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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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Welcome back. Thank you so much for tuning in today. I have a personal experience that I want to share with you because it is something that happened recently to me and it relates well to what a lot of people with multiple sclerosis experience, specifically when they are working towards getting stronger and walking better, walking longer distances. So I want to share this story with you and I'll get into the specifics, but basically what you need to know is about a month or so ago I fell down the stairs in my home and at this point I was seven and a half months pregnant and baby is fine. I am fine. I did get injured and I'll get into that. But it reminded me something about a pain principle that is quite common in the physical therapy world. And I've known about this principle for years and years. I've taught it to countless clients. But experiencing it myself was a whole different level and gave me a different perspective of what it feels like to be the person experiencing it. And it doesn't just relate to pain again, it relates to, to any type of improvement. We're looking to see whether that's lessening pain or walking better, better balance, et cetera. So this is going to be a super relevant episode for you to listen to if you have Ms. Or really any other chronic condition and you've ever felt like your exercises are making you worse because new symptoms keep popping up. My recent fall that I'm about to share with you is the perfect example of why more likely than not, that's not actually what's happening. So I'm just gonna dive right into what happened. So again, about a month ago I was seven and a half months pregnant and I was actually right about to go to New Orleans for a keynote that I was supposed to be giving in two days. So I was upstairs packing up my suitcase, which was just a small little carry on suitcase. I was only going to be going for two days, so it wasn't Heavy, but I had that in one hand. In the other hand, I think I had my toiletries bag. Again, neither were that heavy. But I'm walking down my stairs going along just fine. And then about the last maybe six or so steps, my feet just slip out from under me. I fall on my back and, and slide down the last six steps. And with every single step, I could feel the edge of this stair pounding into my back. So I land at the bottom of the steps. And first and foremost, I'm thinking, oh my gosh, is my baby okay? And immediately just got the sense that she's fine. And flash forward, just even maybe 20 minutes later, she was starting to move and kick and thrive in there. So fortunately, baby is completely fine. That was my first worry. My second worry was, oh my gosh, am I okay? Like, this hurts so bad. I just laid on the bottom of the stairs and did not move because I felt like if I tried to move, I'm going to hurt something even worse. My husband, meanwhile, is nearby and hears the fall, but he's changing my daughter's diaper over in a different area. So he finishes that, runs over, and is able to move the things that I was carrying out of the way. He helps me up and immediately I feel back pain mostly on my left side as well as pain in my left elbow. My left elbow must have hit with every step as well. So those were the two main points that immediately hurt. And I just felt like, this is going to be black and blue. This was the worst fall I have ever experienced. Now, prior to this happening again, I'm seven and a half months pregnant, and with this pregnancy has come quite a few pregnancy pains, I'll call them. And so just to give a few examples, because it becomes relevant in a bit here, I have been having symphysis, pubic dysfunction, or spd. I've had SI joint pain. I've had low back pain. If I'm standing on my feet for more than two hours or so, and those things, those physical things have been bothering me for quite a while now. I would say maybe two or three months. However, once this fall happened, all of those pains, the SI joint pain, my low back pain, the pubic symphysis pain, all of that suddenly went away. And my first thought was, thank goodness I could not imagine dealing with this pain from the fall and my pregnancy pain. And at the same time, and I actually had to cancel my flight, which was the next day after the fall, because I just could not move even if I had someone to come to the airport with me and help me with my luggage and whatnot. I had to have my husband help me, lower me down into bed and take me out of bed because moving was just so hard. I was having such bad back spasms and I just could not imagine having this, that level of pain and all these other pregnancy pains as well. So I was super grateful. Now flash forward about a week or so. Fortunately, my recovery from the fall is moving along quite quickly. About a week or so later, I was feeling better. I. I won't say pain free, definitely still having pain, but also definitely a bit better. And. And as my back and my arm were improving with things like rest and using a heating pad, I went to the chiropractor once. As those pains started to lessen, not go away, but lessen, I noticed that my pregnancy pains started coming back. Now flash forward a few more weeks. I continued going to the chiropractor. And as some of those pregnancy pains improved, my other new pregnancy pains appeared or others got worse. My si joint pain was getting worse. I started having plantar fasciitis. And my very first thought was, what the heck is happening here? Am I going backwards? Why are things getting worse? Why are new symptoms popping up? I'm doing everything I can to improve. And the immediate answer that I had for myself was, no, I'm not going backwards, because I know the principle, and it's just the first time that I've experienced it myself. So I want to tell you what this principle is, and it relates to our brain's pain limit, or threshold, if you will. So our brains can only handle so many pain signals at once. So when I fell, my brain prioritized the most urgent pain, which was my back and my arm. However, one thing that's important to note is that the pregnancy pains that I had been having up until that very fall didn't disappear. They were still there. My brain just couldn't process all that pain all at once, which brings in the theory that is called the gate control theory. So when we're talking about the gate control theory, it's important to know that there's lots of different types of pain, such as sharp pain, dull ache, even sensory things like numbness