Clinic Speak: maintaining balance in MS

How is your balance? Are you at risk of falls. #ClinicSpeak #MSBlog #MSRisk

“This study highlights another under-reported and managed problem in MS; balance problems. The study below uses a highly technical method to show that MSers have balance problems compared to normal control subjects. The real question is can this be corrected by rehabilitation? I suspect so provided we can switch off the on-going damage and allow the surviving circuits to adapt and compensate for the one that have been damaged (not conducting quickly enough due to demyelination) or lost (axonal loss).”

“Balance problems causes a large number of problems for MSers and is responsible for falls and fractures. Preventing or slowing down the accumulation of balance problems should reduce the number of falls. Poor balance also affects MSers who do certain types of work; for example dancers, sports man and woman and workers who need to use ladders.”

“How can you find out if you have problems with balance. The following is the Berg Balance Scale that was used in the study below to assess balance. If you are interested you can download it and complete it for yourself.”

Epub: Chua et al. Movement Strategies for Maintaining Standing Balance during Arm Tracking in People with Multiple Sclerosis. J Neurophysiol. 2014 Jun 25. pii: jn.00598.2013.

Background: The purpose of this study was to quantify hip and ankle movement strategies during a standing, arm tracking task in MSers. 

Methods: Full body kinematics and kinetics were assessed using motion analysis cameras and force plates in 9 MS and 9 age-matched controls. While standing, participants used their dominant hand to track a target moving around a large horizontal or vertical figure-eight. The target moved at constant speed, or linearly increasing speeds, with a frequency between 0.05 Hz and 0.35 Hz. Hip and ankle moments and angles during tracking were calculated from kinematic and kinetic measurements. The ratio of peak-to-peak (PP) hip/ankle moments (kinetics) and angles (kinematics) were calculated to determine the strategies of the hips and ankles used to maintain balance during arm movements. The center-of-mass (CoM) root mean square (RMS) acceleration was calculated as a measure of overall balance performance. 

Results: The MS group produced larger PP hip/ankle moments at all speeds, compared with the control group (p<0.05). The CoM RMS acceleration increased with tracking speed for both groups but was not significantly different between groups. Additionally, the ratios of hip/ankle moments were highly correlated with the Berg Balance Scale during horizontal steady speed tracking in MS. 

Conclusions: These results suggest that MSers increase the use of the hip during standing arm tracking compared to age-matched controls. This adapted strategy might allow MSers to achieve similar balance performance to controls, possibly increasing the importance of the hip in maintaining balance during voluntary movements.

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.


  • Prof G – I've got huge balance problems as long as I can remember resulting from my MS:

    is there any medication / excercise / reliable assessment (is it Berg?) to help me?

    The problem I have is to make it clear to my neuro cos he doesn't seem to believe me (cos I can walk straight for 10m but with much will power only).

  • Yes, neuro physio corrected the 'bulge' in my weak hip as well as showing me that it was the hip not the leg which was causing the walking difficulty. As I see it, until an MSer gets the specialist info about exactly which muscle groups are affected, it's impossible to have an effective personal exercise routine. I found there was a HUGE amount to learn, plus the fact that muscle strength and flexibility can be quite variable. But not every MSer will have access to this sort of help – that is surely the issue!

  • Got into v bad hip probs last few years unknowingly before asking for physio help as walking so bad. Have been unpicked by brilliant nhs physiotherapist who is targetting 'switched off' muscles, core muscles and balance. Bit shocking how bad Id got and that if you don't ask you don't get. Would encourage others to seek physio x

  • I do realise that some people get cross with these 'soft' pieces of research that are not dealing directly with disease treatment and repair but to me there are 2 streams of research needed, one with to do with treatment/repair/prevention and the other to do with the best way of assessing and managing the damage caused by MS.
    Then also needed in an overall improvement in MS services (talking about UK here), with more resources (difficult) and a more active and positive attitude from MS professionals in terms of assessments and treatments including neurophysiotherapy.
    I can also walk the required heel to toe distance and can stand with my eyes closed for 10 secs but on a day-to-day level have balance issues and a few falls. Assessment by neuro-physio highlighted specific problems and I was given exercises and have also taken up Pilates. There has been a real improvement and although I do have residual problems I have fewer falls and move more confidently and freely. Good to know my brain has useful reserve still but I do wish that there were more physio services and it became part of an MDT assessment of all people with MS.
    Provision of good and equal services has to underlie all of this research.

By Prof G



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