Physical Therapy Exercises for Multiple Sclerosis

We know that living with multiple sclerosis (MS) comes with fatigue, muscle weakness, spasticity, balance issues, and mobility challenges, making daily activities, from walking and climbing stairs to dressing and cooking, difficult.

Physical therapy (PT) can play an essential role in managing MS symptoms and improving day-to-day activities. Exercise and movement help maintain strength, flexibility, and coordination; it also gives your cardiovascular system a boost and supports metabolic health. Continuing physical therapy exercises at home doesn’t have to be rigorous or performed in a gym – activities like walking, gardening, or gentle water exercises can be enough.

This blog will guide you through the types of physical therapy exercises most effective for managing MS, practical tips for exercising safely, and how to create a consistent routine that supports long-term mobility and independence.

Why Physical Therapy Matters for MS

MS damages the protective myelin sheath around nerves, disrupting communication between the brain, spinal cord, and muscles and causing muscle weakness, spasticity, balance problems, and reduced coordination. Over time, decreased physical activity can exacerbate impairments, creating a cycle of fatigue and reduced mobility.

Physical therapy targets multiple aspects of movement and function:

• Resistance training helps combat muscle weakness and improves functional strength for everyday tasks.
• Coordination exercises reduce fall risk and improve confidence in movement.
• Stretching and flexibility exercises help keep muscles relaxed and joints mobile.
• Aerobic exercises support heart and lung function as well as energy levels.

Physical therapy programs are structured around an individual’s needs and abilities, following an assessment of their strengths, limitations, and goals. Starting PT at the initial stages of MS can help slow symptom progression and maintain function.

Physical Therapy Exercises for MS

Physical therapy exercises for MS generally fall into four categories: strengthening, flexibility, balance, and cardiovascular endurance.

Strengthening Exercises

Muscle weakness is common in MS, so strength training is an inherent part of PT. Types of exercises include:

• Seated leg lifts to strengthen quadriceps and hip flexors.
• Adjustable resistance band exercises without weights to tone arms and legs.
• Wall sits and mini squats to build lower-body strength while supporting balance.

It’s important to start with low to moderate resistance and multiple repetitions at your skill level. You can even adapt exercises using water bottles or canned goods, but avoid overexertion and rest between sets.

Flexibility and Stretching

Spasticity and stiffness can inhibit mobility and range of motion; regular stretching can keep the muscles limber and help reduce discomfort. Movements should be gentle and could include:

• Gentle yoga poses and breath work.
• Hamstring and calf stretches.
• Shoulder and neck stretches that focus on posture.

Overstretching is counterproductive, and bouncing can damage the soft tissues. Be sure to extend slowly and hold the position for as long as it’s comfortable, about 20-60 seconds.

Balance and Coordination Exercises

Impaired balance can increase fall risk for people with MS, so targeted exercises can help improve stability and proprioception. Simple coordination exercises include:

• Heel-to-toe walking to synchronize intention and movement.
• Single-leg stands performed with the support of a wall or sturdy chair.
• Tai chi or stability ball exercises to promote core strength.

Balance exercises can also be adapted for seated positions if standing is challenging, and either way, the equipment should be able to support your weight.

Endurance Exercises

Aerobic activity improves cardiovascular health, lung function, energy levels, and mood, but strenuous activity can be too much. Options for people with MS include:

• Stationary cycling or arm cycling to minimize fall risk while building strength.
• Swimming or water aerobics that take advantage of buoyancy and keep you from overheating.
• Brisk but low-impact walking with breaks to stimulate blood flow and engage different muscle groups.

Progression through exercises should be done gradually and based on tolerance. MS symptoms, including fatigue and heat sensitivity, make safety a top priority during exercise. This isn’t the time to push yourself too hard, and listening to your body will help you pace yourself according to symptom fluctuations. The guidance of a physical therapist will help you establish correct form, address specific limitations, and help prevent injuries. They can also help you figure out how to use adaptive equipment, like resistance bands, to make exercises safer.

Committing to a Routine

One of the most important parts of managing MS through physical therapy is consistency. We know that symptoms can fluctuate day to day, but doing your best to develop a routine, no matter how small, helps your body adapt and preserve strength over time. Movement doesn’t have to be strenuous or complicated; the bottom line is finding a rhythm that fits your energy levels and physical ability.

A well-rounded program may include strength training two to three times a week to build muscle and support mobility; stretching daily to ease stiffness, especially after more demanding days; balance training three to four times weekly to improve coordination and reduce the risk of falling; and aerobic activity three to five times per week in short sessions that last 10 to 30 minutes. Of course, these numbers aren’t hard-and-fast rules – MS symptoms can change from day to day, and it’s completely normal to adjust based on fatigue or flare-ups.

Much of this is physical, but a weekly exercise routine also has emotional benefits. Regular physical activity helps regulate the body’s stress response by improving the function of the hypothalamus-pituitary-adrenal (HPA) axis – the system that controls how we react to stress. When it’s in balance, the HPA axis helps manage cortisol levels, energy, immune response, and mood; engaging in exercise “trains” this system to respond more efficiently.¹

Good intentions aside, listen when your body asks for rest and recognize the need for professional input. If you experience increasing instability, frequent falls, pain during movement, or unusual fatigue, it’s time to reach out to your healthcare provider. Likewise, any new or worsening neurological symptoms, such as changes in vision, coordination, or sensation, warrant evaluation before continuing any exercise program.

A physical therapist can modify your plan to meet your current needs and introduce adaptive tools and home-based strategies that make exercise accessible and effective. Living with MS often means learning to adapt, and collaboration with physical therapy evolves as your physical ability and needs change.

At PREMIER Orthopaedic & Trauma Specialists, we understand the challenges associated with fatigue, weakness, and balance issues, and we work closely with each patient to build a plan that fits their lifestyle and goals. With consistency and professional guidance, many people with MS find that intentional physical activity becomes a cornerstone of their well-being. Our team is here to help you move with purpose and live with greater confidence every day.

1. Mahindru, A., Patil, P., & Agrawal, V. (2023). Role of Physical Activity on Mental Health and Well-Being: A Review. Cureus, 15(1), e33475. https://doi.org/10.7759/cureus.33475.