Multiple sclerosis, or MS, is a disease where the body’s immune system mistakenly attacks the brain and spinal cord. These two parts make up the central nervous system, controlling how we move, feel, and think. MS typically begins between the ages of 20 and 40 years old. About 1 million people in the U.S. and 2.8 million people worldwide have MS.

MS symptoms can be very different for each person. It can affect vision, movement, touch, thinking, and emotions. There is no cure, but medicines and physical therapy can improve quality of life. Physical therapists help people with MS understand how the condition affects their movement. They also help people manage symptoms, recover after flare-ups, and stay active and independent.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.

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On this page

• What Is Multiple Sclerosis?
• Signs and Symptoms
• How Is It Diagnosed?
• How Can a Physical Therapist Help?
• Can This Injury or Condition Be Prevented?
• What Kind of Physical Therapist Do I Need?

What Is Multiple Sclerosis?

Multiple sclerosis happens when the body’s immune system damages a tissue called myelin. Myelin covers nerves throughout the body. It helps messages travel quickly between the brain and the rest of the body. If MS damages the myelin, these messages slow down or get blocked. This can cause changes in how someone moves, thinks, sees, and feels.

MS symptoms are different for each person. Symptoms depend on which part of the central nervous system is affected. Common symptoms include fatigue and balance problems.

Types of Multiple Sclerosis and Related Conditions

• Clinically isolated syndrome. This represents the first episode of MS-like symptoms, such as vision problems or difficulty with balance. Thye type of symptoms last at least 24 hours and often improve. Many people recover completely. It may or may not develop into MS.
• Relapsing-remitting multiple sclerosis. This is the most common type of MS. Flare-ups (called relapses or attacks) occur when symptoms get worse and are followed by times when they improve or go away (remissions). Flare-ups can occur weeks, months, or even years apart. Medicine can help reduce how often and how severe these attacks happen. In some people, this type of MS can progress to secondary-progressive MS over a 10-to-20-year period.
• Secondary-progressive multiple sclerosis. This type usually starts as relapsing-remitting multiple sclerosis but slowly gets worse over time. Symptoms increase and cause more disability. People may still have flare-ups and remissions, but overall, the disease keeps getting worse. This type of MS can be active (with relapses and new MRI lesions) or inactive.
• Primary progressive multiple sclerosis. This type of MS is less common. From the start, symptoms steadily get worse, leading to more disability. There may be short periods of stability. It can be active or inactive.
• Pseudo-exacerbations. These are temporary flare-ups that are not caused by new damage to the brain or spinal cord. These symptoms usually go away within 24 hours once treated. Pseudo-exacerbations can be caused by:
• Infections (like urinary tract infections)
• Other illnesses (like a cold)
• Exercise or heat (people with heat-resistant MS can experience temporary symptom flare-ups when their body temperature rises)
• Warm environment
• Depression, exhaustion, or stress

Neurologists are the main doctors in charge of treating people with MS. Treatment may include:

• Disease modifying therapies to slow the progression of MS
• Medications to manage symptoms and treat relapses
• Lifestyle changes
• Rehabilitation (physical therapy, occupational therapy, and speech therapy)

Physical therapists help people with MS at all stages. They teach people how to manage symptoms, avoid overheating and overexertion, maintain mobility, and stay physically active.

Signs and Symptoms

The symptoms of multiple sclerosis are unpredictable and can change over time. MS may affect how a person moves, feels (both physically and emotionally), or thinks. MS can impact mobility and lead to the need for assistive devices like canes, crutches, braces, or even a wheelchair. Common symptoms may include:

• Vision problems (double vision, pain with eye movement, or vision loss)
• Feeling very tired (mental or physical fatigue)
• Difficulty walking
• Weak muscles in the arms and legs
• Muscle stiffness and painful muscle spasms
• Numbness or tingling in the arms, legs, trunk, or face
• Pain in the arms, legs, trunk, or face
• Problems with balance and coordination
• Bladder control issues
• Dizziness that can be constant or occasional
• Trouble speaking or swallowing
• Depression or other mood changes
• Sexual problems
• Difficulty concentrating, multitasking, thinking, or learning
• Memory or judgment problems

Multiple sclerosis affects each person differently. Medical treatment can help improve symptoms and slow the disease. Physical therapists create personalized treatment plans to keep people stay mobile, active, safe, and living well.

How Is It Diagnosed?

