Multiple Sclerosis Physiotherapy: Improving Mobility and Quality of Life

Fatigue is also one of the most pervasive symptoms. It is not simply tiredness but a profound, energy-limiting state driven by altered neural signalling, immune activation, and reduced motor efficiency [10]. When fatigue intensifies, individuals may find everyday tasks more challenging, further reducing physical activity and accelerating deconditioning [10]. Many individuals also report reduced physical confidence, activity avoidance, muscle tightness, and joint stiffness, which collectively contribute to a cycle of reduced movement, declining resilience and an impaired quality of life [11].

Balance issues and gait disturbances are equally prominent. Research highlights that MS-related demyelination (where the protective coating around your nerves becomes damaged or worn away) can affect brain regions responsible for motor planning and coordination, leading to instability, slowed walking speed, shorter stride length, and altered posture [12]. In many individuals, this contributes to an increased risk of falls, which is nearly double that of the general population.

Emerging research also highlights the influence of environmental and metabolic factors on symptom severity. Low vitamin D levels, reduced physical fitness, chronic stress, and altered inflammatory pathways have all been associated with symptom fluctuation in MS [13]. Additionally, factors such as heat sensitivity (Uhthoff’s phenomenon), inadequate sleep, and medication side effects can contribute to worsening mobility or fatigue on certain days [14].

While symptom progression varies significantly from person to person, persistent mobility challenges can greatly impact independence. Difficulty walking, standing, or transferring may limit participation in work, hobbies, and social activities [15]. Crucially, though MS is a lifelong condition, proactive and targeted physiotherapy can significantly slow functional decline, preserve mobility, and strengthen the neuromuscular system [16], enabling individuals to stay active and engaged in daily life.

Recognising the Role of Physiotherapy and Lifestyle in Symptom Management

In recent years, the approach to MS care has evolved from reactive symptom management to proactive, long-term lifestyle and movement-based strategies that support the nervous system. And today, the conversation has broadened beyond medical treatment alone to include function-focused physiotherapy, strength training, targeted exercise, and holistic lifestyle interventions designed to maintain mobility and enhance everyday capability.

Physiotherapy is fundamental to MS care because the nervous system retains the capacity for adaptation and motor relearning, even in the presence of neurodegeneration [17][18]. Evidence shows that regular movement training can improve gait speed, muscular strength, flexibility, and endurance while reducing fatigue and improving mood [19]. Structured exercise programmes – particularly those incorporating aerobic training, resistance exercises, and balance work – have repeatedly been associated with measurable functional benefits. For example, controlled trials in MS show that 8-12 weeks of supervised, physiotherapy‑style exercise can improve walking performance, increase lower‑limb strength, and reduce fatigue scores on validated scales, with some studies reporting fatigue reductions of around 20-25% from baseline [19][20][21].

Balance-focused rehabilitation, such as proprioceptive training, core strengthening, and vestibular exercises, has also been shown to significantly enhance stability and reduce fall risk [22]. Likewise, targeted stretching and mobility work can alleviate spasticity, improve joint mechanics, and reduce discomfort associated with muscle tightness [23]. Lifestyle factors have also become a central part of the MS wellbeing conversation. Adequate sleep, stress management, hydration, and balanced nutrition all play a role in supporting nerve health and overall resilience [24]. Chronic stress, for example, can amplify symptom severity by increasing systemic inflammation and altering immune signalling [24].

A holistic, lifestyle-inclusive model acknowledges that MS affects every aspect of daily function. As such, physiotherapy is not only about exercise; it encompasses strategies for posture, ergonomics, mobility aids, fatigue management, and empowering individuals to maintain independence through sustainable, evidence-based habits.

Applying Physiotherapy-Led Strategies to Improve Mobility and Quality of Life

This integrated model – combining tailored physiotherapy with strength training, balance work, lifestyle adjustments, and supportive self-management strategies – represents a shift in MS care.

Instead of waiting for symptoms to escalate, the focus is on preserving functional capacity for as long as possible and helping individuals adapt confidently to changes.

A physiotherapist-led plan for MS may typically include:

• Targeted Strength and Conditioning: Resistance exercises help counteract muscle weakness and prevent deconditioning. Lower-limb strengthening – focusing on key muscle groups such as quadriceps, glutes, and calves – is strongly associated with improved gait mechanics and easier transfers. Strength training can be adapted for all physical levels, including seated or assisted positions [19][20][21].
• Gait Training and Functional Movement: Physiotherapists may use treadmill training, overground walking practice, cueing strategies, or assistive devices to optimise gait patterns and improve endurance. Interventions such as task-specific movement practice help reinforce efficient motor patterns.
• Balance, Coordination, and Core Stability: Balance exercises, including single-leg stance practice, dynamic stability drills, and core activation work, can significantly reduce fall risk and improve confidence when moving through daily environments.
• Flexibility and Spasticity Management: Stretching programmes, soft-tissue techniques, joint mobilisation, and positioning strategies can reduce muscle tightness and support a more comfortable, fluid movement pattern.
• Fatigue and Energy Management: Pacing strategies, rest planning, and guidance on activity prioritisation help individuals sustain energy throughout the day. Physiotherapists may teach breathing techniques and efficient movement patterns to reduce unnecessary energy expenditure.
• Cardiovascular Exercise for Endurance and Cognition: Moderate-intensity aerobic exercise has been shown to improve cardiovascular fitness, walking capacity, and mood, while supporting cognitive function and fatigue reduction in MS populations [19][20][21].

Assistive Technology and Adaptations

Depending on symptom presentation, physiotherapists may recommend orthotics, mobility aids, or home adaptations to support safety and independence. Together, these components create a resilient foundation for long-term mobility. By focusing on sustainable, personalised strategies, individuals can reduce symptom impact, maintain physical autonomy, and enhance daily quality of life.