Multiple Sclerosis: Physiotherapy, Exercise and Rehab

What is Multiple Sclerosis

Multiple Sclerosis (MS) is a neurological condition affecting the brain and spinal cord. It is chronic, meaning symptoms continue for more than three months, and is defined by the immune system mistakenly targeting the protective sheath that surrounds nerves in the body. When this happens, the protective sheath becomes disjointed and breaks down. This break down then influences how well signals can travel between the brain and the body, resulting in poor communication and a lot of unwanted symptoms. These symptoms include unsteadiness, poor movement, reduced muscle strength, altered sensation, coordination difficulties and fatigue. Many people begin exploring MS exercise therapy as a way to manage these symptoms.

 

Medical and Exercise-Based Management

MS can cause very unpleasant symptoms, especially as the condition advances. When we look at research to see what can be done, it continues to constantly point towards two directions:

• Medical management including certain medications that modify the condition prescribed by the neurologist
• Exercise and physiotherapy which remain one of the strongest non-medication ways to protect mobility, improve strength, reduce fatigue and keep well over time, regardless of the medications you use.

Although our expertise here at MoveImprove is exercise therapy, medical management forms one major pillar of MS care. If you would like to find out more about the medical management of MS, refer to the National Multiple Sclerosis Society and read the information under the heading FDA-Approved Medications and Devices to Treat MS Symptoms.

At MoveImprove, we support people living with MS across Sydney through our mobile physiotherapy and home-visit exercise physiology services, meaning we bring rehabilitation directly to you. Our service is particularly valuable for people with MS since symptoms such as fatigue, movement difficulty, heat sensitivity and cognitive effort needed for travel can make attending an appointment draining before therapy even begins. Receiving care at home preserves energy for movement rather than transport, and allows sessions to be scheduled during the time of day when people feel most capable and alert.

Understanding how MS affects the body gives us a roadmap for treatment. If reduced balance, fatigue, muscle weakness and walking changes come about because of disrupted nerve communication, then targeted movement, strength work, aerobic conditioning and balance retraining become key tools to help maintain function. This is where physiotherapy and exercise physiology for MS rehabilitation play a key role.

 

Why Exercise Matters in Multiple Sclerosis

A recent group of researchers (Du et al, 2024) looked into how routine, structured and well-tailored exercise programs can help improve the following areas in people with MS:

• Walking ability and endurance
• Balance and coordination
• Strength and muscle function
• Fatigue management
• Quality of life

What made their findings valuable was the depth of evidence they reviewed. The researchers analysed 40 individual studies, comparing the effects of different exercise programs for MS. The exercise programs included aerobic training, resistance training, pilates, aquatic therapy and high-intensity programs. Across these, the most consistent and meaningful results were when exercise programs were combined. Meaning a combination of 2 or more different types of exercises provided the best results. Additionally, the authors recommended resistance and aerobic training to be an essential part of the program.

Therefore, the conclusion was clear. Even though MS affects the nervous system, the muscles and cardiovascular system remain highly trainable. Structured exercise programs for MS incorporating strength training and aerobic conditioning can create improvements in mobility, endurance and function.

The takeaway message is that exercise is not an optional add-on. It is a core part of MS treatment, supporting independence, slowing decline, protecting function and helping people continue doing what matters in everyday life.

But a question arises here.

If exercise is helpful, what happens when we push harder?
Can high-intensity training help or could it trigger symptoms?

 

Are High-Intensity Programs Safe?

High-intensity programs used to be approached with great caution in the past. The caution was understandable as you are pushing people to their limits. Especially when you don’t know how their body will respond. Perhaps with fatigue, more heat sensitivity or symptom flare-ups.

But research now gives us a more confident outlook.

A 2023 review of 13 trials with 375 participants found that high-intensity aerobic and functional training:

• Improved walking speed and endurance
• Was safe when supervised and progressed appropriately
• Showed mixed (but not negative) balance outcomes

The functional training referred to exercises that mimic real-life movements rather than isolated machine-based exercises. Far too often people attend gyms or exercise classes where many of the exercises are made up from machines or restricted movements. This is not always the best option. When possible, free-weight, body-weight and whole-body tasks are often more transferable to real activities at home and in the community.

Balance outcomes in the studies were mixed. One reason is that balance specific exercises were not always included in the programs. Without balance training, balance may not improve. This supports the earlier research showing that a blend of exercise types works best. Strength + aerobic + balance + functional tasks together create the strongest outcomes.

In summary, high-intensity training can be safely prescribed for appropriate MS clients, particularly when supervised and progressed carefully by a physiotherapist or exercise physiologist experienced in MS care.

 

Early Exercise Matters After Diagnosis

The earlier you start exercising, the better the outcomes.

Exercise is not something to wait for until physical decline begins.

There are clear benefits of exercise even in the initial stages of MS. We have included the benefits in an image below.

Starting to exercise early means building strength and endurance before they decline. The longer someone waits, the harder it becomes to regain what was lost. Many people tell us they wish they had begun physiotherapy sooner.

Think of exercising in the initial stages as building a buffer of physical capacity. The stronger the foundation, the more resilience someone has when symptoms fluctuate. Even small early gains, like smoother walking rhythm or less effort standing up from a chair, help maintain independence.

Exercise does not stop MS. But it slows the functional decline and keeps you moving well for longer. When someone begins therapy early, they are not waiting for things to get worse. They are protecting what they can do today and building capacity for tomorrow.

How Physiotherapy and Exercise Physiology Help

MS symptoms can vary daily. Some people notice weakness. Others experience fatigue, changes in sensation or falls. Some look physically well while experiencing invisible challenges. No two people are the same.

