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Dr. Gretchen Holley
Hello.
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Thank you so much for tuning in today. I experienced something recently at an Ms. Event that I was speaking at where it became extremely evident that a lot of people at this event didn't know the proper way to exercise with multiple sclerosis. And you might know what I'm talking about. If you've ever been to traditional physical therapy or a personal trainer or even just done your own workouts and you felt like it didn't help your movement, your walking wasn't any easier, stair climbing wasn't any easier, day to day activities like getting dressed wasn't any easier, then this episode is for you. You're in a very similar position to a lot of people. And let me back up for a second here. So I was at this event, I was speaking, and my topic that I was speaking on was heat intolerance. This event was in early July. So here near Buffalo, New York, it's hot. Not nearly as hot as other areas, but very hot for us. And we were actually in a heat wave, so it was hotter than usual. So we're talking about heat intolerance and exercises that you can do when it's too hot and how the barometric pressure can affect heat intolerance. And it was a really great talk. And so many people came up to me afterwards saying that they learned a lot of new stuff. But several people came up to me afterwards and they explained that they've been going to physical therapy for a year or so. And here's the exercises I'm doing and they literally listed out, you know, X, Y, Z exercises, and they wanted to know, are these the best exercises for Ms. And are these good ones for me to be doing? And of the people that came up to me, every single one of them were doing exercises that were not the most appropriate for Ms. I assume that because I talk about Ms. Specific physical therapy all the time on my podcast, on my Instagram channel, my YouTube channel, literally everywhere. I just assume that everyone with MS, or at least the majority of people with MS, know how to exercise or with Ms. And this was such an eye opener for me because clearly that is not the case. And that's okay. That's why I'm here. That's why I love educating on how to exercise with Ms. The big question is, how does someone.
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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 Missing Link podcast. Tune in as I share the top strategies and exercises 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.
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Ms. For over 30 years, whether you.
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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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So I'm going to break it down for you. We're going to be talking about why traditional physical therapy, traditional personal training, traditional work outs often doesn't cut it when you have Ms. And let me preface this by saying that any exercise is better than no exercise. And also there are some people who have Ms. That do greatly benefit from traditional forms of physical therapy or personal training. So if that's you, wonderful. Absolutely amazing. But for the majority of people with ms, you will often find that that type of exercise might improve your strength in that specific movement. Like you might be able to do that same exercise, but more repetitions or with an ankle weight on, but it doesn't improve your walking or it doesn't improve your stair climbing or getting dressed, getting in and out of your car, your daily situations. And for 99.999% of the people that I work with, the main goal of exercise isn't just to get strong just for the heck of it or get better balance just for the heck of it. It's because they want their daily movements in their home, outside of their home to feel easier and less cumbersome. And there is a specific way to exercise for that result. So just to give you an idea of these people who came up to me after the conference and what exercises they were shar, what all of them had said was, Dr. Gretchen, here's what I'm doing at physical therapy. I'm laying on my side and I'm lifting up my leg. Now, traditionally, this is a great exercise for your hip abductors, your outer hip muscles. They would also say, I'm laying on my back and lifting my butt up, doing a bridge exercise. I'm laying on my back and lifting my leg up like a straight leg raise exercise. I don't know if you're catching on to this yet, but almost all the exercises mentioned were, I'm laying on my blank, laying on my back, laying on my side. And the thing to know about multiple sclerosis, one thing is your brain and spinal cord does not have the same carryover as someone without Ms. What I mean by that is for someone who doesn't have ms, they can do lying down exercises and get really strong. 5 out of 5 strength and then they go to stand up and that strength that they gained lying down is still there. Those muscles are still five out of five strong. But for someone with ms, that carryover isn't there. So you might get really strong with these lying down exercises, but you then go to stand up and that strength is non existent. And you got five out of five strength with lying on your side and lifting your leg or lying on your back and lifting your leg or your butt up off the table, but you go to stand up and that strength just isn't there. That's what I mean by lack of carryover. And I know this to be true just from research and 10 plus years of working with people with Ms. But in this specific instance, I asked each of these individuals and was their movement feeling any easier after they've been going to physical therapy for a year or six months in some of these cases. And every single one of them said, no. You know, I'm just going because my neurologist told me to go. I know physical therapy is good for me, which it is, it's great. But not one of them had noticed any improvements in walking or stair climbing or whatever their goals were. And it can take a while. I don't want to take that away from anyone. With Ms. We don't know how long it's going to take to see improvements. It could take six months, it could take a year, it could take a year and a half, but it's only going to take longer. If you're not doing the right type of exercise, you might know what I'm talking about. If you've done these types of exercises before and didn't notice the improvement in a different position. But if that doesn't relate to you, you might be able to understand it from this other perspective. I have a lot of people, the majority of people with Ms. That I work with will say, Dr. Gretchen, I'm doing a recumbent bike in physical therapy and I'm getting so good at it. I used to start at only five minutes, now I can do 20. I can crank the resistance up now