or tingling or pins and needles. There's so, so many different types of pain, and each type of pain travels to our brain at a different speed. And not to get too technical here, but it really depends on what type of nerve it's on and how thick it is. It's any type of pain that is on a Thicker nerve takes longer to get to the brain, meaning it takes longer for our brain to interpret what's going on and feel that pain. But if it's on a thinner nerve, it gets to our brain even faster. So we feel that faster. So the acute injury pain, so in my experience, the fall, it travels faster and it essentially closes the gate to, to the slower pain signals. Once that acute pain lessens, the gate opens back up and more pain from other areas can come in. And I like to think of this like an elevator. So if our brain is an elevator, you can only accept so many people in an elevator before it's just too full. Our brains can only accept enough pain signals until we just can't take any more. So the doors close, but the doors are gonna open again and people are gonna get off of the elevator. That's essentially when our pain is lessening and again, not necessarily going away, but lessening. So when people get off the elevator, AKA some pain leaves. Now there's room for more people to get on and for more pain to come in and be acknowledged by our brain. So in my specific case, when some of my people got off the elevator, in my brain when, meaning my back was improving, my elbow was improving, some of the pregnancy pains, people got on the elevator and that's when I started to notice these pregnancy pains started coming back. So these pregnancy pains weren't new and they didn't fully disappear. They were always there, they just were waiting in line for their time to enter my elevator, again, enter my brain. So. So this happens with multiple sclerosis quite frequently. The most common scenario that I have experienced when working with my patients and clients with Ms. And my missing link members is that you're working on a specific symptom and it starts improving, but then suddenly a different symptom seems worse, or it might appear like a brand new symptom has started. So just to give you some tangible visuals, I was working with a patient who has Ms. On reducing spasticity. And we were doing that effectively. And as soon as her spasticity started improving, she started noticing that her hip weakness was getting worse. With a different person, we were working on improving foot drop. Cuz that was her biggest concern. It was the thing that was limiting her the most. It started improving and as that improved, her balance issues became more apparent and, and she was thinking, what the heck, my balance was fine, it was my foot drop. Why is this now an issue? And as one thing gets better, but another thing worsens or appears, it can feel extremely discouraging and defeating. And almost like all of your efforts in exercise aren't truly making a difference, and they are. But I. So I want to explain this to you so that you can understand this, so that if you are experiencing that, you can understand that you are still doing good things for your body, just part of the process. So here's how the gate control theory works when it comes to multiple sclerosis. So when one symptom is really limiting. So when you feel like this specific symptom is the main reason I'm having difficulty walking right now, or it's the main reason I'm struggling with X, Y, Z, your body focuses on compensating for that. And likely, I mean, everyone's Ms. Is different, but likely there's things that we can do to improve that symptom. So as that symptom improves, your body and your brain have more capacity to notice other limitations. More likely than not. Even with a disease like multiple sclerosis that is chronic and progressive, you have multiple symptoms, physical symptoms, all at once, but your brain and body might only be able to focus on one, or it might even be aware that there are multiple symptoms. But again, it focuses its priority on one being the main thing that is causing your difficulty and your struggle right now. So you would assume that when that one symptom improves, the other symptoms would just stay the same. But in reality, what happens is your brain is now able to have more space for acknowledgement of what's actually going on in your body, and you've got control over the one symptom now. So your brain and your body is saying, okay, well, now that that's cleared up, your balance actually is not great. And we've been overcompensating. Like, let's work on that right now. So, for example, that I gave earlier, when your hip was weak, when we improved the spasticity and she started noticing hip weakness. The hip, it's not that it was getting weaker, it was weak the whole time, but the spasticity was the bigger problem. So now that the spasticity is managed, you can actually feel and address the weakness in the hip or whatever body part it is. I have a specific example of a client with Ms. That I worked with, and I actually recorded her story as a podcast episode, Missing Link, episode number 140, if you want to hear the whole thing. But long story short, as we were working together, we kept finding new limitations. So just as we're talking about for her, it, we started working with her hip. She had a few different Things going on with her hip, we, we got them stronger and then she started noticing her balance was worse. We got her balance better. And then she started noticing her foot drop and she was questioning, are these exercises making me worse? I, you know, I wasn't noticing these symptoms before and now that I am, but the reality was, and what we continued to find to be true, is that we were just uncovering layers that were already there. And for her, by uncovering all of these layers, while it can feel discouraging and defeating and like what the heck is even happening, it's actually a good sign. As a physical therapist, we want to uncover these different layers because if we just work on the hip, but all these other things are still underlying, then you're still going to have symptoms with the goals that you're working towards. In this case, it was walking. So finding new areas of weakness or limitation is actually a very good thing so that we can address it. And for this person in particular, her name was Deb, she went from tripping 20 plus times a day to not tripping at all. And she was shuffling just without actually picking her feet up in the beginning of us working together to three months later actually walking and picking her feet up and being able to walk safely into restaurants