Proprioception Impairment and Other MS Balance Issues
When I stop and think about the MS symptoms that affect me on a daily basis, I usually think about the pain, fatigue, spasms, and cognitive problems I deal with. There is one issue that I don’t always talk about, but it still has a major impact on me. While many of my symptoms have come and gone or showed up gradually over my 20+ years with the disease, this one symptom has continued to plague me since my very first exacerbation. Because it’s always been an issue, I think I tend to gloss over it and not discuss it as much. I am referring to problems I have with my balance. Balance issues are common for those with multiple sclerosis and have had a significant impact on my life, so I thought I’d talk a little bit about them.
What is balance?
I’m pretty sure most of you know what I mean by “balance”, but so we are all on the same page, let’s put it out there. Balance, in the sense that we are talking about it, is our ability to evenly distribute our weight, which enables us to remain upright and steady. Whether you are standing, walking, or running, your sense of balance makes it possible because it is distributing your weight in such a way that you don’t tip to one side and fall. Balance keeps your center of mass over its support.1 If your sense of balance is disrupted, you can fall, stumble and almost fall, or even drop something. All of which can not only interrupt what you are doing but also cause injury.
One of the most common reasons that people with MS have difficulty with their balance is because their body begins to have problems with what is called proprioception. Proprioception is our ability to determine our body’s position without using our vision. Our brain gets information from throughout the body, particularly our ankles, to help us manage our position. However, with MS, those signals may be sent on damaged nerves (meaning the signal doesn’t get where it’s going on time or at all, or becomes corrupted) or our brain may misinterpret those signals. When our proprioception gets impaired, so does our balance.2
Maybe you’ve never heard the word proprioception, but if you have MS, I guarantee you’ve been evaluated for it often. Has your neurologist ever had you close your eyes and try to touch your nose? I’m willing to bet he has. If you have difficulty doing that, chances are you have some proprioception problems leading to difficulty with your sense of balance.2
Other MS balance issues
Proprioception isn’t the only problem when it comes to balance difficulty with MS. Muscle weakness in our legs can also be problematic. Spasticity, which can affect our flexibility, also impacts our balance. Vision problems, like reduced depth perception or field of vision, can severely impact our balance. Cognitively, our brains may not correctly interpret all the signals coming in from any of our various senses, which can cause us to misinterpret our position.3 Vertigo (which I discuss further here) can also be an issue when it comes to our balance.
My experience with balance issues
As I mentioned before, I’ve had problems with balance since the very beginning. Even when I am doing well, I consistently have problems when it comes to the testing of my balance (you may hear this referred to as the Romberg test). In particular, I have difficulty with proprioception. When I close my eyes, I struggle to touch my finger to my nose. I also struggle to stand still when my eyes are closed. If the doctor pushes me slightly while standing with my eyes closed (as is common in these tests), I will almost always start to fall. Along with that, if I am having a good day, I can put one foot in front of the other and walk just fine, however, if I close my eyes, I struggle to take a single step without falling.
That’s what my balance issues look like clinically; in real life, I fall a lot. When I was younger and newly diagnosed, it particularly affected my athleticism (going from a very good ice hockey player to suddenly struggling to stand on skates). I’m at a point where my balance has been impaired for so long, that I’ve kind of learned to deal with it and have become used to it. I almost never feel steady on my feet, which means I end up wall walking a lot or leaning against something whenever possible.
As always, if you suspect you are having problems with your balance, discuss them with your MS specialist.
Thanks so much for reading and always feel free to share! As always, I would love to hear about your experiences in the comments below!
May is Mental Health Awareness Month. We want to check in. How are you feeling?