For people with multiple sclerosis – the autoimmune disease that attacks the brain, spinal cord and optic nerves – walking may become difficult. Damaged nerves can interrupt the signals telling the body to put one foot in front of the other. But trying to treat walking problems by simply buying a cane off a shelf is risky.
“I’d say that approximately 50 percent of the time, patients I see have already gotten some kind of device on their own. But the devices are often not the right type or are being used incorrectly, and patients are at a higher risk for falls,” warns physical therapist Jeffrey Hebert, associate professor at the University of Colorado School of Medicine and director of rehabilitation at the Rocky Mountain MS Center at the University of Colorado.
The MS Effect on Walking
The breakdown of nerve signals in MS affects walking in many ways. For example, the muscles may not get the message to coordinate properly and may weaken without use. The eyes and sensory nerves may lose the ability to detect where the body is in space. Many people also experience MS-related fatigue, which can make walking harder, especially over long distances.
Exactly how walking issues unfold depends on a person’s unique MS progression and the location of damage. “A bad MS attack in the spinal cord may affect both legs. Or problems may start in only one leg, and then there may be vertigo, balance and vision problems. Add a tremor and problems with coordination, and that’s where people run into trouble walking,” explains Dr. Riley Bove, assistant professor at the University of California–San Francisco School of Medicine and a neurologist at the UCSF Multiple Sclerosis Center.
Not everyone experiences walking difficulty. Bove says that historically, about half of all MS patients needed some kind of walking device within 15 years of a diagnosis. “What we’re seeing now is very different. Our research suggests that fewer than 15 percent of patients need a cane after about 15 years. It’s a huge difference,” Bove explains. She attributes the improvements to earlier MS detection, newer medications that may slow disease progression and more proactive treatment that includes physical therapy.
A lifetime of cognitive, physical and emotional challenges can take a toll in older age.
Assistive Walking Devices
For those who struggle with walking, an assistive walking device like a cane or walker can keep them mobile and independent. But there are many kinds of devices. Selecting the best one depends on your needs.
A physical therapist can help make that determination by assessing your physical strengths and weaknesses and uncovering the mechanical reasons for your walking problems.
The most commonly used assistive walking devices include:
Types. Canes have either a single tip that touches the floor or a broader base that has four tips (a quad cane). They’re available with different grips, which can help relieve pressure on your joints, according to the Mayo Clinic. “Avoid the old-time, small, curved handle. The broader the handle and more ergonomic, the better,” Hebert says.
When they help. Canes offer support with overall balance while standing and walking, especially for people whose legs feel tired when they walk and those who have a foot that trips them as they walk. “The muscle that holds the foot up when trying to swing the leg forward doesn’t pull up the foot. The foot ‘drops,’ and that’s when a trip or fall occurs,” Hebert explains.
Benefits. Canes are light, they help support stability and they can be used to navigate stairs.
Accommodations for mental, physical and emotional symptoms of the disease may keep you working longer.
Types. Trekking poles may have adjustable lengths or fold for convenience. You can use just one pole or a pair. Each has a strap that goes around your wrist and a grip for your hand. Grips come in materials such as cork, foam and rubber
When they help. If your arms are less affected by MS, you can push off of each pole to help propel you forward with each step.
Benefits. Use a trekking pole for support on one side or use two poles – one on each side. “That keeps you centered and keeps the movement of walking as normal as possible. When one uses a cane or just one trekking pole, you tend to lean to that side, leading to an inefficient economy of walking,” Hebert says.
Types. Front-wheeled walkers have four legs, with two wheels in front and rubber tips on the back. Rollators have swivel wheels on all four legs, as well as a seat you can fold down, hand brakes for stopping and a basket.
When they help. Walkers offer more stability on both sides of your body than canes or trekking poles. Rollators can help you go farther, faster, which you may need in a store or a long hallway, for example.
Benefits. Front-wheeled walkers are lighter and cheaper than rollators and are better if you have trouble controlling forward motion and are prone to falls. Rollators offer a seat for resting, which is crucial since muscles fatigue faster in patients with MS. Rollators allow for a smoother walk than canes or trekking poles. “You can truly use it for physical fitness,” Hebert says.
Types. The most common brace for people with MS is called an ankle foot orthosis, or AFO. It’s typically made of plastic or carbon fiber, with a base that goes in your shoe and a bar that runs up your leg just below the knee. Velcro straps help keep it in place.
When they help. AFOs are best for people who have foot drop or a knee that hyperextends backward.
Benefits. The brace keeps your foot at a 90-degree angle to prevent foot drop and can support the knee to keep it from hyperextending backward when walking.
The type of assistive walking device you’ll use will depend on your needs and activities. It may be best to have several devices, such as a cane for going up stairs or a rollator for walking longer distances.
Once you and your physical therapist decide which approach is best, the physical therapist will measure and fit the devices to your height. It’s a crucial step. “If it’s not fitted for you, it can cause you to lean on it incorrectly, which may lead to pain in the back and leg,” Hebert warns.
Once you have the device, you’ll need physical therapy to learn to use it. You’ll learn which side to use a cane on, for instance; or how to move forward, take a step and make turns with a walker. Also important, no matter which device you use: learning how to walk on all kinds of surfaces, such as uneven sidewalks or grass.
It may take time to get used to using the device. But Hebert says it will be worth it. “Think of it as an enabling device versus a disabling device,” he says. “It will enable you to be safer and to increase your activity and fitness level.”
