← The MSing Link
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- [00:06]
A
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 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. Ready? Let's dive in.
- [00:58]
B
Foreign. Hello. Hello. Thank you so much for joining us again today. I have a weird question for you and possibly a question that no one has ever asked you before, and that is how well do your toes move? Can you wiggle your toes independently from one another? And the reason that I ask you this is because back when I was a student physical therapist, so this was, gosh, back in maybe 2012, 2013, possibly, I was working with a physical therapist during one of my clinical rotations and I was watching him work with his patients who were trying to improve their balance. Now, these were not patients who had multiple sclerosis. They just had balance issues for other reasons and wanted to improve, improve their balance for safety reasons. And I witnessed 99% of these patients who had difficulty balancing struggle to wiggle their toes independently from one another. And then as time went on, I became a licensed physical therapist myself, started working with people with ms, now have my online program, the Missing Link. And over the years, it's occurred to me that I've had this revelation that even people without Ms. Couldn't isolate toe movement independently from one another. All toes moved together like a unit. So when this physical therapist said, wiggle your toes, sometimes the toes wouldn't move at all. Sometimes they would move, but they'd all move together, not wiggling, just one at a time or independent from the other. And why this matters if you have multiple sclerosis is because if neurotypical people, we'll call them, if people without Ms. Struggle with moving their toes, then imagine the challenge with multiple sclerosis, which tends to affect those muscles anyways, but also the opportunity for improvement. If you have multiple sclerosis, you likely know that toe movement and ankle movement can be one really challenging. Those tend to be two of the muscle groups that Ms. Seems to attack most, in addition to our knees and our hips. So you have two things going against you. You have the possibility of Ms. Going against you. Where Ms. Is Making the nerves weaker that go to your toes and go to your ankle. And that can be what's causing difficulty wiggling your toes. But, but also if you haven't been practicing wiggling your toes, which the majority of us don't practice, that that too can make it challenging to move your feet. So why am I harping on wiggling your toes? And why do we have a full podcast episode dedicated to this? It's because our toe movement is so, so, so important for a lot of our movements that we do throughout the day. Of course, it matters for, for balance. If your toes, which are the foundation of our stance when we are in standing, if they don't have good control or mobility, then it can drastically affect our balance when we're standing and when we're walking and moving in general. So having better toe mobility and toe control can improve our balance. It can also improve foot drop. If you have multiple sclerosis, it a huge symptom that I see in the majority of people that I work with is foot drop or drop. Foot, foot drag, toe drag. There's lots of different names for it, but it's weakness in the ankle and foot and toe muscles. And you might know that you have this, or you might not know, but you might notice that you have scuffed shoes in the toe box area or, or if you have really, really tight calf muscles or you can hear your feet slapping the ground when you're walking. There's lots of different ways that foot drop can present, but better toe control and toe mobility can actually improve foot drop. It can also help improve spasticity if you have toe curling, which again, is another pretty common symptom that I run into when working with my clients with ms, where your toes just curl, curl under, and it's really hard to get them to uncurl. Toe mobility can help with that. It can also help with circulation and blood flow. It can help with proprioception, which is our awareness of where our feet are in space as we're moving around. So that's quite a bit of things that's a lot that moving our toes can help with. Yet we don't often think about moving our toes and there are actual exercises that you can do for, for this. So I'm going to review a bunch of these for you right now. Just a note before we get into that, if you want to see these. I know that we're recording a podcast episode right now, but I am recording this for YouTube as well so that you can see in video if you're a visual person like me, what these exercises are. Also, if you are a member inside the Missing Link online program, then we have a full toe yoga class for you. It's about 25 or 30 minutes long where we go through these exercises as well as other ones. In an actual exercise class where we're doing a certain number of repetitions, certain amount of holds time, we do two rounds. So if you're in the Missing Link, go to the search bar and type toe yoga and do that class right along with us.
- [06:56]
C
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.
