Podcast Summary: The MSing Link

Episode 241: The Rule of 2 – How to Stop Compensating and Use Your Real Strength With MS
Host: Dr. Gretchen Hawley, PT, DPT, MSCS
Date: July 16, 2025

Episode Overview

In this episode, Dr. Gretchen Hawley addresses a common challenge for people living with Multiple Sclerosis (MS): the tendency to compensate for muscle weakness by relying on their arms and hands for movements their legs and core should perform. She introduces her practical “Rule of 2,” a method designed to retrain the brain and body to use real strength in daily activities, reducing overcompensation habits and bridging the gap between exercise gains and real-world function.

Key Discussion Points & Insights

1. Understanding Compensation Patterns in MS

• Many people with MS unconsciously use their arms and hands to assist in movements such as lifting a leg into/out of a car, scooting forward or backward in a chair, or standing up from low surfaces.
• Key Insight: Even after building muscle strength through MS-specific exercises, these compensation habits often persist because the brain hasn’t relearned how to access that strength functionally.

“You might gain full strength in your legs from the exercises that you’re doing, but your brain hasn’t learned to use that strength in real life situations.”
— Dr. Gretchen Hawley (04:17)

2. The Habitual Nature of Overcompensation

• Compensation often becomes automatic. Patients are frequently unaware of when they’re doing it—such as touching walls, using armrests unnecessarily, or physically moving their limbs with their hands.
• Dr. Gretchen gives a relatable story: a client insisted he never touched walls, despite unconsciously doing so during a clinic walk (08:31).

“He touched the wall the entire way from the waiting room back to the room... he wasn’t even aware that he was doing it.”
— Dr. Gretchen Hawley (08:48)

3. The “Rule of 2” Method

• Definition: Before compensating with your hands/arms, attempt the movement with your targeted muscles twice. If unsuccessful, then use your compensatory strategy.
• Purpose: This method retrains the brain to attempt movement using the intended muscles, not just rely on existing habits.

Step-by-Step Guide:

• Awareness: Recognize specific situations where you compensate.
• Pause: Before compensating, try to do the movement using the correct muscles—TWICE.
• Accept Attempt: Success is not required; the effort matters.
• If needed, compensate after two tries.

“You are training your brain that you want to use your leg strength in that specific moment, in that specific situation... This isn’t about forcing movement. It’s about giving your brain the opportunity to try the neural pathway first.”
— Dr. Gretchen Hawley (13:47)

Examples:

• Getting out of the car: Attempt to lift your leg with hip flexors twice before assisting with your arms (13:20).
• Standing up from a chair: Try to rise using only leg and core strength twice before using armrests (13:54).

4. Why the Rule Works

• MS affects both muscle strength and the brain’s recognition of movement pathways.
• This method specifically targets the brain-muscle connection, not just physical strength.

“Every time you try twice to use good form and use the correct muscles before compensating, you’re literally rewiring your brain. This is how you get your exercises to carry over into real life situations.”
— Dr. Gretchen Hawley (15:24)

5. Implementation Tips

• Start Small: Choose one situation that causes the most frustration or is most important to you.
• Enlist an Observer: Ask a close friend or family member to watch for unnoticed compensation habits (14:28).
• Be Patient: Learning a new habit requires time and repetition. Using assistance after two attempts is not failing; it’s strategic retraining.

Notable Quotes & Memorable Moments

• “Stop feeling guilty about using your arms to lift your leg... I want to give you a strategy that will help you get stronger so that you don’t need to compensate in that way anymore.”
  — Dr. Gretchen Hawley (01:04)

• “The beautiful thing about the Rule of 2 is that you don’t have to be successful with the movement that you’re trying to do. You just need to attempt.”
  — Dr. Gretchen Hawley (14:43)

Timestamps for Key Segments

• [01:04] – Introduction to compensation and guilt
• [04:17] – Explanation of disconnect between strength and function
• [08:31] – Story illustrating unconscious compensation
• [13:20] – Step-by-step use of the Rule of 2 (getting out of the car)
• [13:54] – Rule of 2 for chair/armrest situations
• [14:28] – Tips for building awareness and involving others
• [15:24] – The benefit of rewiring the brain

Action Steps for Listeners

• Identify daily moments when you compensate for weakness.
• Apply the Rule of 2 in one situation this week.
• Practice patience and understand that attempts—not perfect success—help retrain your brain and body.
• Enlist trusted observers for honest feedback.

Summary:
Dr. Gretchen Hawley’s Rule of 2 empowers people with MS to thoughtfully tackle compensation habits by making conscious, repeated attempts to use real strength before relying on assistance. This not only nurtures the brain-muscle connection but also builds genuine functional confidence—ultimately supporting mobility, energy, and independence.