Exercise is beneficial for everyone but there is specific evidence to support the importance of exercise for people with MS, hence why exercise is one of the seven steps in the OMS Recovery Program.
Exercise as essential maintenance
The human body is a dynamic structure and, like any structure, if a force is distributed through it unevenly for long enough something will eventually give.
Like a crack in a wall of a building, the human body (a dynamic structure) will also show signs of wear and tear in areas that are subjected to unbalanced forces over a period of time.
To help your body maintain even force distribution through good bio-mechanics, reduce the risk of pain and, most importantly, injury, the first things to consider when beginning an exercise regime are strength, stability, mobility and symmetry in the body’s core.
Keeping the foundations solid
It makes sense to ensure that a building is set on solid foundations before adding any extensions - the same logic applies to your body. All day, our bodies are fighting gravity.
People of all ages and abilities will present with many postural issues due to the constant gravitational force on the body. Look around at other people and you will notice excessive spinal curvatures and rounded shoulders among other things.
Factors such as genetic predisposition, injury (past and present), lifestyle and work cause consistent and damaging postures and movement patterns. Any time you sit down, the muscles in your core 'switch off', promoting slumping forward and to one side.
Eventually, these poor bio-mechanics will lead to pain, injury and sometimes severe restriction of movement in an attempt to protect from pain. By using effective, well-performed resistance exercises specifically selected to counter your issues, you are much better placed to correct and avoid them.
The power of resistence
A resistance exercise is an exercise which involves pushing, pulling or holding your body or part of your body against a force. The force could simply be the weight of your own body or you could use resistance banding or tubing.
If you have access to free weights and machines it will only add to the amount of weight you can use and the variety of exercises you can perform.
However, to perform many of the most beneficial core exercises, all you will need is your own body weight. Depending on how your ability, you may have to improvise or modify certain exercises.
If you have trouble doing a push up because MS is affecting your legs, you could do them from your knees rather than your feet, for example. If you use a wheelchair but don't have someone around to help you out of it to exercise on the floor, there are many seated exercises you can perform to work your core and upper body.
Anyone new to exercise should start with only body weight or low resistance exercises and should take special care to warm up properly before. Always be safety-conscious when exercising and be mindful of body stability, safe surroundings and equipment.
Preferably, you should exercise while someone is around as you never know when you’re going to need some help. Before you attempt any resistance exercise, your body should be set in the recommended position and should be as stable as possible. You may have heard the term 'engage your core'.
To me, the core is every muscle that helps to stabilize your spine from your bottom up to your neck, inside and out, but when you’re told to 'engage your core', you are trying to engage the abdominal muscles in and around your tummy and spine that help to keep the spine in an neutral, naturally curved position with minimal movement.
The first few exercises help you to recognize the different areas in the 'core' and then use them all together when exercising.
- Start by lying on your back with your knees bent and your feet flat on the floor.
- Use two fingers on each hand to find the ridges on the front, top bony portions of each side of your pelvis.
- These areas of bone are called the ASIS of the pelvis (Anterior superior iliac spine).
- Push your fingers about an inch or so into the muscles on the inside of each ASIS and get familiar with how it feels there.
- Now try to use those muscles to push your fingers upwards away from them.
- Practice switching these muscles on and off.
- Once you have worked out how to activate these muscles and practiced for a few minutes you can add some pelvic tilts.
- To do this you stay in the same position while you swing your tail bone up to the sky and back.
- Work on creating a small arch in your lower back and then flattening it out against the floor.
- As you swing your tail bone up down squeeze your bum muscles and push down through your heels.
The bum muscles (gluts) and the hip flexor muscles in the front of the pelvis act together to stabilize the pelvis, hips and core and should all work effectively together with your abdominal muscles.
Another exercise requires you to use your diaphragm muscle as efficiently as possible, which is the way it was supposed to move before we all started sitting down so much and slouching. If you didn’t know, the diaphragm is the muscle that makes your lungs work when it contracts and relaxes.
- To get your diaphragm working correctly and efficiently you should stay in the same position on your back and ensure that your head and shoulders are sinking back into the floor.
- Lift your rib cage up and back and start concentrating on slow deep breaths in and out.
- When you breathe in your tummy should start to lift up, which shows that the rib cage is not restricting your diaphragm and breathing.
Lots of people slouch and let the rib cage fall down which restricts your ability to use the diaphragm properly. So remember; rib cage up and back and shoulders back and down. Once you are comfortable with the above exercises you can progress through some of the next exercises that are great for a healthy, strong core. Explanations and queuing techniques are discussed at the end of the article and if you can’t manage them keep working on the ones you can.
Supine bridge with leg lift
Prone thoracic extension with scapula retraction
Quadruped with arm/leg raises
If you find them hard to do, a push up can be performed from the knees instead of on the toes. For all the above exercises you should engage your core muscles and avoid letting the pelvis drop so that one side is lower than the other.
For exercises that you are on your back, you should squeeze your gluts to activate them and if you are raising your pelvis off the ground, you should push down through your heels into the floor while squeezing your gluts.
The thoracic extension (middle back) exercise requires you to try and bend against the normal bend in the thoracic part of the spine while pulling your shoulders down and in towards the bottom and spine.
When performing push ups and bridges, keep your hips high, and don’t let them drop to form a dip in your lower back. Always look straight down so that you have a neutral spine. Try to avoid rocking the pelvis from side to side. If you are struggling on your toes, drop onto your knees but keep your body strong from your knees to your arms.
Exercise Therapist DIP. Personal Trainer Cert IV.