There is no single test to diagnose multiple sclerosis. Neurologists’ base diagnosis on a combination of signs and symptoms, MRI findings, and lab tests. To confirm a diagnosis of MS, neurologists look for the following:

• Other causes of symptoms that may rule out MS
• MRI that shows MS-like lesions in at least two different areas of the central nervous system
• Signs of new MRI lesions or worsening symptoms over time
• Proteins linked to MS through a spinal fluid test
• Symptoms such as vision changes, balance problems, and fatigue

Tests may include:

• MRI of the brain and spinal cord
• Spinal tap (a procedure in which a needle is inserted into the lower back to sample the fluid around the spinal cord)
• Eye tests like optical coherence tomography (an imaging technique that uses light waves to capture images of the retina and detect levels of optic nerve damage)
• Tests of nerve signal speed (nerve conduction studies, or NCS)
• Blood tests to rule out other conditions.
• Thinking and memory tests (neuropsychological testing)

How Can a Physical Therapist Help?

Physical therapy helps people with multiple sclerosis stay active and independent. It can help at any stage of MS from the time you’re first diagnosed to the later stages.

When someone is diagnosed with MS, it’s important to start working with a physical therapist right away. They will:

• Help you recover from the flare-up that led to your diagnosis.
• Teach you exercises and habits to take care of your body over the long term.

Staying physically active can make MS attacks less severe and help you recover faster. But some people with MS can have temporary symptom flare-ups (called pseudo-exacerbations) if they get too hot or exercise too hard.

Physical therapists teach you how to:

• Pace yourself
• Avoid overheating
• Manage fatigue

Physical therapists also share energy-saving tips and breathing techniques so you can make the most of your energy levels.

What to Expect With Physical Therapy

MS affects everyone differently, so your treatment plan will be designed just for you. If your needs change, your physical therapist will modify your treatment program.

Your first visit is called an evaluation. During this appointment, the physical therapist will talk with you about your medical history and your experience with MS. They also will look at how your body moves, checking things, such as:

• Posture
• Strength
• Flexibility
• Balance
• Coordination

The findings from their assessment and your goals will help your physical therapist design a treatment plan that fits your goals and needs. Your physical therapy treatment plan may include:

Hands-on (Manual) Therapy. Your physical therapist may use hands-on techniques to help your muscles and joints move better and feel less stiff.

Strengthening and Flexibility Exercises. Your physical therapist will guide you through exercises to improve strength, flexibility, and range of motion. These exercises usually start simple and then progress to activities that feel like everyday tasks, such as picking something up from the floor or reaching for a shelf.

Exercise is helpful at all stages of MS. Physical therapists help you choose safe exercises and teach you how to monitor your exercise intensity to avoid flare-ups.

Aquatic therapy and exercise is a great option for people with MS who are sensitive to heat. Pools provide a temperature-controlled environment that helps keep your body cool while you exercise. Water also offers natural resistance, which can be adjusted for different levels of intensity. This means you can get both strengthening and aerobic benefits in a safe, comfortable setting.

For overall health, adults should aim for 150 minutes of moderate exercise each week (about 30 minutes a day, 5 days a week) with 2 sessions of strength training. For people with MS, regular exercise helps you stay active and doing the things you love longer.

Patient Education. Because fatigue is common with MS, your physical therapist will teach you how to pace yourself and save energy. This may include guiding you through breathing and relaxation techniques. If you have trouble walking, balancing, or coordinating movements, your physical therapist may use a method called neuromuscular reeducation. This helps retrain your body to move smoothly and safely with daily activities.

Your physical therapist will also teach you techniques to help you:

• Recover from MS flare-ups
• Improve strength, balance, and stamina for daily activities
• Exercise safely without overheating or overexerting
• Save energy with daily activities
• Adjust to changes in your mobility
• Reduce your risk of falling
• Stay physically active

Can This Injury or Condition Be Prevented?

Scientists don’t know the exact cause of multiple sclerosis, and there’s no guaranteed way to prevent it. But living a healthy lifestyle can improve your overall well-being. This includes:

• Exercising regularly
• Eating nutritious foods
• Limiting alcohol
• Avoiding smoking
• Getting enough sleep
• Managing stress

Early diagnosis, treatment, and management of MS is important. It can help control symptoms and slow its progression.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat multiple sclerosis. However, MS is a unique condition, and you may want to consider:

• A physical therapist who is experienced in treating people with neurological conditions and multiple sclerosis.
• A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in neurologic physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to MS.
• Physical therapists who have earned a multiple sclerosis certified specialist certification from the Consortium of Multiple Sclerosis Centers.

You can search for physical therapists near you who meet these criteria by using Find a PT, provided by the American Physical Therapy Association.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family, friends, or other health care providers.
• Ask about the physical therapists' experience in helping people who have multiple sclerosis.
• Be prepared to describe the physical issues and symptoms that are causing you the most difficulty and identify your goals for daily and leisure activities that support your long-term health.