Low Muscle Endurance and Impaired Gait in Early MS

Even in the early stages of MS, we may walk differently than others.

In my late teenage years, I was often told that I "shuffled" and took tiny steps. I probably never stopped, but reached an age that the people around me no longer felt compelled to point out any and all of my defects. Then I recently saw a video from last year of myself (very slowly) crossing the finish line of a 5K run. When I was at that finish line, I felt like Atalanta, the goddess of runners.

When I looked at the video, I was shocked to see that I looked like a very elderly person, shuffling as fast as I could to get out of a burning building.

One small study has demonstrated that people in the very early stages of multiple sclerosis (MS) have much lower muscle endurance than people without MS, which may affect their gait.

Comparing a group of 52 people with early MS to 28 healthy volunteers, the researchers found that people with MS had 40 percent less muscle endurance than those without MS.

In addition, the people with MS had specific gait abnormalities, including:

  • walking with a wider base (legs farther apart) for stability
  • walked more slowly
  • walked in an asymmetrical pattern
  • took shorter steps

The researchers do say that early intervention with physical therapy and exercise can help our endurance and potentially cut back on some of the fatigue that we deal with.

I asked people with MS about their gait and muscle endurance, specifically, if they had ever had their gait formal assessed and if they felt like their muscle endurance was low.

This is what they had to say: 

  • Abnormal gait and ataxia, as well as left leg muscle weaknesses, were the symptoms that made me investigate and find out about my MS last year. The MRI showed many lesions in the spinal cord that can justify leg problems. Now I have physiotherapy sessions twice a week to improve my gait, balance and muscle strength.
  • I was diagnosed just over a year ago and am definitely noticing changes in my walking and growing weakness in my legs. It’s frustrating because a year and a half ago, I was running five miles regularly. Now I struggle to walk to the subway to get to work. I still run now and then, but mentally I definitely feel held back.
  • I have been diagnosed with MS for 28 years. My legs are weak, the right one much weaker than the left. I walk with a limp but no assistive device. I was very conscientious about exercising for a two-year period a couple of years ago. I have also tried electrical stimulation and physical therapy. Since I never noticed any progress, I quit all of the above and did not have a decline. I have decided if the nerves aren’t working that there is nothing that can help certain people like me.
  • I am newly diagnosed as PPMS and was very interested in the article on muscle endurance and gait problems. They are the main reason for my referral to a neurologist, along with tingling sensation in my tongue. Prior to that, it was many trips to the MD, physiotherapist, chiropractor with no improvement. I am seeing a new physiotherapist who assessed me and has recommended working on balance and “core” exercises for stability. She also suggested I would perhaps benefit from a cane, but that is pretty hard to accept. She did say that due to my balance problems, my muscles are working extra hard to keep me upright and that a cane may actually help me to be less tired as the day wears on. My main goal is to try and maintain the function I have, but it seems my symptoms are steadily increasing. I was told attitude and exercise are the only things the medical community can suggest.
  • I resisted using a cane because I felt old. I needed it. Now I use a walker. Any device that helps you to get out and about is well worth it. I am in PT now and we work on gait, balance and building up my stamina. I’ve had MS for 15 years now. I am not on any of the medications because of side effects. I’m doing ok, hope to get stronger.
  • I have always had a wider than normal gait pattern. After diagnosis, I had my gait reviewed by a specialist in gait analysis. Without telling him I had MS, he commented on my wide gait pattern and how unstable I was when walking. It didn’t take long for the specialist to put it all together.
  • I have had MS for over 20 years and now wear a leg brace on my right leg. It is still difficult to keep my balance, but it does help. I do find myself not going out as much for fear of tripping and falling. I am very slow, but still, keep trying.
  • I was diagnosed at age 66 after years of complaining about muscle weakness and difficulty walking. I told a neurologist that I walked like an old lady (I was 65 at the time). The neurologist said that I walked like a 65-year-old with arthritis. That neurologist missed the MS diagnosis as did the radiologist, who misread my MRI. My mobility has continued to decrease. I exercise and have maintained strength. Unfortunately, my muscles are not getting the stimulus they need from my damaged nerves and therefore I cannot lift my right knee and have difficulty walking. I am on “the list” to receive the Bioness L 300 Plus when it is finally available. The Plus is a thigh cuff that stimulates either the hamstrings or quads to lift the knee when walking. This addition to the L-300 that prevents foot drop miraculously coordinates all aspects of walking. Hopefully, when I have the Plus, I will be able to walk with a better gait and be able to increase my endurance. When I tried the device last fall, I found it to be very, very helpful.
  • I had my gait assessed in 2010 at MS Can Do, but since then, have had multiple problems (broken ankle, surgery to repair). I believe the MS has progressed - or is it that the fatigue has worsened, and/or that my muscle endurance is lessened, and/or that my balance is worse than before? It’s probably all three things.
  • I noticed that my foot would “slap” the ground after walking a few miles more than a dozen years ago. That was it until I was diagnosed by an incidental MRI 2 years ago..
  • Since my diagnosis, I have made a point of stepping up the exercise with resistance work. It has made a difference. Even years after my first symptoms, I am making a lot of progress.
  • I have received the Bioness L300 Plus and I am thrilled. I have had the L300 for just over two years. The Plus has improved my gait by stimulating mu hamstring muscles. I am trying to walk more so that I can build up endurance and decrease fatigue. In the short time that I have been using the Plus, I have found that I am more willing to get out and walk. I am hoping for the day when a neighborhood walk will be part of my evening routine.
  • Frankly, I’m tired of my inconsistent gait pattern. Sometimes my gait is fine and then just moments later I’ve got this wobbly thing going on. The uncertainty is unnerving. I don’t use a cane because I don’t see the use and I look WORSE when I use it.
  • My gait is slowly getting worse. My diagnosis was 9 years ago, but I’ve only felt the change in gait about a year ago. My neuro says I don’t need more physical therapy, I will just have to exercise on my own. I started using a scooter at work because my walking was so wobbly. My left knee gives out, and my left ankle twists, buckles, and has made me fall a few times. 

Bottom Line: In the many years since my diagnosis, I have gained a different perspective on things that had to do with how I looked doing things. I guess as I aged with MS, I became less vain and am just happy that I can still move around of my own accord (most days) funky gait or not. I certainly am also noticing my muscle endurance decreasing. I try to stay active, as I have noticed that the more hesitant I am to use my muscles, the weaker they get, then I am more hesitant to use them, and so on. 

Sources:

Kalron A, Achiron A, Dvir Z. Motor impairments at the presentation of clinically isolated syndrome suggestive of multiple sclerosis: Characterization of different disease subtypes. NeuroRehabilitation. 2012;31(2):147-55.

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