need a plan to improve my gait !

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CAGirl
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need a plan to improve my gait !

Post by CAGirl »

Hi there I've had MS for 21 years. I've only seen very gradual losses. Things sped up a bit a year ago, and I am now slightly limping some of the time. The kind of limp where people sometimes say "oh are you limping?" I am not sure why but strenuous hiking is ok (routinely pass younger people) but normal walking is where the limp becomes more noticeable and problematic. The limping leg has lost muscle mass (when I measure my thighs and calves) and the foot becomes "muddy" in terms of sensation after I walk a bit. I appreciate this is common in advanced MS. I would love to be inspired and motivated by this community to try and some new ways to improve my gait. I cannot afford physio therapy co-pays BUT MOSTLY I am not sure I'd find a PT willing to take on tackle this in a positive assertive way. I would really appreciate your suggestions.
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Scott1
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Re: need a plan to improve my gait !

Post by Scott1 »

Hi,

Can you expand a little on what your leg is doing-

do any of your toes curl under (which ones)?
Can you wiggle your toes on both feet?
are you tight in the calf on the side with the limp?
above the knee and below your torso which parts of your leg on the limping side have increased tone (tightness)?
do you ever feel tight in your torso (where abouts)?
are you tight or sore in the lumber region?
Do you get cramps at night in your legs?

When you limp does it feel like you have to hitch your hip to bring the leg forward or does it feel like your foot gets left behind?
If you sit on a chair, can you leave your heel on the ground and raise the sole of the foot so the toes point at 45 degrees to flat? Is one foot different to the other?

Your leg is complex and muscles affecting it start just below the ribcage and go all the way down.

How it feels is sensory but what it does is motor related.

Sometimes a sudden limp can be a good reason to ask the neurologist for a quick dose of steroids to avoid a worse scenario.



Regards,
CAGirl
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Re: need a plan to improve my gait !

Post by CAGirl »

Thanks for your response. I've added answers below:

Do any of your toes curl under (which ones)? **No

Can you wiggle your toes on both feet? **Yes very much

Are you tight in the calf on the side with the limp? **No. I'm a bit tight on both legs

Above the knee and below your torso which parts of your leg on the limping side have increased tone (tightness)? **Maybe there is more tone on front/outside of limping leg. But the whole limping leg is smaller in diameter, feels like both smaller muscle size and smaller fat layer

Do you ever feel tight in your torso (where abouts)? * No

Are you tight or sore in the lumber region? **I have scoliosis ,and my right (limping side ) hip is slightly raised. Always had lower back pain when I walk a while : but its def getting worse.

Do you get cramps at night in your legs? **occasionally I will have a cramp where my limp foot contracts and rotates inwards. maybe every few months. I put weight on it to get it out. It has not become more frequent.

When you limp does it feel like you have to hitch your hip to bring the leg forward or does it feel like your foot gets left behind? ** feels I am hitching my hip

If you sit on a chair, can you leave your heel on the ground and raise the sole of the foot so the toes point at 45 degrees to flat? Is one foot different to the other? **Initially yes, and both feet the same, but this is an exercise I do a lot and my limping foot fatigues much quickly till I can no long raise toes

Your leg is complex and muscles affecting it start just below the ribcage and go all the way down. How it feels is sensory but what it does is motor related. **WOW I did not think of walking being a whole body thing, i've been really concentrating on my foot, ie my push-off. I am so glad I asked you !!

Sometimes a sudden limp can be a good reason to ask the neurologist for a quick dose of steroids to avoid a worse scenario. **not sudden, kind of seeped into my walking, but thanks for suggesting that.
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Scott1
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Re: need a plan to improve my gait !

Post by Scott1 »