On a Scale From 1 to 10: Most Painful Medical Conditions
The worst type of pain? It's whatever pain you personally suffer from. But experts and patients agree: Certain medical conditions are especially excruciating. When health care providers ask patients to rate their pain on a scale from 1 to 10, these conditions – whether acute or chronic – can have some of them responding "11." If pain can't always be cured, proper treatment can at least help scale it back.Kidney stones
Trying to pass a kidney stone stuck in the urinary tract can bring people to their knees and straight to the emergency room. Usually made of calcium, these hard pellets block the flow of urine, making the kidney swell and causing waves of sharp pain at the mid-back, abdomen or sides and for men, pain at the end of their penis. Nausea, vomiting, fever and blood in the urine are common. Once a kidney stone is confirmed, treatment with IV fluid and medication allows the stone and the pain to pass. Stubborn small kidney stones may require shock wave therapy, or lithotripsy, to break them up. Larger or recurring stones may call for more complex methods.Childbirth
For some women, intense pain in the lower back is an unforgettable aspect of childbirth. Often called back labor, the pain peaks during contractions and lingers in between, making it more difficult for women to push. It's sometimes caused by the baby's head position, with the back of the head pressing into the mother's tailbone, but that's not always the case. Non-medication methods to ease the mother's pain include moving away from a back-lying position, walking and applying counter pressure, for instance with a tennis ball or warm compresses, to the back. If these aren't enough, relief options include pain medication or an epidural nerve block using local anesthesia to numb the area.Trauma
With a gunshot wound or other trauma, sudden, severe pain can strike a healthy person to a degree they've never experienced, says Dr. Asokumar Buvanendran, an anesthesiologist specializing in pain medicine with Rush University Medical Center in Chicago. Acute pain provokes a variety of bodily signs, says Buvanendran, also the president of the American Society of Regional Anesthesia and Pain Medicine, or ASRA. Rising blood pressure, a racing pulse and cues from the patient's physique, movements and posture all tell the story of intense pain. But clinicians must rely on patients to gauge exactly how much pain they're in – thus those requests to "Rate your pain on a scale from 1 to 10."Shingles
Older adults who suffer from shingles may wish they'd been vaccinated against herpes zoster, the virus that causes chickenpox in kids and shingles in seniors. Besides rashes, blisters and scabbing, shingles patients suffer intense pain. This occurs in parts of the body along a nerve pattern, called the dermatome, where the virus resides – often across the trunk. Unfortunately, some patients go on to develop a chronic condition called post-herpetic neuralgia, with symptoms including deep or burning pain, extreme sensitivity to touch and numbness in the affected area, which can last for years if not addressed promptly. Early treatment for shingles can help prevent the transition from acute to chronic pain, Buvanendran says.Sickle cell disease
Sickle cell disease
Although it's classified as a rare disorder, sickle cell disease is well-known for the pain it causes. The inherited condition affects red blood cell formation. In sickle cell crisis, normally flexible and disc-shaped blood cells become stiff and crescent-shaped. Blood can't flow smoothly, which reduces delivery of needed oxygen to the body's cells. Pain management is an ongoing challenge for people with sickle cell disease, some of whom encounter acute pain during crises along with ongoing day-to-day discomfort.After-surgery agony
No surprise here: Recovering from surgery can be painful. But some procedures cause more postoperative pain than others. Knee replacement surgery would rank near the top of the list, Buvanendran says, because of all the cutting through bone. However, he says, for whatever reason, the aftermath of hip replacement doesn't seem to hurt as much. But with every breath, lung surgery brings postoperative pain to the involved muscles, he adds.Spinal headaches
Spinal headaches can result from an accidental tear or puncture made during a spinal tap procedure. Leaking of fluid from around the spinal cord can cause a severe spinal headache, Buvanendran explains. In some cases, he says, lifting heavy objects (like a fish tank for one patient) can cause a vulnerable spot to tear. Nausea, dizziness, light sensitivity and neck stiffness are symptoms. Doctors sometimes treat spinal headaches with blood patches from the patient's own blood to plug the leakage site.Back injury
As a source of agonizing back pain, an acute disc herniation – possibly caused by heavy lifting – is all too common. "Your disc protrudes and bulges and pushes on the nerve," Buvanendran says. "You have severe pain going down your legs." Many other people suffer from less dramatic but still-debilitating chronic back pain. The ASRA website offers a gamut of pain treatment options.Migraines
They're not as sudden and sharp as spinal headaches. Even so, migraines can knock people out for days, notes Penney Cowan, founder and CEO of the American Chronic Pain Association. For this and other pain conditions, she says a balanced approach using a variety of therapies – which will depend on the condition and patient – is best. ACPA provides an A-to-Z rundown of treatments, including over-the-counter and prescription medications, acupuncture, complementary and alternative medicine, and cognitive behavioral therapy. With each individual, Cowan says, the goal is "to reduce their sense of suffering and improve the quality of their life and function."Chronic pain conditions
Chronic pain conditions
Lyme disease, fibromyalgia and arthritis are among dozens of chronic conditions addressed by the ACPA. "Pain is so isolating," Cowan says. "It makes you withdraw from everything and everybody." Pain management programs, offered by medical centers such as Cleveland Clinic, Johns Hopkins and Mayo Clinic, can make a big difference, she says. However, she adds, many people don't have access to these programs or can't afford them. With the current spotlight on opioid addiction risks, Cowan says, many chronic pain patients who have functioned well on these drugs for years are now being denied by doctors. See the ACPA site for in-depth information and options for chronic pain management.Read More