The MSing Link — Episode 247
Why Physical Therapy Doesn't Work for MS (And What Does)
Host: Dr. Gretchen Hawley, PT, DPT, MSCS
Date: August 27, 2025
Episode Overview
In this episode, Dr. Gretchen Hawley addresses a common and frustrating experience for people with Multiple Sclerosis (MS): going through traditional physical therapy or exercise programs, often without seeing meaningful improvements in mobility, balance, or daily activities. Dr. Hawley explains why typical PT protocols can fail for MS, and provides clear, actionable strategies for exercise that truly support the needs and goals of people living with MS. Her mission is to empower listeners to use research-driven, MS-specific exercise methods that create real change in daily function.
Key Discussion Points & Insights
The Problem: Traditional PT Doesn’t Always Work for MS
- Many with MS feel their prescribed PT exercises (like hip abductions or bridges, usually performed lying down) don't lead to better walking, stair climbing, or easier daily activity (04:10).
- Dr. Hawley relates stories from a recent MS event, where attendees shared how year-long traditional PT had yielded little improvement in mobility.
Quote:
“You might get really strong with these lying down exercises, but you then go to stand up… and that strength just isn’t there. That’s what I mean by lack of carryover.”
— Dr. Gretchen Hawley, 06:41
Why is There No Carryover?
- In MS, the neural pathways between brain and body are disrupted.
- Strength gained lying down or in seated positions doesn’t automatically translate to functional improvement in standing or walking.
- Unlike people without MS, those with MS need exercises that specifically build neuro-muscular connections for the activities they want to improve.
Example:
- Getting stronger on the recumbent bike doesn’t equate to easier walking, since the movement and posture are entirely different (09:00).
What Does Work: A Functional, Neuroplasticity-Driven Approach
Three Keys to Effective MS Exercise
-
Functional Exercises (12:10)
- Do the specific activity you want to improve, as exercise.
- If your goal is to climb stairs, practice stepping up—even if you start on something as low as a book.
- Break down difficult tasks into manageable parts:
- Dr. Hawley demonstrates how walking consists of 7 distinct movements, each of which can be practiced separately (14:30).
- If the whole activity is too hard, modify it to be easier but stay as close to the real-life movement as possible.
Quote:
“Think about what is my goal… and then do that thing as an exercise.”
— Dr. Gretchen Hawley, 11:40 -
Functional Position (17:00)
- Exercise in the same body position as your goal.
- If you want to improve standing tasks, prioritize standing exercises. If your challenge is getting out of a car, practice in a seated position.
Quote:
“Pick the position that you can be the most successful in, with your mindset being: working towards the most functional position.”
— Dr. Gretchen Hawley, 19:40 -
Functional Location (20:15)
- Practice exercises in the location where you want improvement—your own car, bedroom, stairs, etc.
- This helps your brain form location-specific neural connections, leading to carryover where you need it most.
Quote:
“The best location you can exercise in, if that is your goal, is not a gym… it’s in your car, practicing getting in and out of your car.”
— Dr. Gretchen Hawley, 20:55
Memorable Moments & Audience Reassurance
- Dr. Hawley shares her surprise at how many people still do traditional non-functional PT for MS among her followers, emphasizing the ongoing need for education (02:00).
- She reassures listeners that struggling with a lack of progress is common, not their fault, and not a reason to give up on exercise altogether.
Quote:
“If you've been exercising consistently and don't feel improvements… it can feel really discouraging. And you can often feel like exercise just doesn't work for you… it does work for you. You just need the right approach for MS and for your nerves.”
— Dr. Gretchen Hawley, 22:53
Practical Takeaways & Action Steps
- If your PT isn't making daily life easier, revisit your goals and the settings/positions of your exercises.
- Break down your movement goals into smaller parts and practice each part as its own exercise.
- Modify exercises to be successful, but always aim toward practicing the actual movement, position, and location where your goal lives.
- Prioritize strengthening your weakest muscles, as compensating with strong muscles won’t help the specific deficits caused by MS.
- Remember: Progress comes from working smarter, not harder—and from targeting both your muscles and your neural pathways.
Important Timestamps
| Timestamp | Segment | |-----------|---------------------------------------------------------| | 00:00 | Introduction and story from MS event | | 03:38 | Why traditional PT doesn’t help most people with MS | | 06:41 | On “lack of carryover” and why it happens in MS | | 09:00 | Recumbent bike example; why strength doesn’t equal function | | 12:10 | How to exercise for MS: functional approaches | | 14:30 | Breaking down walking into exercises | | 17:00 | Functional positions and adapting difficulty | | 20:15 | Functional locations and building context-specific strength | | 22:53 | Empathy for listeners; reassurance and motivation |
Episode Tone
- Warm, knowledgeable, conversational, empathetic, empowering
- Dr. Hawley frequently celebrates small steps and emphasizes community support
Further Resources
- Dr. Hawley directs listeners who want additional resources (e.g., exercise videos, Q&A, core exercises) to missinglink.com/insider (24:01).
If you feel stuck with traditional PT and MS, this episode offers a hopeful, practical path forward—one based on your real goals and proven neuroplasticity strategies. Dr. Hawley’s advice is both actionable and compassionate, making it a must-listen for anyone struggling with MS and mobility.