and I used to not be able to have any resistance on. I'm getting so good at this recumbent bike, but my walking's not any better. And my response is always, well, of course, because with Ms. You don't have that carryover. You're getting strong in a seated position, but walking is in a standing position, not a seated position. And because of that difference, your muscles aren't carrying over that strength from a seated position to a standing position. Now, a recumbent bike is great for other reasons. It can be great for cardio or seated leg strengthening. But you can't assume that because your legs are getting strong on a bike that they will also be strong standing. So you are likely wondering, well, tell me what to do, like, what is the best way to exercise? So with ms, we have to exercise in a way where we are making that carryover happen. And we also have to exercise in a way where we're not just strengthening our muscles, we are strengthening the pathway between our brain and the muscles, which, if you've been following me long enough, you know that that is your neural pathway. And it is possible to do that through neuroplasticity. So I like to do this in three ways. And I don't always start off working on all three of these areas. I often start with one, which will be the first one that I share with you. And then once you get stronger there, we move to the other two. So here's how to do it. The first way to exercise with Ms. Is through functional exercises. And there's two ways to do this. The first way is through specific goals that you're working on. So let's go back to that example of a bike. If you have a goal of improving your biking endurance, then biking is a great exercise. But if your goal is to climb your stairs easier, maybe with bending your knee a bit better, maybe without pulling so heavily with your arms, maybe with better balance, maybe without scuffing your foot, whatever it might be. If your goal is to climb stairs better, the best exercises for you to do are going to be standing based exercises that allow you to get your body up, step up, step down, step to this side, because that is specific to that goal. If you have a goal of getting dressed without falling over, then some of the best exercises for you to do will be in a standing position, practicing, putting on socks, putting on pants, putting on your underwear as an exercise. If you have a goal of standing up from your couch on the first try, without plopping down or having a difficult time standing up, gaining your balance, then a great exercise for you to do is to practice standing up from your couch. So you're thinking about what is my goal? And then do that thing as an exercise. Now one thing that you might be thinking is, well, that sounds great, but it's too hard. That's why it's a goal that I'm working on, which I totally hear you make it easier. So, for example, let's go Back to that stair climbing example. If you have a goal of climbing stairs easier, one of the best exercises you can do is climb your stairs. But if it's too hard because the step is too high, instead of practicing stepping up on your stair, practice stepping up on a book that maybe it's only one inch tall. Practice starting there. Make it easier if you have difficulty getting dressed. I actually do this exercise with a lot of my Missing Link members. If you have difficulty getting dressed, practice getting dressed from a standing position. But because that is really challenging for your hip flexors, for balance, you can lean against your wall or maybe even your bed to make it a little bit easier. That will take balance out of the equation so that it makes the exercise easier and you can do it successfully. If you have a goal of standing up from your couch with more ease, with more strength, with more balance, but it's too low and too squishy, and that's why it's challenging, then put an extra pillow under your butt on the couch so that you're not standing up from as low of a surface. So get creative here, but do the specific goal that you're working towards as an exercise. That's what I mean when I say functional exercise. And when we're talking about functional exercises for the specific goals that we're working on, it's not always the full movement. We were just talking about, you know, practicing climbing stairs, practicing getting in and out of a car, practicing walking, things like that. It doesn't always have to be the full movement. We want to break it down. So one thing I talk about a lot is walking. And walking is not just a big step forward. It's seven individual movements. It's shifting your body weight forward. It's then bending your knee, lifting your ankle, bringing your knee up towards the ceiling, straightening your knee, putting your heel down. And then all while that was happening, you were standing on one leg. Even if you were using a mobility aid, you were still standing on one leg. So that's seven movements, if you were counting with me. Therefore, that's seven exercises. So, for example, the first piece of that was shifting your body weight forward. That's an exercise. Practice shifting your body weight forward and then back, forward and then back. The second movement was bending your knee. Practice standing in a staggered stance and bend your knee. Then straighten, Bend and straighten. If that's too hard, maybe try that seated. We'll talk about that in a second here. But break down your movement. So for functional exercises, we can think of it as do the thing that's hard. Do the activity as an exercise. We can also think of it as break that activity down into lots of different movements. And those are your exercises. In the Missing Link, we do both. We focus on both. Usually it's not just one or the other. The other component to functional exercise is exercising for specific muscles. And what I mean by that, to take it a step further, is the weakest muscles. And I always feel bad giving these exercises to my Missing Link members because they are hard. They should be. We are trying to strengthen your weakest muscles because those weak muscles are the reason you're walking the way that you're walking, or it's the reason that those activities are hard for you to do. And if you're not careful, if you're just doing any old exercise, even traditional physical therapy exercises, it is so easy to overcompensate with your stronger muscles and you're not doing it on purpose. It just happens. So we have to exercise in a way where we don't let those big muscles work, those stronger muscles work. We are trying to only get those smaller, weak, well, sometimes not necessarily smaller, but the weaker muscles to work. Okay, so once that is getting a little bit easier, we've got a good grasp on function. The next two ways that you can improve that carryover is by functional positions and functional locations. This is not talked about