Many people know that Pilates can help improve core strength and build muscle, but they don’t know that it can also help improve balance, coordination, and mobility. Exercises can be done lying down or in a seated position on a floor mat or reformer (Pilates machine), which is extremely convenient and helpful for people with walking impairment, especially for those with multiple sclerosis (MS).

What You Need to Know Before Starting Pilates
Before practicing Pilates or using a reformer, people with MS and Pilates instructors should consider special guidelines and exercises that are tailored to fit the needs and capabilities of the MS population.  Just like any person who exercises with the Pilates method, people with MS have their strengths and weaknesses in their ability to carry out certain Pilates techniques. However, their abilities can be affected by MS symptoms such as fatigue, overheating, and weakness, which put them at risk for injury.

Don’t Overheat
Take precautions to keep cool during exercise because even a half-degree increase in core body temperature can temporarily exacerbate MS symptoms (the symptoms don’t actually progress).  If you get hot, you should stop exercising until your symptoms subside and body temperature returns to normal.  It’s best to exercise in an air-conditioned room or wear accessories such as a cooling scarf and vest. Drinking cold water would also help but if you have the MS symptom of urinary incontinence, drinking water during exercise can lead to frequent restroom trips or accidents.

Be Safe and Don’t Over-Exercise
When exercising on a reformer, you can sit, lie or stand to perform exercises on its moveable carriage. Since people with MS may lack balance or strength, the carriage should be locked to provide a stable base for you to move onto.  You can use a chair, walker, or any stable prop to provide assistance when transferring onto the carriage. 

If you haven’t exercised in a long time, you may experience a decrease in your fitness ability once you start exercising again. As a result of over-exercising, you’ll feel the pain later in the day or the following day. To prevent injury and inflammation of the muscles, start the initial exercise routine with 5-10 repetitions of 5-10 low intensity exercises.

Manage Your Spasticity
People with MS may experience spasticity, or involuntary muscle contractions. This usually causes stiffness in your legs and makes walking more difficult.  To help ease the spasticity, stretch your muscles and use positions which help to decrease muscle tone.  You can use the footboard to maintain your feet in a flexed position, while you perform extension-exercises for your knees and hips. For quad strengthening, lie on your side on the reformer carriage and use the footboard for feet placement.  Avoid lying on your back in full leg extension, as this tends to facilitate an increase in spasticity in the legs.  When using the footbar, avoid putting pressure on the ball of the foot.

Practice Flexibility and Motor Control Exercises
One of the symptoms of MS is a decrease in flexibility. To increase your range of motion and motor control, use the foot straps to perform leg circles. Varying amounts of assistance may be required.  Again, if spasticity is an issue, doing leg circles with bent knees is a useful variation. 

To strengthen muscles and improve motor control, exercises should be done in small movements. It’s best to extend and flex the knee or ankle in isolation, while pushing against the footbar or footboard in a closed-chain exercise. Later, these movements can be integrated into larger, more functional movement patterns. 

If you don’t have a reformer available, these exercises can be adjusted to be done on a floor mat.  By following these tips and receiving guidance from a Pilates instructor, you can improve your core strength and walking ability. 

Mary Kay Foley, PT, GCFP, is a staff therapist at St. Luke's Elks Rehab and coordinator for the Integrative Therapies Program at St. Luke's Wood River Medical Center in Ketchum, Idaho. She is also a program staff member at The Heuga Center for Multiple Sclerosis, a nonprofit organization which provides lifestyle empowerment programs to people with MS and their support partners to transform and improve their quality of life. For more about Mary Kay’s work and The Heuga Center, please visit www.heuga.org.