Physical Symptoms

MS affects the way your muscles and nerves communicate, so it can lead to walking problems (your gait). This is one of the most common MS symptoms, and is related to several factors like muscle weakness, spasticity, numbness, balance and fatigue.

MS can cause you to fall more often (studies from several countries report that 50-70% of people with MS say they have fallen in the past 2-6 months), which can cause injuries. You can be more at risk of falling for a few reasons like poor balance, walking slower than usual, a reduced ability to sense where your body parts are in space, using the wrong canes or walkers or using them incorrectly, and using certain medicines that affect your nervous system.

If you have gait problems, you may have to walk more consciously to avoid falls, avoid slippery or cluttered surfaces and wear safe, stable shoes.

Other things you can do to manage walking issues are:

• Physical therapy
• Stretch
• Use the right assistive devices
• Talk to your doctor

Spasticity is a word for feelings of stiffness and muscle spasms (muscle contractions that don’t stop, or sudden movements). It can range from mild (muscle tightness or stiffness) to severe (painful, uncontrollable spasms of muscles or pain in the joints). It can occur in any of your limbs, but it’s the most common in the legs. Spasms can be bothersome, especially at night, and they can add to feelings of fatigue.

Common spasticity treatments may involve physical or occupational therapy.

Tremor is a movement disorder that involves rhythmic, involuntary movements. In MS, tremor happens during or can be triggered by voluntary movements (“intention tremor”), and they can affect any muscle group in the body, such as the arms, legs, trunk, head, vocal cords, jaws, lips and tongue. Sometimes, people with tremor can also have difficulty swallowing or speaking. Tremor often contributes to feelings of fatigue and overall disability, since it can make regular things like dressing or eating more difficult. For this reason, tremor can have an impact on your emotions and social life as well.

Addressing tremor can involve occupational or physical therapy.

Muscle weakness is a very common symptom of MS, and it can happen in any part of the body. It can be caused by several things, like your muscles being out of shape because you are not using your body as much or inflammation or damage of the nerve pathways in your brain or spinal cord. People with MS can face many physical challenges (pain, balance and coordination problems, tiredness) that make it harder to be active, and MS nerve damage sometimes means your muscles aren’t receiving the messages from your nerves as well as before.

Muscle weakness can affect your daily activities (like walking), and can be treated with physiotherapy, occupational therapy, assistive devices and/or other approaches.

Fatigue is another MS symptom that can affect your ability to function at home or at work. Fatigue, or tiredness, is very common: up to 90% of people experience fatigue or tiredness with MS. It can also interfere a lot with your ability to function in daily life. And is one of the top symptoms that make people stop working.

Fatigue can be a primary physical symptom related to MS, or it can be secondary (related to the effects other MS symptoms have on your life, like muscle weakness, depression or trouble getting enough sleep). Treating fatigue can also mean looking at causes other than your MS, like vitamin deficiency.

This specific kind of fatigue related to MS is called “lassitude”. MS fatigue is different from other types of fatigue in that it:

• Generally happens every day
• Happens in the morning, even after a good sleep
• Gets worse as the day goes on
• Gets worse with heat and humidity
• Can be sudden
• Is worse than “regular” fatigue
• Interferes with daily responsibilities

There are many factors that can affect fatigue, so treating this symptom can involve occupational therapy, physical therapy, sleep therapy, psychological treatment, energy conservation counseling, mobility aids, temperature regulation or other approaches.

Inflammation of the optic nerve is common for people living with MS. For about 16% of people with MS this is their first MS symptom. It usually happens in one eye and can cause aching pain when you move the eye, blurry vision, or dimness and loss of colour in your eyesight. Sometimes you can temporarily lose vision in the affected eye or see a dark spot in the middle of your vision while at the edge (periphery) things look normal. Usually, most of these changes aren’t permanent.

Regulating your temperature (cooling down) can sometimes help with this symptom.

This is when you have rapid, involuntary eye movements that interfere with your vision. Sometimes called “dancing eyes”, the eyes move quickly up and down or from side to side. It may make you feel like the world is moving, and you may notice that you can hold your head at an angle to reduce this symptom.

Diplopia, or double vision, happens in MS when the nerves controlling your eye movements are inflamed or get damaged. It happens when the muscles for one eye are weaker, due to nerve damage, than the ones for the other eye. This can be temporary or persistent, and sometimes goes away on its own. It can be part of a relapse and you may need special eyeglasses or an eye patch.

Neuropathic pain is caused by “short circuits” of the nerves that carry messages from the brain to the body. It can be acute (with a rapid onset and short duration, usually associated with a relapse) or chronic, (where the pain can be an unpredictable, almost daily occurrence). These types of pain can include the following:

Acute

• Trigeminal neuralgia (TN): A sharp, stabbing pain in the face or jaw area. This is caused by damage to the trigeminal nerve. This pain often comes and goes and can be an initial MS symptom or happen during a relapse.
• Lhermitte’s sign: A quick, electric-shock-like sensation running from the back of your head down your spine and into your arms and legs. It can be brought on by bending your neck forward and is caused by damage to nerves in your neck. This can also be an initial MS symptom or part of a relapse.
• MS hug: This is an uncomfortable squeezing sensation around your trunk. It feels like a blood pressure cuff as it tightens. Like the previous two types, this can be an initial MS symptom or part of a relapse.
• Paroxysmal spasm: A type of spasticity that involves the off-and-on painful tightening of muscles.

Chronic

• Dysesthesias (abnormal sensations): Typically, not associated with a relapse, this is a type of chronic pain that can feel like burning, prickling, “pins and needles”, stabbing, or ice-cold or electrical sensations.
• Pruritus (itching): This is a form of dysesthesia that can happen in MS.

This type of pain is the kind you have when you pull a muscle or sprain something. It can happen due to falls related to your MS, but it can also happen because you are moving differently and putting different pressure on your joints and muscles. Spasticity (tight, stiff muscles) is caused directly by MS and can change the way you move, which can contribute to musculoskeletal pain in your ankles, knees, hips or back.