Physical Therapy for MS

Finding the right physical therapist to help someone with MS can be a challenge. A member of our MultipleSclerosis.net community recently reached out with the question as to how to find the right type of therapy and get better access to it for her spouse. From my own experience with physical therapy (PT), I can share the following thoughts and tips.

I have heard the analogy of picking a physical therapist compared to choosing a car mechanic. All mechanics work on cars, but if you have a specialty sports car such as a Lamborghini or Porsche, you are most likely not going to take it to the mechanic who fixes Fords and Chevys. They are all cars, but some cars have special needs and require special knowledge to repair, just like those of us with multiple sclerosis often have. So first and foremost – be sure the person you see for physical therapy is trained in treating people with neurological problems.

There are many different types of PT and those professionals often specialize in a particular area. If you have a broken bone or an injury from an athletic activity you would want to see a PT who specializes in orthopedic therapy. Geriatric physical therapy focuses on activities that particularly affect the elderly while pediatric therapy is aimed to improve the lives of children who have physical deficiencies that can be helped through PT. Physical therapy and rehabilitation therapy is commonly prescribed for people who have a serious cardiac or pulmonary problem, such as open heart surgery, and this type of help is geared to improve endurance and confidence in these patients.

The remaining major category of therapy would be neurological physical therapy that focuses on things like improving balance, mobility and understanding and compensating for muscle loss associated with neurological disorders, and how to adjust for those losses to give the person a better quality of life.

Your MS doctor or nurse should know of people in your area who specialize in neurological PT and make the referral to the correct type of therapist. When you call to make that first appointment, be sure to ask again if the person who will be seeing you is familiar with MS and comfortable working with you. If not, ask for a different referral. I’m fortunate there is an excellent Neuro Rehabilitation center close to my home and they specialize in treating people affected by MS, Parkinson's Disease, stroke and other neurological conditions.

The referral from your neurologist must have specific problems identified – some people get into therapy and find they are quickly given a few exercises to do on their own at home and then dismissed from PT because the directions from the doctor are not specific enough. The referral should also have a length of time (number of weeks) and how often (two-three times a week is usual) you should go to PT. The physical therapist will then do an assessment of your problems when you first meet and by consulting with you select the target goals of therapy. For me recently, my major problem was gait – my walking had problems and we wanted to work on making my steps stronger and smoother. In previous sessions with PT I have worked on my balance, and was very happy to see improvement over the course of a few weeks.

For PT to be continued over a longer period of sessions, the person must often show they are benefitting from the therapy through improvement. Normally if you stop making progress, the payer (insurance) will decide there is no further benefit in PT and stop covering the costs. This is one place where it is especially important for the therapist to understand neurology and will note how even small changes can make major improvements to our quality of life and those changes can be well documented so therapy might continue.

The cost of physical therapy varies widely and is often a major barrier to people accessing this important type of care. If I see a therapist through a private practice, I have to pay an office charge of $50 for each session. If I see the therapists through the center affiliated with a local hospital, I then am charged according to my 80/20 co-pay, which can make it much less but it is still costly. The charges are confusing and can add up quickly so it’s important to have an idea of what those fees might look like. In my opinion everyone with MS should have PT, but I’ll save that rant about the cost and access for another time.

Advocating for physical therapy if you need it might take extra effort but it is well worth it when you connect with the right type of therapist. Don’t hesitate to ask your doctor for the specific referral if you think there is the chance that physical therapy might improve your condition or quality of life. You might be surprised at what a good evaluation and a tune-up can do for you if you connect with the right physical therapist.

Wishing you well,

Laura