Because we work inside the home, we see how MS affects your morning routines, bathroom transfers, stairs, community mobility and energy levels. We then tailor a program that matches real needs, not theoretical ones. This also helps remove some pressure from your shoulders to describe all the struggles you have. We can simply ask you to show us then and there.

What happens in your first session

The steps below show what a first session would look like with us.

🔽 1. Getting To Know You

We get to know you, your story, what you like doing and how we can help you.

We ask you specific questions about your symptoms, what good days vs harder days feel like, what activities you find difficult, how you are sleeping and eating, how socially active you are, who is a part of your care team and how can we work better together.

🔽 2. Assessment & Movement Check

We complete a physical assessment to learn how your body moves.

We look at how you move, walk and balance. We score your flexibility, strength, fitness and endurance. We observe your home layout and see if there are points of higher falls risk.

We take a gentle approach. You are never pushed beyond what feels safe.

🔽 3. Your First Exercise Program

We begin with a tailored MS exercise program as soon as practical. Exercises are simple, achievable and based on our assessments. They are tailored, not generic or a printout.

We give you a program for a good day and a harder day.

Our approach is flexible, and our goal aligned with yours.

🔽 4. Planning Ahead

We finish the session with a clear plan.

Together we set the focus for the coming weeks. You would be confident to start with a program that fits your situation. You will have an idea of when to push and when to pace. You will be equipped with safety tips for if symptoms flare or feel unwell.

Most importantly, you will be confident you are in good hands.

 

Common Symptoms We Treat

People with MS experience symptoms differently. Some have symptoms that come and go. Some have symptoms that worsen with fatigue, heat or stress. These are some of the common challenges we help clients manage:

• Fatigue and reduced recovery tolerance
• Foot drop or tripping
• Balance problems or loss of confidence
• Leg weakness, spasms or stiffness
• Difficulty walking distances
• Heat or sensory sensitivity
• Upper limb coordination changes

Small improvements create meaningful change.

Standing from a chair more easily is progress.

Walking a few extra minutes is progress.

Confidence is progress.

Every gain contributes to independence. Even gradual steps forward can make daily life feel easier, safer and more achievable.

 

Why Mobile Physiotherapy Works for Multiple Sclerosis

Travelling to a clinic can increase fatigue. Transport, parking, waiting rooms and environmental stress all drain energy before therapy even begins. On hot days or flare days, getting to an appointment may be impossible.

With our mobile physiotherapy and exercise physiology services in Sydney, we come to you.

Imagine when you do not need to travel. You conserve your energy for therapy.
You practice in your own home, the space where you cook, stand, walk, shower and move every day. This is where independence is built.

Carers can join sessions easily because they are already in the home.
Appointments are scheduled around your routine. This helps maintain consistency, improves adherence, and supports real carryover into daily life.

We train you for your goals, in the spaces where those goals relate to and matter most.

Currently, the areas we service are the North Shore, Northern Beaches, Hornsby, Ku-ring-gai, Lane Cove, Ryde, Macquarie Park, Pymble, Turramurra, St Ives and surrounds.

Click here for our comprehensive suburb list.

 

Long-Term Multiple Sclerosis Rehabilitation

MS rehabilitation is not short block therapy. It works best with long-term planning, gradual progression and regular review. Exercise needs to be ongoing to maintain strength, mobility and confidence. Stopping and starting repeatedly makes progress harder to sustain.

A sustainable program often includes:

Foundation phase
Developing strength, balance and movement confidence.
Learning how to pace activity and manage fatigue.

Progression phase
Gradually increasing challenge and exercise load.
Progressing strength, walking endurance and balance tasks without triggering fatigue crashes.

Maintenance phase
Staying active consistently.
Using exercise to protect function and support day to day independence.

Tune-up blocks
Short review blocks after illness, relapse or routine disruption.
Helpful when symptoms flare or mobility changes.

The goal is not perfection. The goal is consistency. Small gains over time accumulate to meaningful improvements.

 

What Progress Can Look Like

Progress is not always linear, but it is measurable.

You may feel strong in some weeks. More drained in others. Matters is the overall direction over time. Progress is not just numbers. It is how you live, move and participate.

Meaningful progress could look like walking a little further before fatigue sets in or standing from a chair without needing to push from your hands. It may be negotiating stairs more confidently or noticing fewer falls.

Progress can also look like joining a family outing, attending a social activity without as much worry, or simply feeling more secure and steady in your body again. Sometimes a smile on your face is the biggest progress we could ask for.

We focus on you as a person, not just metrics, like how many sit to stands you can do.

 

Getting Support With MoveImprove Performance

If you or a family member lives with MS, the right support makes a big difference. Early physiotherapy and ongoing care are two of the most effective ways to protect your independence.

At MoveImprove, our services include:

• Mobile physiotherapy for MS
• Home exercise physiology for MS rehab
• NDIS support for self and plan managed clients
• Strength, balance and walking programs
• Falls prevention
• Carer and family education
• Long term neurological condition support

We come to you. So you can be assessed and helped where it matters most, your home.

Email us on info@moveimprove.au to discuss how we can help or contact us here.

 

References

Du, L., et al. (2024). Effects of exercise in people with multiple sclerosis. Frontiers in Public Health.

Bae, M., et al. (2023). High intensity exercise training on functional outcomes in persons with multiple sclerosis: A systematic review. Disability and Health Journal.

Riemenschneider, M., et al. (2023). Exercise therapy in early multiple sclerosis improves physical function but not cognition. Randomized Controlled Trial.