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The big question is, how does someone with Ms. Actually improve their mobility, strength, energy independence? The list goes on. My name is Dr. Gretchen Holley, physical therapist and multiple sclerosis specialist. Welcome to the MissingLink Podcast. Tune in as I share the top strategies and exercises and to help you gain control over your life with Ms. Using research driven insights and advice from top industry experts. Whether you're newly diagnosed or have had Ms. For over 30 years, whether you have relapsing Ms. Or progressive MS, this podcast is for you. You're sure to feel empowered and inspired after each episode.

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Ready?

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Let's dive in.

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Hello. Thank you so much for tuning in today. I want you to stop feeling guilty about using your arms to lift your leg. This is something that is so, so common amongst my patients with Ms. Where they use their arms or their hands to lift their leg in specific situations. Like if you're sitting in your car and you're trying to get out of your car, you'll use your hands to lift your leg up and out. Or maybe you'll lift your leg up and in the car. Or if you're sitting and you need to scoot forward or scoot backward, you'll lift your leg to help you scoot. Or you'll bend your knee, using your hands to put your leg in the optimal position so that you can then scoot forward, scoot backward, move, whatever it might be. And I want you to stop feeling guilty about that. But also I want to give you a strategy that will actually help you get stronger so that you don't need to compensate in that way anymore. Because here's what I see all the time in my clients with Ms. They get stronger by doing their Ms. Specific functional exercises, but they still automatically use their hands and their arms to lift their legs again in any of those situations that I previously mentioned. And here's where the disconnect lies. You might gain full strength in your legs from the exercises that you're doing, but your brain hasn't learned to to use that strength in real life situations. And so today I'm going to teach you my rule of two, which is a simple method that bridges the gap between strengthening exercises and functional strength, that you'll notice more ease and mobility in your day to day life. Now I understand what you might be thinking because this is what a lot of my patients tell me, which is, Dr. Gretchen I can't not use my hands because I don't have enough strength yet. So if I don't lift my hands, I'm not going to be able to lift my leg. And that's okay. This approach will still work for you. But the problem is that overcompensation by using your arms, your hands, it ends up becoming a habit. And what overcompensation looks like is using your arms and instead of your hip flexor strength. So when you're getting into your car, what you should be doing is lifting your leg using your hip flexor strength. But the overcompensation is when you use your hands instead. Or it might be using your hands to physically bend your knee instead of using your hamstring. Strength or overcompensation can be reaching for walls or furniture while you're walking instead of sitting, staying stable and balanced within your own body and not reaching outside for your base of support. Overcompensation could also mean pushing up off of armrests. And of course, armrests are there for you to use and make movement safer and easier for you. However, if your goal is to stand up with more strength and sit down without plopping due to more strength, then overcompensation might mean that you're still using your. Your arms to push yourself up out of a chair or a couch when you don't really need to, because you've built up the strength to do it yourself. So why does this happen? Sometimes, and I would even argue that it's the majority of the time you're not even aware that you're doing it, and other times you might be doing it because you know that you're not strong enough yet. A good example of not even being aware that you're doing it is when I was working with a client in person and it was my very first day treating him. So it was our evaluation day. And the way that we would run things in the clinic is that I would go up to the waiting room, I'd grab my client, and then they would walk in front of me back to whatever room we were going to be meeting in. And so I loved this because I was able to watch this person walk. And. And they didn't even realize that I was evaluating them yet. And there was this one specific situation where he was walking in front of me, going back to the proper room. And once we got to the room, I started asking questions. And one of my questions was, do you ever touch walls while you walk? And mind you, I just witnessed this person touching a wall with just one finger, but he touched the wall the entire way from the waiting room back to the room. And. And he said, no, I never do that and I don't blame him because he wasn't even aware that he was doing it. It was this subconscious thing that his mind was making him do because he was feeling a bit unstable. And the real issue, whether you realize you're doing it or not, the real issue is that your brain learns these compensation patterns and makes them automatic. Even when your strength improves, you might assume that if you get stronger, your walking will get better, or if you get stronger or better balance, you won't need to touch that wall or you won't need to lift your arms. But more times than not, that is not true, because you still have the habit of compensating in some way, shape or form. So you could get full strength, full balance from your exercises, but still need to use your hands or your arms or the wall, because your brain hasn't learned to access that strength functionally, meaning in your daily situations, daily activities. So this is where the rule of two comes in. So here's the method. Before you compensate with your hands, attempt to move your leg first without assistance twice. And I should also preface this by saying the very first step is you need to become aware of when you're overcompensating. Is it when you're trying to get in and out of the car? Is it when you are trying to get in and out of bed, when you're trying to stand up, when you're walking? When is it? And then that's where this rule of two comes into play. So to paint a picture, let's say you're trying to get out of your car. So you're sitting in your car in the passenger seat and you need to