Hi,
I would ask a neurologist if your limp is a symptom of a flare up. Maybe a 3 day dose of steroids might avert something worse developing.
If you hitch your hip but the rest of the leg seems moderately ok, it suggests the psoas muscle is a bit tight. That's the muscle in your torso that shortens to lift the leg. Your leg muscles, on their own, aren't easily able to perform that action. The psoas acts like a pulley to assist the leg muscles. There are exercises that can lengthen and strengthen the psoas but Pilates exercises do a better job than PTs would. A lot of people talk about hip flexors but the muscle you need to focus on is the psoas. If you google psoas muscle you can see where it is and how it connects to the leg bone.
As you are hitching your hip it is obviously no longer in a neutral position. Eventually that will start to impact on your hamstrings and lower back. Better to deal with it before they start to get grumpy.
When your leg rotates inward, the muscle group to look at are the adductors. They are located on the inner side of your thigh. As they tighten it gets more difficult to perform an action like swinging your leg over a low fence or getting on a horse. To compensate your foot turns inward and you start to swing the leg in an arc rather than move it backwards and forwards. To stay balanced you want to put your foot flat on the floor but the leg action is compromised.
It sounds like a muscle in your lower leg called the flexor digitorum longus might also be a bit tight and that would be a big part of the fatiguing in your foot. When it is really affected you will drag the foot and it will want to point downward, making tripping more likely.
So what to do.
The first thing is go to the neurologist and talk about whether the limp is indicative of a change and whether some steroids might break a cycle.
I don't find PTs very useful, so, I would go to a Pilates studio and tell them exactly what I've said to you. Tell them you would like to do 'leg and footwork' on a reformer. It isn't hard but it might help get those muscles in the leg working better. They have some good psoas exercises as well. PTs tend to focus on exercises like 'sit to stand' but Pilate work is much more effective. You don't need to sweat in a Pilates class but do make sure they have reformers and other equipment. Pilates floor exercises are usually not appropriate with MS.
There are number of alternative ways to relax muscles through either drugs or supplements but I think the first place to start is the neurologist to ensure that this is not the start of something more challenging.

Regards,
CAGirl
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Re: need a plan to improve my gait !

Post by CAGirl »

Its a good idea, I have avoided seeing a neurologist aside from the time of my initial/fairly intense episode about 20 years ago. I'll speak to my GP and get a referral. Can you tell my why "pilates floor exercises are usually not appropriate for MS"?? I am not sure if a pilates private instructor is something I can afford , so may try to find pilates floor exercises online). Or perhaps if I get a few sessions with reformer I can better isolate the problem and then do floor exercises.

Also, could you possibly explain what you think is going on -- why muscles waste and become weak with MS. Why is it only SOME muscles? Why do they not strengthen with exercise? Thanks for anything you think would be helpful for me to know to better address this.
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Scott1
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Re: need a plan to improve my gait !

Post by Scott1 »

Hi,

Floor exercises may be ok but, if you're really stiff, getting up from and down to the floor can be difficult. The second reason maybe floor exercises don't give you the resistance you need to optimise control over an isolated muscle. The consequence can be an ineffectual exercise and a cramp in an unexpected part of your body that seems unrelated. The Pilates equipment uses springs rather than weights to give you that resistance. I understand the issue of cost but having someone watching and correcting you is far more beneficial than thinking you have done the exercise correctly. The beginners mistake is to think you don't need that correction but a slight change in posture, whilst exercising, transforms the exercise.
The other alternatives are massage (which might be painful), dry needling of the tight spots on your leg or botox which is more efficient at releasing a tight muscle. (I'm ignoring drugs like Baclofen and Dantrium here.)
The reason you have some wasting is probably due to disuse. Although you think you're using the muscles your movement may be controlled by the tight muscles and the lesser muscles are doing nothing at all. There are diseases of the peripheral nervous system that can cause wasting through disuse but a CNS disease like MS can cause the same thing with unused muscles. If tight muscles dominate our movements and the lesser muscles just do nothing,they shrink. You think you are exercising them but you're probably not. Pilates is very good at overcoming this but once a week isn't enough. You'd need to think 2-3 times per week (I understand the cost issue)
Muscles either work together (agonists) or they oppose other muscles (antagonists). They can contract in three ways: concentrically (like a weight lifter), isometrically (neither shortening or lengthening like a 'plank'), or eccentrically where the muscle is contracting even though it is lengthening, like a ballet dancer would lower an extended leg or a removalist would gently lower a heavy object.
Most exercise is concentric but pilates is eccentric and that is what you need to avoid wasting.

Regards,
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Scott1
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Re: need a plan to improve my gait !

Post by Scott1 »

I should also point out that you don’t need a private instructor. A group class of four keeps the cost down and the instructor can easily manage that. You won’t be surrounded by photogenic Instagram models. More likely, they will ordinary people with issues of their own. Classes can be quite chatty once you get to know each other. It’s not like a gym full of body sculptors.
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