Podcast Summary

The MSing Link – Episode 272

Title: Walking Outside with MS: What Makes It Hard—and What Helps
Host: Dr. Gretchen Hawley, PT, DPT, MSCS
Date: February 18, 2026

Episode Overview

In this episode, Dr. Gretchen Hawley addresses a common and frustrating question for people with Multiple Sclerosis (MS):
“Why can I walk better indoors, but struggle when I’m outdoors—even as my strength improves?”
The discussion covers the three main reasons why walking improvements indoors may not carry over to outdoor settings, digging into physiological, neurological, and environmental factors. Dr. Hawley also provides practical strategies for bridging this gap, encouraging listeners to approach their mobility challenges with both understanding and actionable steps.

Key Discussion Points and Insights

1. Why Does Indoor Improvement Fail to Carry Over Outside?

(03:11–10:00)
Dr. Hawley kicks off with a reassurance: this experience is common, and “you are not alone.” She lays out the three main contributors:

A. Temperature and Weather Effects

• Internal body temperature, not just outdoor temperature, can affect symptoms.
• Barometric pressure and sudden seasonal changes can intensify symptoms like weakness, tightness, and instability.
• Even those without prior heat or cold intolerance may experience symptoms triggered by changes in weather or pressure.
• Quote:

  "So when it comes to temperature, it's our internal temperature that we're talking about... it can actually affect your body." (03:27)

B. Different Physical Demands: Indoors vs. Outdoors

• Indoors = predictable, level surfaces; outdoors = unpredictable, uneven, requires more strength, balance, and adaptability.
• Improvement in strength or balance in one environment doesn’t always translate elsewhere, even to other indoor settings.
• Surfaces like grass, cobblestones, ramps, and cracks on sidewalks require more energy and neuromuscular adjustments.
• Shoe choice and sensation: Indoors, people may exercise barefoot and gain more sensory feedback; outdoors usually requires shoes, limiting this feedback.
• Quote:

  "When you exercise indoors, your strength and mobility is learned in an indoor environment. And your brain does not automatically transfer those improvements and those strength gains to other environments, like outside." (06:26)

C. Brain and Psychological Adaptation

• The mind plays a crucial role—often neglected.
• Lack of practice in outdoor settings means the brain perceives the environment as unsafe, leading to anxiety, reduced confidence, and worsened physical performance.
• Visual processing is more demanding outdoors (cars, changing light, depth perception, crowds).
• Quote:

  "Our brains... do not have the same carryover, which is why we run into this problem... your brain doesn't feel safe or comfortable outdoors, because you don't practice that thing outdoors." (12:08)

• Memorable analogy: Dr. Hawley describes her daughter’s adjustment to a new gymnastics class—emphasizing how exposure and practice build confidence:

  "She did not feel comfortable. Her mind did not want to participate... Now, this week... she started participating... It's because she felt safer and more confident. That's how our brains work, regardless of our age." (13:36–14:34)

• Being watched or in public places can increase self-consciousness and stress, further impacting walking.

Solutions & Strategies

2. Actionable Steps for Better Outdoor Mobility

(18:33–25:00)

Recap of Factors & Solutions

• 1. Temperature/Weather:
  • Use cooling or warming devices proactively (e.g., cold water, neck fans, adjusting clothing).
  • Pick optimal times of day for your body.
• 2. Physical Demands:
  • Acknowledge increased strength and balance requirements.
• 3. The Brain:
  • Practice exercises and walking outdoors to increase your brain’s sense of safety and familiarity.

How to Implement

• Practice familiar exercises (marching, knee bends, heel raises) outdoors—with assistance if needed (cane, rollator, trekking poles).
  • Safety takes precedence! More support is encouraged outside, even if not used indoors.
• If a leap from indoors to outdoors is too intimidating, use intermediate spaces:

  "Think about what is outdoor-ish... If you have a garage... your eyes can see the outdoors while you're still in a safe, confined environment." (20:40)

• Walking practices: Focus on specific walking exercises you already do indoors and deliberately recreate them outside.
  • For example, “single step,” “exaggerated walk,” or “bridesmaid walk.”
• Don’t chase perfection—consistency and repetition matter more:

  "It's not like you need to practice exercising outdoors every single day... Something is better than nothing." (22:50)

Notable Quotes & Memorable Moments

• On temperature’s impact

  "Even if the temperature and the weather outside feels fine to you, it can actually affect your body... it more likely than not is going to increase your core temperature." (03:26)

• On environmental unpredictability

  “When we are thinking of outdoor environments, we often are running into uneven surfaces or inclines or declines... These uneven surfaces that are unpredictable require more strength. It requires more balance.” (07:41)

• On the brain’s need for practice and safety

  “The more regularly you practice exercises outdoors... the more your mind will feel confident. It's just practice like anything else.” (14:20)

• Analogy about learning environments

  “A great example of this is I just started gymnastics classes for my daughter... She did not feel comfortable. Her mind did not want to participate... Even after just one week... she felt safer and more confident to move.” (13:36–14:34)

• Advice on starting slow and gentle

  "You don't need to have great quality with all of these things, but it's just the fact of trying, of getting out there, of doing what you can." (22:30)

Timestamps for Important Segments

• [00:00–03:11] — Intro & the core question: Why is walking outside harder with MS?
• [03:11–10:00] — Temperature, weather, and environmental contributors
• [10:00–16:30] — Differences in strength, balance, and sensory feedback
• [16:30–18:33] — The brain’s role in adaptation; importance of psychological comfort
• [18:33–22:50] — Step-by-step strategies for practicing outdoors and building confidence
• [22:50–24:46] — Recap, encouragement, importance of regular (but not perfect) practice
• [24:46–25:52] — Closing thoughts and encouragement to try these strategies

Conclusion & Takeaways

Dr. Hawley demystifies why walking indoors with MS can feel easier than walking outside and empowers listeners with solutions grounded in neuroscience and practical rehabilitation. She encourages progressive, safe practice in various environments and emphasizes that incremental exposure is key to building both physical capability and mental confidence. Listeners are reminded to be gentle with themselves, celebrate small steps, and revisit the strategies when the timing and weather are right.

Quote to Remember:

"When things feel like a mystery, oftentimes we don't know what to do, we don't know how to get past that and reach the goal that we have. So hopefully you have that understanding a bit better now and also have these tools and strategies to implement..."
— Dr. Gretchen Hawley (24:46)

For more exercises, video classes, and direct Q&A with Dr. Gretchen, visit missinglink.com as mentioned in the episode outro.