Physiotherapy for Multiple Sclerosis in Bolton

For decades people with MS were told to conserve energy and avoid exertion, on the theory that activity accelerated the disease. That advice has not survived contact with the evidence. NICE guideline NG220, Multiple sclerosis in adults: management — published in June 2022, replacing CG186 — recommends exercise for people with MS, and is clear that there is no evidence exercise is harmful or worsens the condition.

This matters practically, because the deconditioning that follows years of avoiding activity produces its own weakness, stiffness and fatigue on top of the MS. A good deal of what physiotherapy achieves in MS is unpicking that second layer.

Be clear about the distinction, because it is the one that gets blurred:

• Physiotherapy does not alter the disease. It does not slow progression, prevent relapses, or affect lesion load. That is the job of disease-modifying therapy prescribed by your MS team.
• Physiotherapy changes function. Strength, walking distance and quality, balance and falls risk, spasticity management, and how well you manage fatigue across a day and a week. These are the things that determine what your life actually looks like.

Anyone who implies physiotherapy influences the underlying disease is overselling. Anyone who implies it therefore does not matter has misunderstood what people with MS are usually trying to solve.

Fatigue is the symptom people with MS most often rank as their most disabling, and it is not ordinary tiredness — it is disproportionate to effort and does not reliably resolve with rest. It is also the symptom most likely to be mishandled by a generic exercise programme, because the intuitive response, pushing through, tends to produce a payback that sets you back days.

The workable approach is graded and paced: starting below what you think you can manage, building in small increments, spreading effort across the week rather than concentrating it, and treating consistency as more important than intensity. That is unglamorous, and it is what works.

Heat sensitivity — Uhthoff's phenomenon, where symptoms temporarily worsen as body temperature rises — is worth planning around rather than fearing. The worsening is temporary and reverses on cooling; it does not indicate damage. Practically that means cooler rooms, cooler times of day, breaking sessions up, and cooling strategies during and after exercise.

The first appointment is 60 minutes, because an MS assessment has to cover more ground than a standard musculoskeletal one.

• History. Type of MS and how it has behaved, current disease-modifying therapy, relapse pattern, what your MS team is managing, and what a good and a bad week look like for you.
• Examination. Strength, tone and spasticity, sensation, coordination, balance and falls history, walking quality and endurance.
• Fatigue and pacing. Mapped across a real week, not a questionnaire in isolation.
• A programme built to be sustainable on your worse weeks, not just your better ones — a plan that only works when you feel well is not a plan.

Sessions run in clinic at Unit 28, Flexspace Bolton, or as home visits and video appointments. Remote sessions matter more in MS than in most conditions: they remove the travel and the heat exposure of a journey, and mean a flare or a bad fatigue week does not have to cost you the appointment.

Physiotherapy sits alongside neurology, MS nursing and, where relevant, continence, speech and occupational therapy. Marcus is not a replacement for any of them, and will say where something needs referring on — new or worsening symptoms lasting more than 24 hours, for instance, need your MS team rather than an exercise programme, because a relapse is managed medically.

If you are under an MS team, bringing or sending their letters before the first appointment saves real time. The MS Society is a reliable general resource, including on exercise and fatigue.