and into the bathroom at restaurants. So I would encourage you to think of these new discoverabilities of things that might feel like new symptoms or worsened symptoms due to exercise. I would encourage you to see them as a good sign because Great, now, now we can do something about it. If you didn't know it was a thing, we wouldn't that we should be focusing on it and exercising for it. Now, I do just want to add a disclaimer here because of course with multiple sclerosis, there's always the possibility that a muscle truly is getting weaker over time due to demyelination. But keep in mind that that typically takes many, many, many months, if not years to get to that point. So when you've been exercising for a few weeks, or honestly even a month or two, and you start seeing improvements in one area, but also these new areas of weakness, more likely than not, 9.5 times out of 10, that's not a truly new symptom or a truly new area of weakness. It just wasn't limiting you as much. But it's been there all along. And sometimes I actually find this quite frequently. You might not know that you have weakness in a specific muscle or area because you weren't doing exercises that used that muscle. And it wasn't Weak enough where it was causing limitations in your mobility, so you didn't know it was weak. But now that you're working with a physical therapist and they've identified which muscles are weak, you are doing specific exercises for, for that specific area and you're thinking, whoa, why is this so, so hard? Again, it would have been challenging this whole time. It's not that it something has made you weak, it's just that you're focusing on the specific area and it's now heightened of how weak this muscle is. So let's quickly recap here what is important for you to take away from this conversation. So first and foremost, recognize if this is something that's happening to you. If you feel like new symptoms are appearing after making progress with another symptom, that is often a good sign. It means that your nervous system is working better and it can now detect other areas that need attention. The most common mistake that I see when people hit this point point is that they think the exercises either aren't working or they're making them worse and then they quit. And I can totally understand why. Again, I've mentioned this several times, but it can be discouraging, especially when you've put in so much effort, likely weeks to months of consistency. That's hard for anyone and anything. So it's totally normal to feel like you're defeated or discouraged. And I'm just going to stop because clearly this isn't working. However, instead it'll be important for you to notice what the pattern is. One symptom improved and another became apparent. Share this with whichever provider you're working with. If you're going to an in person physical therapist, or if you have a trained personal trainer perhaps. But share it with someone and then adjust your program to address the newly apparent limitation. If you are inside my membership. The missing link we have a newer feature, new as of October of 2025 called Dr. Gretchen AI. This would be a perfect example of what you can put in there. You can tell it what has improved and what you are now feeling and ask for suggestions of what you could do for this newly apparent symptom or limitation. And while you're going through this process, whether it's with Dr. Gretchen AI or an in person physical therapist, or your neurologist or whoever, trust that you're peeling back the layers, not going backwards. I know this sounds weird and maybe even wrong, but finding new areas of weakness or symptoms is often a good thing because it, at least as a physical therapist, it gives us a very clear path forward of what we need to start working on to address that. A perfect example of this is we actually have a Missing Link member right now. She just posted today that I saw inside our Missing Link community that she's been doing her exercises and she's been improving but now she's noticing that her knees are knock kneed, AKA sometimes called knee kissing and she's wondering what she can do for that. So she can put that symptom into Dr. Gretchen AI or we have a document inside the Missing link that outlines tons of different Ms. Symptoms and under each symptom or goal it links to which exercises inside the missing link will actually help with that symptom, symptom or with that goal. And knee kissing is the very first one on that list, that document. So she could go there and find the exercises there as well. So this is why personalized, customized, tailored, whatever we want to call it, guidance can help because it gives you something to do to address these symptoms that are happening versus just feeling like it's not working and now you're going to give up. And I know that it's easier said than done, but as a physical therapist who has seen this time and time again, I can assure you that if you are experiencing this, you are not alone. This is quite, quite common even if you don't have Ms. Again, I do not have Ms. And my body was even experiencing this when it comes to pain. So this is very common and I like to think of it as every limitation or symptom that you uncover is an opportunity to improve. New symptoms appearing doesn't mean that you're failing or doing the wrong thing. It often means that you're succeeding. And just to be clear, again, we're talking about new symptoms that are appearing or symptoms that are seem to be worsening specifically related to an exercise routine. We're not talking about flares here or exacerbations or relapses. That's a different type of progression. What we're talking about here is specifically related to new things that you're noticing from an exercise routine that you're doing. If you found that this was helpful and resonated with you and maybe you're even currently experiencing this, I would highly encourage you to check out my membership, the Missing link that I've mentioned a few times. I'll put the link down in the show notes in the description so you can see if it's a good fit for you. But we not only have that document that I mentioned where it outlines if these are your symptoms These are the exercises that you can do, but there's also structured exercise programs and calendars that tell you which exercises to do each day. We have weekly check ins, a monthly Q and A call our community. There's so many components of the Missing Link that can help you through through specific situations like this. I hope you found this helpful. Thank you so much for tuning in. I will see you again next week.