Clinic speak: balance exercises

More on balance; rehabilitation works. #MSBlog #MSResearch #ClinicSpeak

“In response to some of the questions generated by yesterday’s post on balance rehabilitation I have pulled up this small study published in 2007. The answer is yes, you can do something about it and balance rehabilitation works. The other question is can you do these exercises yourself. Yes, I suspect so but you need to discuss this with your physiotherapist and if you don’t have a physiotherapist with your MSologist or MS nurse specialist. There are numerous causes of balance problems in MS and the type of therapy needs to be targeted to the cause of the problem. For example, balance disorders can be due to malfunctioning of cerebellar, vestibular, joint position, visual or motor pathways. Each of these pathways require a different rehabilitation approach.”

“The following YouTube video from the MS Society touches on these issues.”

“You may find this self-help video from the NMSS helpful as well.”

Cattaneo et al. Effects of balance exercises on people with multiple sclerosis: a pilot study. Clin Rehabil. 2007 Sep;21(9):771-81.

OBJECTIVE: To evaluate the effects of balance retraining in a sample of people with multiple sclerosis.

DESIGN: Randomized controlled trial.

SETTING: Rehabilitation unit.

SUBJECTS: A consecutive sample of 44 subjects was randomized into two experimental groups and one control group. The inclusion criteria were: ability to stand independently more than 30 seconds, ability to walk for 6 m.

INTERVENTIONS: Group 1 received balance rehabilitation to improve motor and sensory strategies. Group 2 received balance rehabilitation to improve motor strategy. Group 3 received treatments not specifically aimed at improving balance.

MAIN OUTCOME MEASURE: Berg Balance Scale, Dynamic Gait Index and fall frequency were used to assess balance impairments. Dizziness Handicap Inventory and Activities-specific Balance Confidence were used to assess handicap and the level of balance confidence.

RESULTS: Frequency of falls post treatment was statistically different among groups (P=0.0001); The Berg Balance Scale showed an overall statistically significant difference (P=0.0008) among groups. Change pre-post scores were 6.7, 4.6 and 0.8 points for groups 1, 2 and 3. Dynamic Gait Index showed an overall near statistically significant difference among groups (P=0.14), with change pre-post scores of 3.85, 1.6 and 1.75 points for groups 1, 2 and 3; after the exclusion of drop-outs a statistically significant difference was observed (P=0.04). The self-administered tests (Activities-specific Balance Confidence and Dizziness Handicap Inventory) did not show clinically relevant improvements.

CONCLUSIONS: Balance rehabilitation appeared to be a useful tool in reducing the fall rate and improving balance skills in subjects with multiple sclerosis. Exercises in different sensory contexts may have an impact in improving dynamic balance.

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • I have RRMS, dx 2013 after experiencing symptoms on and off for seven years. I experienced significant balance issues prior to diagnosis. I use the Wii Fit balance board and have found that the exercises are helpful. I have ongoing sensory issues with my feet — my feet have not felt the same since April 2013 but they are not numb. Last weekend my husband and I tried paddle boarding — an exercise which involves standing up on a board and using a paddle to move on open water. My husband — who has not been doing balancing exercises — had a difficult time getting up. I was able to stand up successfully and maintain balance for 20 minutes my first time out. Later I fell — a not uncommon experience for people doing power boarding — but was able to get back up. In sum, I feel that I've experienced the benefits of balance exercises. The exercises have also helped me increase my physical confidence.

  • Another strong vote for Wii Fit here – I can copy the post above (with a different date of diagnosis, and no paddleboarding – but similar beneficial effects on balance). After a severe relapse, I faced numerous mobility issues, including balance problems. Physical therapy helped tremendously, but balance was still far from ideal. Playing Wii Fit balance games regularly, especially in the winter, when going outside was not always possible or enjoyable, gradually increased my stability and gave me enough confidence to walk alone in the dark on snow-covered roads. The progress was slow, and it's impossible to say what would have happened without Wii Fit, but my balance improvements over the last two years are undeniable, and noted by my neurologist as well (tandem walk is now easy).

  • Definitely Wii-fit has helped my balance and although you're standing in a fixed position, after ten minutes of exercises you feel as though it's been aerobic. Very clever because each game develops a different aspect of balance – I'm pretty sure if you looked at them closely you'd see how they correspond to what is talked about in your blog article. Secondly, Pilates is VERY good. I consider it as an extension to physiotherapy. In my class we use standard physio kit – therabands, rollers, weighted balls etc. I have found it more forgiving than yoga because each movement/pose/stretch is adaptable to the individual's capabilities. It develops the core and balance equally. Lastly, if anyone is able to access physio in a warm pool (i.e. hydrotherapy) you find that you get extra benefit. You're not working against gravity and your muscles respond differently in the warmth. Any specialist neuro-physio techniques (e.g. helping you to build new neural pathways) can really get going. I spend a lot of time and money on all the above, but I know it's a good investment.

By Prof G



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