to Improve Walking, Strength & Balance for People With Multiple Sclerosis. She spoke with Yoga Moves MS founder Mindy Eisenberg in February 2024 about the role physical therapy and yoga therapy can play in restoring balance in people with MS. 

People with MS may have poor balance for many reasons

Vestibular system issues

The vestibular system is in the inner ear and helps your brain know where your body is in space. If you have poor posture while seated or standing it affects your vestibular system. If you’ve been slouching for years, when you first sit up tall your vestibular system may make it feel like you’re falling backwards because your body things slouching is your center of balance.

Practice your tall seated posture for 10-30 seconds at a tine and then come up over time to a taller posture. Improving your neck and back strength will help you be able to hold your head high over your spine more easily. Closing the eyes can help you use the vestibular system or know if you’re having a vestibular system issue. Turn your head left and right, slowly at first with your eyes open.

Visual system issues

If you have any lag between your vision and your optic nerve, which is one of the nerves that can be affected my MS it can affect both vision and the inner ear balance. You can have a hypomobile vestibular system where you look one way but your eyes don’t move quick enough or they moved faster than your brain can keep up with.

In an ideal world we walk and move with our gaze at eye level. If you have altered sensations and can’t tell where you’re going, you’ll need the visual and tactile feedback to see what you’re leg is doing. Gaze at a downward diagonal until you gain more proprioception and then start to look up more.

Poor proprioception

Proprioception is knowing where your limbs are in space may make you feel off balance. If you can’t tell where your leg is, instead of placing it forward in font of you, you’ll place it across or far to the side and you may walk like you’re drunk becasue you can’t get your leg to go where you want it to. Proprioception is responsible for sensation including the feeling your feet, calves, knees and legs all of which play a big role in balance.

An exercise to improve proprioception starts by putting something in font of you on the ground. Lift your leg up and tap it whether it’s a pen, or a spot on the rug, the intersection of tiles on the floor, or a piece of lint on the floor with your heel. The higher up the object is, the more difficult the exercise will be. You could to this exercise seated or standing. You can hold onto a rollator, cane, or other mobility aid if you do this exercise standing. If this is still too challenging, practice marching by lifting the leg and setting it back down — even if there’s limited or no movement in the hip. This can be done throughout the day.

If you have drop foot, this exercise may be difficult. An exercise that helps with drop food is lifting your toes and midfoot, but not the heel. Practice by lifting the toes on one foot then the other.

Fully locked knees makes moving and adjusting to the ground more difficult. Slightly bending the knees help us adjust quickly and feel more balanced.

Touching something lightly with the hands can help with balance such as touching the sink or countertop. Keeping your arms out wide can help with balance, as can a wider stance with the feet. One point of contact will help, so just one finger is enough sometimes rather than the whole hand.

Poor Coordination

Coordination needs to be practiced so your brain doesn’t get confused while you’re doing the movement. Practicing opposite arm and leg movements. Often people with MS don’t move their arms while walking or only move one arm. When you focus on swinging your arms while walking your body can feel more balanced and coordinated. Start with just the arms seated. Then add marching with the legs and arms in the chair. Finally practice marching with arm swing on one side while holding onto something with the other arm and then switch.

In an ideal world when you’re seated your center of gravity should be centered over our hips, not back on your sits bones or too far forward into the hip flexors. Leaning forward and backwards helps you find your center of gravity when you feel steady and sturdy. When you’re standing your center of gravity should be centered over your feet, not in your heels or toes but balanced throughout the center of the foot and the arch. Use tiny movements forward and backwards to adjust and try to hold your balance in a centered position. Press into the big toe mound if your weight is mostly on the outside of the feet. If you have knee kissing and more weight on the big toe and inner foot, focus on moving the weight to the middle of the foot.

Engaging the core before starting an exercise can help make you feel more stable and balanced.