- [07:53]
B
And one last quick note before we go further into the exercises is about sensory changes. So another common symptom with Ms. That can pretty significantly affect our feet and our toes and our walking and mobility is the sensation in our feet. Things like numbness, tingling, burning, pins and needles. Those sensations are very common and toe exercises are likely not going to help with sensation. So if you have any of those sensations, these toe exercises will mostly be helping with muscle strengthening and relaxation, not sensation. The sensation is on a different neural pathway than the motor or the muscles that we're working on. So for sensation, I recommend desensitization exercises, which we've talked about in the past here on the podcast and YouTube. And again, if you're in the Missing Link, we do have a full demonstration video for you. So go into the Missing Link, go to the search bar, type in desensitization, and it will pop right up for you. And I also recommend different products. One of my favorite products for sensitivity in our feet so that we can help feel our feet more is the Naboso products. They have socks with the patented design on it where it helps you feel your feet more. They have shoe inserts with the same type of socks, sensory material. So I really like that company as well. But when we're talking about our toe strengthening exercises, it's really important that we look down at our toes so that we can see what's happening. Especially if you have numbness or tingling or burning pins and needles, or you just can't feel what your feet are doing. So when I demonstrate these, I am going to be looking down at my foot and to make sure that something is moving or to get that visual feedback of is it moving? Is it not moving? What's happening? Okay, So I am sitting in my chair and I'm forward enough where I can pretty easily look down at my foot. I've got my left shoe and sock off so that I can see exactly what my left foot is doing. I'm actually going to straighten my knee just a little bit so that I can see my foot and toes even easier. If you want, you could do the these exercises on both feet at the same time, or one and then the other. But for today's purposes, I'm just going to show you on one foot. Now, the first exercise is something that we've been talking about this whole time. Just wiggle your toes. We can use this as an assessment to see how are things working or are they not working? What's happening when you try to wiggle your toes? So for this, look down at your feet. Try to make sure your knee is facing forward. It's not caving in or falling out. And just try to wiggle your toes. Can you move your toes? Can you spread them? Can you wiggle just your big toe up? Can you wiggle your little toes? Can you get them to move at the same time as well as independently from one another? No, no right or wrong here. Just try to move them and see what happens. And if you're either saying no movement or they're all moving at the same time, or maybe it looks like your toes are moving, but it's actually your ankle coming up and down. That's ankle movement, not toe movement. We're specifically looking at toes here. So wiggling can be a really good exercise for assessing your movement, but also an actual exercise. And this is a pretty great one because you can just do this throughout the day, even when you're not looking down at your feet. So right now on both feet, you can't see, I have my shoe on this one. I'm wiggling my toes. So you can wiggle your toes throughout the day as an exercise. No one's even going to know you're doing it. But just practice. Wiggling your toes. Another exercise that you can do is practice lifting just your big toe up and then down and then up and down. And if you've never done this before, what you are probably experiencing or thinking right now is, holy cow, nothing is happening. This is a weird movement. Why is she telling me to do this? But I promise you, a lot of the times, even if it's really hard right now, within a few days or weeks, it will actually start moving. You will likely feel this once it does start moving on the front of your foot, the front of your big toe, and maybe even the arch muscles as well. But we're trying to stay separate the big toe from the others. Lifting just the big toe and then lower down. The next exercise is can you lift and spread all of your toes? So you're keeping your foot down, but you're trying to lift all of your toes up and then spread them wide, and then place them down wide and then relax and come back to wherever your normal start position was. Then lift your toes up and spread. Place them down and then relax up and spread, spread, spread. Try to get your toes as far apart. And again, if you've never done this, I doubt they're moving much right now, but this is going to be a really great exercise for you. And down. The next exercise is keeping your big toe down, but lifting your smaller toes. So the pinky and all the smaller toes, lift those up and down, up and down. And I know, I'm well aware that I sound like a crazy person right now, especially if you've never done these before. But I promise these exercises can be really helpful and you will likely be pretty shocked and impressed with how you might see zero movement today. But again, within a few weeks, you do actually start seeing or feeling movement. So the big toe stays down. Other toes come up and lower down. So those are my favorite strengthening exercises for our toes. There are some other things that we can do to get our toes working better, including massaging the arch of our foot, even using toe spacers, or putting our fingers between our toes to try to get that stretching between our toes. This can be pretty common in yoga classes, but again, if you're in the Missing Link, we have a full class where we focus on the strengthening as well as the stretching and releasing exercises. So definitely check out our toe yoga class. I know I've said this a few times, but I really can't harp on this enough where if you see zero movement or you feel zero movement or very minimal movement, that's okay. Of course, Ms. Affects everyone differently. And there's no way to know who this is going to be helpful for versus who this is going to take months to improve or years to improve. But what I can tell you anecdotally from working with people with Ms. Who have done these exercises is that typically you will see some improvements. Again, we might be talking minuscule, the tiniest, a type of improvement where when you're looking down, you say to yourself, oh my gosh, I think that's lifting a little bit higher. I do think that's moving a little bit more. And that is a win. When you start seeing or feeling that, it will compound and it will lead to more and more movement, more and more feeling, more and more success with wiggling our toes and therefore helping with our balance, our circulation, all those things that we talked about earlier. So if you see no movement, that is not an excuse to not do these exercises. If anything, it's a reason to even more so to do these exercises. But we do know that Ms. Affects everyone differently. It might take everyone a different amount of time to see those levels of improvements. And of course, the amount of improvement that you see is going to be different for each person and it is going to depend on the level of Ms. Damage that you have. But progress is possible. Typically, I recommend doing these types of exercises. It doesn't have to be all of them. Maybe it's just one or two, but. But I would recommend doing them about two times a day, maybe six days a week, for at least eight weeks. That tends to be my minimum. But again, once you understand what to do and you know what you're looking for and feeling for, you can do them throughout the day, as you're watching tv, even as you have shoes on. But initially it is really important to look down and be able to see and feel exactly what is happening. Typically, I like to start with about 10 repetitions of each of the exercises just to give it a fair chance. Usually the first three to five repetitions, nothing happens because your brain is so confused on what you're even trying to make happen with your toes and your feet, that signals are getting crossed and that your foot doesn't know what to do. But after you've tried about five times, your brain might start understanding and allowing that movement to happen a little bit easier. I hope you found this topic helpful and even insightful and eye opening, because I know that it's something that a lot of us don't ever really talk about or think about. So hopefully you're starting to think about your toes in new ways and that you're excited to give these a try. I'm excited to hear how they go for you, so definitely keep me posted. If they were super challenging, easy somewhere in between how long does it take you to start seeing improvements? And regardless of where you end up with these, just start where you are. Even attempts of these movements without visible movement is meaningful and it's still building strong neural pathways over time so you don't need to see movement in order to actually be improving the neural connection that wi fi between your brain and your toes with these exercises. Thanks so much for tuning in. I will see you next time.
- [18:19]
A
Thank you for listening to today's show.
- [18:21]
B
I am so grateful to have you as a listener.
- [18:25]
A
If you'd 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 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.
- [19:12]
B
It.