Balance and Falls in MS

Carolyn Bacon, Junior majoring in neuroscience
Pomona College, Claremont, CA
Michelle Cameron, MD, PT - Neurologist
Portland, Oregon

Imbalance: Common Symptom
Walking Problems
Risk of Falling
Preventing Falls
Resources for Veterans 

Because MS can affect all areas of the central nervous system it can cause different problems for each person but, more than half of the people with MS have problems with their balance and walking and are at high risk for falls.  Research is helping scientists find out more about how these problems are related, why they happen and how to help people with MS have better balance and fall less.

Imbalance: Common Symptom Imbalance is one of the most common, and often the first symptom of MS.  People with MS often say they feel off balance or dizzy.  Researchers have found three main problems with balance in MS.  First, most people with MS sway more than they should when they are trying to stand still.  This swaying worsens more than expected with eyes closed or with reduced support, such as standing on one leg or with feet together.  Second, when leaning, reaching or starting to walk, people with MS cannot go as far or move as quickly.  This is not only leaning, reaching and stepping forwards but also upwards, such as getting something off a tall shelf or walking up stairs.  Third, they have difficulty maintaining balance and controlling how much their body sways when pushed or pulled.
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Walking Problems
These three balance problems are related to a very important function that is often impaired in people with MS--walking.  Walking problems are common in people with MS.  They tend to walk more slowly than healthy people, take shorter and slower steps, and their joints move less when they walk.  They also use more energy to walk.  Their walking gets even slower when performing a mental task like walking through a store while looking at things on the shelves, talking, or trying to remember a grocery list.  Walking problems in people with MS are related to problems with balance.  Walking involves standing on one leg, leaning forward, and then using the other leg to catch oneself and maintain balance.  Because people with MS often have trouble standing, leaning, and maintaining balance when their body moves, it’s not surprising that they also have trouble walking.
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Risk of Falling
Problems with balance and walking also put people with MS at risk for falling.  People with MS fall frequently and often fall badly enough to be injured.  Many people with MS are also afraid of falling and stop being active to avoid falling.  Trying to do mental tasks while walking increases the risk of falling and many people with MS say they fall more when fatigued or hot. 

Scientists are trying to understand what underlies problems with balance, walking and falls in MS so they can develop the most effective treatments for these problems. Recent research indicates that imbalance in MS is caused by slowed conduction, from the legs along the spinal cord, of the sensation of where one’s body parts are.  This sensation is known as proprioception.  Stepping forwards and landing where you want to, without looking down, requires you to be able to feel where your legs and feet are.  When proprioception (sensory nerves that provides a sense of the body’s position) is slowed you don’t know where your feet are quickly enough to put them in the right place, and this can make you unsteady and more likely to fall. Difficulty with thinking about many things at once can also contribute to problems with balance and walking and make people with MS fall.
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Preventing Falls
Understanding why people with MS fall and studies on preventing falls in older people have yielded good ideas for helping people with MS.  Some of these ideas include exercising in a standing position while gradually increasing balance challenges. This type of posture and slow moving body movements are similar to the martial art form of Tai Chi. There are various programs that use this milder form of yoga to improve balance. Before engaging in any exercise program you should check with your healthcare provider.

Another way to prevent falls is to walk with a purpose by minimizing distractions and taking note of possible floor hazards like rugs or cracks in the sidewalk. Removing “throw rugs” in your home, tying up drapery/shade cords off of the floor and/or securing rugs to your floor are other examples of ways to prevent falls.  As mentioned earlier, with MS your sensory nerves can have slowed conduction that interferes with your body’s sense of position. If you are engaged in difficult mental tasks and then you begin to stand up or walk you might experience slowed nerve conduction and it can bring about a sense of imbalance and possible fall. Using well-fitting lace-up shoes, leg braces or elastic straps on the legs can help give your body more information about where your legs and feet are in relation to your body’s position.

Although many people with MS have problems with their balance and walking and are at risk for falling, fortunately, we are starting to understand why and what to do to help.  More research is needed to know what works best, but for now, get help from your healthcare provider and a physical therapist to choose the best strategies for you to improve your balance and walking and to reduce your risk of falling.
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Resources for Veterans
If you are experiencing some of the problems mentioned in this article you should contact your healthcare provider at your local VA Medical Center. Your provider can assess your medical needs and more likely refer you to physical therapy to help you manage your balance problems and help you reduce your risk of falling.
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Date Posted: January 2011