nearly enough, but we're going to break it down. So exercising in a functional position, we've already touched on this a little bit already. I'm just giving it a name right now. So the functional position is going to be the position that your goal is in. So for example, if your goal is climbing stairs, the functional position would be standing. Because when you're climbing the stairs, you're standing. For most of us, sometimes you might be scooting on your butt, in which case that would be seated. So if you're looking to improve getting dressed, again, for most people, if you want, if your goal is to get dressed standing, then the most functional position would be standing. So what do you do with this information? You use that position as your main position to exercise in. For example, in the Missing Link, we have an exercise called marching and there's lots of positions you can march in, you can stand, you can sit, you can sit in a reclined position, you can be laying on your side, laying on your back, on all fours. So you want to choose the position that is the most functional for your goals. So if you have a standing based goal, the most functional and therefore the best position for you to do marching is likely going to be standing. If your goal is to get out of the car easier, the most functional, AKA the best position for you to do marching would be seated. Because you're sitting in the car and you're trying to lift your leg to get out of the car. So you're sitting in that case. So you want to be thinking about what position is your body in when you're doing your goal and exercise in that position. Now again, that might be too hard right now, and that's okay. Let's just say your goal is to get out of the car, lifting your leg with your leg muscles, not with your arms, not lifting with your hands. The most functional is that seated position. But to be honest, seated marching for a lot of people is harder than standing marching. So if seated marching just feels impossible, that doesn't mean don't do the marching exercise. We still want those muscles to get stronger. It just means maybe try it standing and get stronger in that standing position first, and then get stronger in the seated position. Or maybe it means get stronger lying on your side doing the marching. You can pick a different position. And for any exercise, there's often five to seven different positions to exercise in. So choose the one that you can be the most successful in with your mindset being working towards the most functional position. And the last one is the functional location. I love this one. This might be my favorite one. Although I don't know functional exercises is up there. Functional location means to exercise in the specific location of your goal. So again, let's stick with that car example. The best location that you can exercise in, if that is your goal, is not a gym. It's not in your home, it's in your car practicing getting in and out of your car. If you have a goal of climbing stairs in your home, the most functional location is going to be practicing the stairs. Whether it's one step or a full flight or anywhere in between. Practicing your stairs in your home, it might even be a standing marching exercise in front of your stairs. If your goal is to practice getting dressed without falling over and with more strength, the best place place that you can practice your exercises like the standing, marching, leg kick, squats, whatever it is you're going to be doing, the best location is going to be in your bedroom, assuming that's where you're getting dressed. If it's not, then wherever you get dressed, do those exercises in that room. What this does is it allows your brain to understand when and where you want to use this strength that you're gaining because I know a lot of you listening have felt improvements in your strength and you might feel like you can walk better in your home, but not when you're at your friend's home or you can stand up from a chair in your office, but not a chair that's the same height in your living room. This is so common and you are not crazy if you're experiencing it. It is really common, but it's often due to the location that you're in, so making sure that you're practicing your exercises in the locations that your goals are based in.
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For almost 10 years, I've been helping people with Ms. And what I've seen is that most people with Ms. Have a desire to get stronger, but what they've tried hasn't worked. I've created a revolutionary program called the Missing Link specifically for people with Ms. Where I teach you how to strengthen your brain, your muscles and the neural connection between the two, which is the key to seeing improvements in strength, walking and everyday activities. When you have ms, regular exercise often doesn't cut it. But it's not just exercise. You'll experience the warmth of our supportive community where every small victory is celebrated and every struggle is met with encouragement. Check the link in the show notes to learn more about the Missing Link and see if it's a good fit for you. Okay, let's dive back in.
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I hope that if this resonated with you at all, you feel like you aren't crazy. So often when we're exercising especially consistently and we don't feel the improvements from it, we feel like we're going crazy or like we're not doing the right things, which you might not be, but hopefully you have more clarity on that now. But it can feel really discouraging and you can often feel like exercise just doesn't work for you and 9.9 times out of 10 that is not the case. It does work for you. You just need the right approach for Ms. And for your nerves. So I hope you have more clarity around that and you feel more excited and motivated to try this type of exercise that does have carry over and can help improve the strength and balance and ease in your daily movements.
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Thank you for listening to today's show.
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I am so grateful to have you as a listener.
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If you'd to like like extra resources such as a video of one of my seated exercise classes, my favorite core exercises, and the opportunity to ask me your questions, head to missinglink.com insider. That link will be shared in the show notes along with links to my social media handles. If you loved this episode and think a friend or family member with Ms. Would benefit from listening, please go ahead and text or email this podcast to them right now. Sharing this podcast will help me educate and empower as many Ms. Warriors as possible. Thanks again for joining and be sure to tune in next week for another episode of the Missing Link Podcast.