| What We Treat
Multiple Sclerosis
Exercise does not worsen MS. It improves walking, fatigue and strength, and the evidence for that is now good.
Overview
What It Is
Multiple sclerosis affects the coating around nerve fibres in the brain and spinal cord, disrupting the signals that travel along them. The result varies enormously between people and over time: weakness, altered balance, fatigue, stiffness, changed sensation. Physiotherapy addresses the consequences rather than the disease itself, and there is now solid evidence that exercise improves function without provoking relapse.
It Does Not Cause Relapse
Strength and aerobic training both improve walking, fatigue and function without increasing relapse rate.
Symptoms
How It Tends to Feel
These are the features that point towards this diagnosis rather than another:
Fatigue
The most commonly reported symptom, and often the most limiting.
Walking Difficulty
Reduced distance, catching a toe, or increased effort over the day.
Balance Problems
Particularly in low light or on uneven ground.
Spasticity
Stiffness or spasms, most often in the legs.
Weakness
Frequently asymmetrical, and often more pronounced with fatigue.
Heat Sensitivity
Symptoms worsening temporarily when overheated, which is expected rather than harmful.
Causes & Risk Factors
What Drives It
The usual contributors, in rough order of how often they turn out to matter:
Autoimmune Demyelination
The immune system attacks the myelin sheath around nerve fibres.
Genetic Susceptibility
A modest inherited component rather than direct inheritance.
Vitamin D and Latitude
Consistently associated, and relevant in the UK.
Smoking
Associated with faster progression, and modifiable.
How We Can Help You
Treatment & Management
Treatment is built around what the assessment finds, but generally follows this shape:
When to Seek Help
Red Flags — Don’t Ignore These
Most presentations are straightforward. These features are the exceptions, and warrant prompt assessment:
⚠ Seek Medical Advice If You Notice
- New or rapidly worsening symptoms lasting more than a day — contact your MS team, as this may be a relapse
- New bladder or bowel changes
- A significant fall, or a rapid increase in falls
- Swallowing or speech difficulty
If any of these apply, contact your GP or seek urgent medical care rather than waiting for a physiotherapy appointment.
Common Questions
Frequently Asked Questions
Will exercise make my MS worse?
No. This was believed for many years and is now clearly contradicted by the evidence. Exercise improves strength, walking and fatigue without increasing relapse rate.
Why do I feel worse when I get hot?
Raised body temperature slows conduction along already-damaged nerve fibres. It is temporary and not causing damage, and cooling strategies allow you to train comfortably.
Should I stop during a relapse?
Reduce rather than stop, and let your MS team know. Full rest during a relapse costs capacity that then has to be rebuilt.
Not Sure If This Is What You Have?
An assessment will tell you what is actually going on and what to do about it. I see everyone myself, and you will leave with a plan rather than a leaflet.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. If you’re experiencing any of the warning signs above, contact your GP or seek emergency medical care as appropriate.