Although individuals with multiple sclerosis (MS) seem pretty clear on the idea that exercise is helpful in controlling some of the disabling effects of the disease, it always surprises me that there is less awareness of the opposite, that not exercising may actually make the disabling effects of MS worse.The combination of disuse, sedentary lifestyles, and inappropriate compensatory movements, leads not only to a loss of mobility, but may actually prevent the nervous system from undergoing reorganization that is a necessary part of functional recovery.

The idea that the nervous system is capable of specific change as a result of specific activity is referred to as neuroplasticity. Neuroplasticity means that a brain is capable of healing itself to some extent. When the activity that the person with MS performs results in functional improvements, it is called adaptive neuroplasticity, meaning that the brain changes itself in a positive way. However, if the person with MS engages in a sedentary lifestyle, performing little or no exercise or mobility activities, the brain will adapt to that as well. This is referred to as maladaptive neuroplasticity, and can lead to a worsening of disability. As a multiple sclerosis physical therapist, I try to make, as many patients as possible aware of the fact that there are consequences to immobility, and that avoiding it as much as possible will result in the best outcomes.

*Herb Karpatkin, PT, DSc is a physical therapist specializing in evaluation and treatment of persons with MS. He is a professor of physical therapy at Hunter College in NY, and owns a private practice specializing in MS treatment and care.