lift your leg up to get out of the car. And normally you use your arms to lift your leg instead of your leg muscles. So in that moment you're going to say, wait a second, Dr. Gretchen said the rule of two, don't use my arms twice as I attempt to get out of the car. So you're not going to use your arms. You are going to attempt to lift your leg using your leg strength. In this case, it's your hip flexors to lift and move it out of the car. And if that didn't work, that's okay. Attempt number two, try to lift and move it out of the car. If that didn't work, now you can use your hands. So you get two chances. Two attempts to move in the way that you want to without compensating with your arms or your hands. And you might notice, depending on what strength you're starting with, you might Notice that you can actually lift your leg. Maybe you can fully get it out of the car, or maybe you can't fully get it out, but you can move it closer towards the door. Or maybe it doesn't move at all. It honestly doesn't matter. If it doesn't work at all, that is completely okay at that point. Once you've attempted twice, go ahead and use your hands to help you get out of the car. Or if you were able to get your leg partially out, great, that's fine, too. Go ahead and use your hands to finish the action. Why this works is you are training your brain that you want to use your leg strength in that specific moment, in that specific situation, Ms. affects two things. It affects our muscle strength, and it affects our brain's ability to recognize how you can move. This isn't about forcing movement. It's about giving your brain the opportunity to try the neural pathway first. You've been working, especially if you're in the Missing Link and you're following our exercises in there and our programs, you're working on strengthening your muscles and strengthening your neural pathways. But by compensating, you're not giving your brain the opportunity to use that strength that you've been building. And since compensating is a habit, you're just going to rely on that. We need to train our brain by not allowing us to overcompensate, to use these neural pathways that we have been working so hard to get stronger. So. So let's go through another example. So let's say you have a goal of being able to stand up from low surfaces without pushing on armrests, because you might not always have armrests. For example, a toilet, oftentimes, not always, but oftentimes they don't have armrests. Or you might be on a bench or on a chair in a restaurant, and there's no armrests. What are you going to do? So if you normally stand up from a chair by pushing heavily on the armrests, that means that you are heavily using your arm strength to compensate for weakness in your legs and in your core. So here's how the rule of two would apply to you. So anytime you're sitting in a chair with armrests, you are going to attempt to stand up twice without using those armrests. Instead, you're going to focus on good technique, where you open your feet nice and wide, you bend your knees a bit, you're hinging forward, you're at the edge of your seat, so you're in the ideal position. And then you go to stand up by pushing down through your heels, focusing on pushing your knees out, and you're not going to use your arms. Now, this might work. You might be able to stand up and you might surprise yourself like, wow, hey, I just did that. Or it might not work at all. Or it might be somewhere in the middle where you were able to get halfway up, but then you plopped back down. Either way, remember what the goal is here. And the goal is not necessarily strength training, because you're doing your exercises at a different time throughout the day for that. The goal is to tell your brain that you want to use your leg strength for this action at this time, not overcompensate, not fall back on that habit that you've built. Now, once you've tried two times, if it still didn't work, that's okay. Go ahead and push off of the armrest like you normally would to help you stand up. The beautiful thing about the rule of two is that you don't have to be successful with the movement that you're trying to do. You just need to attempt. The only thing you need to do to get this to work and to get your brain to understand that you want to utilize your strength in this moment, not compensate with your upper body or a different body part to make it easier. The only thing you need to do is attempt the movement without compensating. And over time, your brain will get the message of, oh, she wants to use her muscles right now. Okay, sure, let's kick in. So the way that you can make this work for you is for first and foremost, become aware of the different situations that you might be overcompensating. I've given you a bunch of examples here, but you might be able to think of some other real life situations where you're constantly noticing that you're using your arms to lift your leg in a specific environment or specific situation, or you're touching furniture in a specific situation, or the walls, or bending your knee, whatever it might be. Think of what those situations are, because the first step is becoming aware of when you're doing that. And another thing you can do to become aware is ask someone that you live with or someone that you are pretty close with that sees you frequently, to be brutally honest with you, and ask them if they've ever seen you use your arms to lift your leg, or if they've ever seen you compensate in some way. So just noticing what when you're automatically compensating, there's no judgment here, no shame, just awareness. And then you're going to pick just one of those situations. You don't even need to start with all of them. Just pick one situation that tends to frustrate you the most, or the situation where you want to improve the most. And that's where you're going to apply the Rule of two when you're doing this, be patient. Your brain is learning a new pattern. It's unlearning an old habit and trying to learn a new habit. And this takes time and it takes repetition. And also remember that using assistance after two attempts is not failing. It's strategic retraining. Using this Rule of two method, you will be building both strength and and the brain muscle connection, which is imperative when you have Ms. 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. So get that list of all of the situations that you are now aware of where you might be compensating and just pick one of those situations to apply the Rule of two to this week. And just notice what happens over time. I think you're going to be really surprised.