The MS Trust Podcast — July 21, 2025

Episode: Fear of Falling with MS — and What to Do if You Do Have a Fall

Episode Overview

In this insightful episode, hosts Helena and Stephen discuss the complex issue of falling with multiple sclerosis (MS). The episode aims to demystify why people with MS are more prone to falls, what to do if you fall, and strategies to regain confidence and minimize risk. The conversation features both personal stories and expert advice from Hilary Gunn, Associate Professor in Physiotherapy at Plymouth University, providing listeners with evidence-based guidance, practical tips, and encouragement to approach the challenge of falling with preparedness and self-compassion.

Key Discussion Points & Insights

1. Hosts’ Personal Experiences with Falling (00:31–04:39)

• Why this Matters: Normalizes conversations around accidents and feelings of embarrassment.
• Both Helena and Stephen share vivid, sometimes humorous anecdotes about falls, including slipping in muddy parks and sliding down stairs.
• Quote
  • "[When I fall]... it was probably more my pride than anything that was hurt, but. And a quite bruised tailbone but it's, it's not, not to be. Yeah, it's not fun." — Helena (01:52)
• Emphasize the importance of accepting help, overcoming embarrassment, and focusing on mitigating risk through environment changes.
• Stephen reflects on how being a parent influences his response to falls and role modeling resilience and self-kindness.

2. Expert Guest Introduction—Hilary Gunn, Physiotherapist (05:03–07:02)

• Hilary shares her motivation for working in neurology and MS, highlighting the variety and challenge of the work and the resilience of people with MS.
• Quote
  • "...working particularly, I think, in MS, and this is going to sound really cheesy, but with people who are brilliant at problem-solving and just a positive outlook and, yeah, every day is an inspiration, really." — Hilary Gunn (06:06)

3. Why Are People with MS More Prone to Falling? (08:22–12:06)

• Evolution & Balance: “Standing on two feet was retrospectively, in terms of balance and falls, a really bad choice” (08:42).
• Risk of falling changes at certain transition points in MS, not just with overall disease progression.
  • Early in MS, risk is low; increases as mobility changes begin, then may dip, then increase again when transitioning to two walking aids.
  • For people with limited mobility, falls often occur during transfers (e.g., getting up from a chair).
• Importance of addressing individualized risk and recognizing the role of unpredictability and change in symptoms.

4. Symptoms That Contribute to Falls (12:06–16:52)

• MS impacts balance through multiple pathways: vision, vestibular system (inner ear), sensory feedback, fatigue, cognitive load, and dual-tasking.
• Unpredictable, fluctuating symptoms (like occasional continence or spasticity) may be higher risk factors than consistently severe symptoms.
• Quote
  • “If you've got symptoms that are changeable and unpredictable, that's where you might want to go — okay, this could be a bit of a problem.” — Hilary Gunn (16:52)

5. Early Signs and Risk Factors for Falling (16:52–18:06)

• The best predictor of future falls is having fallen before.
• Variability and transitions in symptoms are warning signs.

6. What to Do If You Fall – Safe Practices and Getting Up (18:06–24:52)

• Don’t Panic: Take a moment to check for injury, compose yourself, and then plan your next move.
• Learn/practice techniques for getting up (see MS Trust resources).
• Prepare action plans for recurring falls, including keeping blankets or water nearby or having call buttons/phones accessible.
• For carers, resist the urge to “pile in” immediately and let the fallen person gather themselves.
• Quote
  • “Once you've landed... you're fine, you can't go any further... Take a bit of time. It's really, really easy. It's embarrassing... but actually it's really important just to stop, do a quick top-to-toe MOT and make sure everything's where it should be.” — Hilary Gunn (18:54)

7. Exercises and Strategies for Balance and Fall Prevention (24:54–37:17)

• Exercise improves balance, though evidence that it reduces falls is less clear—still, good balance = lower risk.
• Key principles for balance training:
  1. Highly challenging balance training — minimize your “base of support.”
  2. Incorporate three-dimensional movement — not just forwards/backwards/sideways, but twisting, reaching, etc.
  3. Practice frequently — aim for roughly two hours a week, broken into small, manageable chunks.
• All activities (housework, dancing, Tai Chi, gardening) can be adapted to challenge balance.
• Individualization and honesty are essential—find exercises you enjoy and will maintain.
• Quote
  • “If you want to get good at playing the piano, you don’t practice the violin.” — Hilary Gunn (32:39)
• Strength training is emphasized as a foundational element for maintaining balance (52:11).

