Interview with MS Physical Therapist Gretchen Hawley

Members of our Editorial Team connected with Gretchen, a Doctor of Physical Therapy specializing in multiple sclerosis. Gretchen was kind enough to let us interview her for an exclusive article on MultipleSclerosis.net answering some frequently asked questions about physical therapy, exercise, and MS. Learn more about Gretchen and the work she does to help MS patients below!

My mission is to help people with MS not miss out on life

Q: What inspired you to get involved with and work with MS patients specifically?

A: I was working for a physical therapy clinic that wanted to start an MS program. I eagerly offered to run the program, as I was always interested in neuro-based physical therapy. Once I agree to start the program, I decided I wanted to freshen up on my MS skills and dive in headfirst to the MS community. I studied for and passed an exam that allowed me to become an MS Certified Specialist. I fell in love with treating people with MS due to the vast differences in symptoms. Each person's symptoms are unique to them, and I love helping brainstorm the best exercises and strategies to help them live a more fulfilling life. My mission is to help as many people with MS gain hope and participate in life without missing out due to their symptoms.

Exercise and MS

Q: Why is exercise so important, especially for those with MS?

A: In multiple sclerosis, the phrase, "If you don't use it, you lose it," is very true! If you don't exercise, your brain will have a difficult time sending a neural connection to your muscles, meaning your muscles won't work as well. This could result in increased drop foot and toe drag, difficulty walking and climbing stairs, and challenges with getting into and out of your car. Additionally, exercise can help improve cardiovascular health, endurance, and strength in your arms, legs, and core.

Exercise vs. physical therapy

Q: What is the difference, if any, between exercise and physical therapy? Is one more important than the other?

A: I like to think of exercise as a way to improve your overall health, and physical therapy as a way to improve your specific weaknesses. Both are very important, however, if you have a goal of improving movements (i.e. walking, balancing, climbing stairs, getting into and out of bed, etc.) then physical therapy is a MUST! An MS-certified physical therapist will be able to give you functional exercises for each activity that is hard for you to do. General exercise typically does not help improve specific movements, but rather will improve your cardiovascular health and strengthen muscles that are already working well. (In MS, this can sometimes lead to overcompensating for weaker muscles, which may then lead to increased fatigue.)

Fighting pain and fatigue

Q: Many MS symptoms inhibit exercising - like pain and fatigue. How do people who are experiencing these symptoms still make exercise a priority?

A: Exercise can often seem counterintuitive when MS fatigue is involved, however research shows that exercise at the right intensity can actually help reduce fatigue! It is important that you speak to your physical therapist about the appropriate number of repetitions and modify all exercises to fit your needs. This will sometimes mean you are sitting down while exercising and perhaps only do 3 repetitions of each exercise per set. It's important to keep in mind that something is better than nothing!

Overcoming MS challenges and staying active

Q: What are the biggest challenges you see those with MS facing when it comes to being active? And do you have tips for coping/overcoming them?

A: One of the biggest challenges I see when people with MS are active is their core temperature rises, which causes one or more of their symptoms to worsen. This is called Uhtoff's Phenomenon - if your core temperature rises by at least 1/2 of a degree, which is likely when moving around, any of your symptoms could temporarily worsen (think: fatigue, foot drop, loss of balance, sensory changes, etc.). My best tip to overcome this is to be proactive! If you know you're going to be active, make sure to have ice cold water with you, bring a cooling device (wrist bands, hat, neck wrap, vest, etc.), and take lots of rest breaks!

Excericse options for progressive MS

Q: What about those with less mobility who may be in a wheelchair or unable to drive or walk? What options are available for those whose MS has more severely progressed?

A: There are actually a lot of exercises you can do in a wheelchair to remain active! Some of my favorites include weight shifting side to side and front and back as well as tricep push-ups! These exercises will allow you to improve your strength so that you are able to adjust yourself in your wheelchair more easily and improve strength when standing up (whether you need assistance from someone else or not). There are also a lot of stretches that can be performed in a seated position to improve flexibility in tight muscles. My online MS physical therapy program, The MSing Link, has exercises that are appropriate for any level of MS progression from newly diagnosed to wheelchair-users, and it is accessible from the comfort of your own home (no need to drive to a PT clinic!).

My virtual MS physical therapy program

Q: Tell us about your virtual MS physical therapy program - what is it?

A:The MSing Link is my virtual physical therapy program, designed specifically for people with MS. It is an online platform where people with MS can access physical therapy exercises geared toward strengthening the brain and its neural connections. The program also includes exercises for stretching, strengthening, balance, and walking as well as activity-specific exercises to help with standing up from the floor, stair climbing, getting into & out of a car, etc. Additionally, the program gives access to live guest speakers and MS research updates.

My inspiration

Q: What inspired you to develop The MSing Link?

A: I've been a physical therapist for 6 years and a certified MS specialist for 5 years. I couldn't help but notice the high cancellation rate & no show rate at the PT clinics where I worked from our MS population - the reason being that my patients with MS had such difficulty getting to their appointments. Fatigue, transportation, forgetfulness, weather; there are a number of valid reasons someone with MS would have to miss a PT appointment, which often results in not getting the results they are looking for. Additionally, there are not many MS specialized physical therapists around, and I'm a firm believer that MS physical therapy is completely different than orthopedic physical therapy. I wanted to be able to meet my clients where they were at and give them an opportunity to participate in PT, guided from an MS specialist, from the comfort of their own home.

Improving the brain to muscle connection

Q: Does it work for all types of MS or is it designed for a more specific type?

A: The MSing Link is designed for all types of MS. Some of my members are newly diagnosed, some have relapsing forms of MS, and others have progressed forms. Since the exercises are geared toward improving the brain to muscle connection, it is extremely important that all levels of MS are doing these exercises. It will result in strengthening the connection that already exists (which could prevent weakness from a relapse) and/or create a new connection so the muscle can get stronger.

Living a more fulfilling life

Q: What do you love most about this program and the work you do?

A: What I love most is hearing feedback from my members. I get feedback weekly with phrases like "I was able to walk my dog on grass without falling over!" or "I was able to walk on the beach without losing my balance." I also hear feedback mentioning improvements in fatigue levels, being able to have enough energy to go out to dinner with their family at night, and improved quality of life by being able to participate in more day-to-day activities and events. It is so rewarding knowing that I'm able to help my members live a more fulfilling life.

Q: What is your advice for someone who's considering an exercise program?

A: Make sure your exercises are directly geared toward your goals, listen to your body, and stay consistent!

Upcoming events

Q: What's coming up for you?

A: I just presented at the Boston Abilities Expo on September 13th where I demonstrated exercises to help improve strength with day-to-day activities through functional exercise! I'll also be keynote speaking at the annual MS Views & News symposium in South Florida on November 16th!