8. Fatigue, Cognition, and Confidence (37:17–49:09)

• Fatigue impacts both risk of falling and the ability to engage in exercise.
  • Strategies: delegate, reduce, or modify activities; rest before; use support devices as needed.
  • Keep a diary to identify links between fatigue and falls.
• Cognition and emotional factors: dual-tasking (walking + talking, or being in busy environments) increases fall risk.
  • Training dual-tasking: perform balance exercises while doing a simple cognitive task, or simulate challenging environments (e.g., watch YouTube supermarket videos while balancing at home).
• Fear of falling itself creates a vicious cycle, increasing both avoidance and risk.
  • Encouragement to plan for “safe mobility” rather than avoidance—use realistic self-assessment and professional input as needed.

9. Tips for Those Newly Diagnosed or Proactively Seeking Prevention (49:09–54:11)

• Don’t ignore fear, but address it with information and action.
• Add balance training to the “exercise portfolio” early, using preferred activities to stay motivated.
• Watch for “yellow flags” (unpredictability or sudden changes in symptoms).

10. Assistive Technologies and Practical Innovations (58:47–63:31)

• Most tech innovation (robotics, brain stimulation) is still early-stage or expensive.
• Gaming systems like Wii Fit offer effective, engaging balance training—not because of the tech, but because of the playfulness and challenge.
• Smartwatches and home sensors can assist with fall alerts.

11. Advice for Caregivers and Family (54:27–58:47)

• Focus on enabling safe mobility, not restricting independence or issuing “I told you so” after a fall.
• Practical support: check/maintain walking aids, analyze environment, and help with risk analysis after a fall rather than reacting emotionally in the moment.

Notable Quotes & Memorable Moments

• “Falling in itself is a normal part. The issue is the frequency of it, the consequences of it and the sort of the knock on effect that that has on the person, everyone around them and so on and so forth.” — Hilary Gunn (08:54)
• “The biggest predictor of falling is having fallen... which again is blindingly obvious, isn’t it?” — Hilary Gunn (16:59)
• “Don’t beat yourself up. That would be the key thing, I would say... There’s help out there and sometimes little things can make a big difference.” — Hilary Gunn (63:59)
• “Safe mobility rather than not falling... just feels less restrictive.” — Hilary Gunn (47:15 approx)

Timestamps for Highlights & Segments

• Personal experiences and general intro: 00:31–04:39
• Interview with Hilary Gunn—career background: 05:03–07:02
• Why people with MS fall, transition points: 08:22–12:06
• Symptoms contributing to falls: 12:06–16:52
• Predictors and early signs: 16:52–18:06
• What to do if you fall, getting up safely: 18:06–24:52
• Exercises for balance/balance principles: 24:54–37:17
• Dealing with fatigue, cognition, and fear: 37:17–49:09
• Advice for newly diagnosed/MS prevention: 49:09–54:11
• Assistive tech and practical support: 58:47–63:31
• Final takeaways: 63:59–64:37

Resource Links & Practical Support

• For more information, visit the MS Trust’s dedicated falls section: ms.trust.org (HS for Falls)
• Exercise videos, including practicing getting up from the floor, available on the MS Trust website.
• Helpline: 0800-032-3839 (10am–4pm, Mon–Fri, UK time)
• Community on Facebook, YouTube, X, TikTok, Instagram, and through email at comms trust.org

Takeaway Messages

• Falling happens—don’t let embarrassment or fear keep you from seeking support or trying new strategies.
• Identify your personal “yellow flags,” prepare and practice fall recovery, and integrate balance training in fun, sustainable ways.
• Little changes and honest self-assessment can make a substantial difference in safety and quality of life.
• “Don’t beat yourself up” about falling—it’s manageable with planning, support, and the right mindset.