Podcast Summary: The MSing Link with Dr. Gretchen Hawley

Episode 279: MS Balance Tips for Real Life

Date: April 8, 2026
Host: Dr. Gretchen Hawley, PT, DPT, MSCS

Episode Overview

In this episode, Dr. Gretchen Hawley confronts a common frustration among people with Multiple Sclerosis (MS): why traditional balance exercises done in physical therapy or personal training often fail to improve real-life situations. She explains the difference between generic and functional balance training, breaks down specific daily tasks that challenge MS warriors, and provides actionable, MS-specific strategies for effective, real-life balance improvement. The episode is designed to empower listeners with practical tools to make meaningful progress in their everyday independence and safety.

Key Discussion Points & Insights

1. The Overlap Between Traditional and Real-Life Balance (00:00–04:16)

• Main frustration: MS patients often see minimal improvement in day-to-day balance despite following prescribed exercises.
• Common complaint:

  "I've been going to a personal trainer or going to physical therapy and I've been working on balance exercises but my balance isn't any better day to day."
  (Dr. Gretchen Hawley, 01:04)

• Challenging daily life scenarios:
  • Getting dressed while standing
  • Walking, especially on uneven surfaces (grass, sidewalk, sand, cobblestones)
  • Navigating crowded environments
  • Turning the head quickly while standing or walking
  • Going from light to dark rooms
  • Reaching side to side
  • Bending down (e.g., picking up pet bowls)
• Goal of episode: Explain why typical exercises don’t translate to real life and how to choose or design better alternatives.

2. Typical Balance Exercises: Why They Fall Short (04:16–08:18)

• Commonly prescribed non-functional exercises:
  • Standing with feet together (possibly with eyes closed)
  • Tandem stance (heel-to-toe)
  • "Grapevine" drills (sidestepping with crossing legs)
  • Using foam pads, Airex, wobble boards
• Core Issue: These exercises often strengthen balance only in the specific conditions practiced—not in diverse, real-life situations MS patients face.

  "You could get really great at all these exercises... But you go into a real-life situation like walking on uneven ground, and your balance is the same, it's just not any better." (Dr. Gretchen Hawley, 06:10)

• Functional exercises are essential:
  Customizing movement practice to closely mimic daily life challenges leads to better neurological carryover and lasting functional gains.

3. Functional Balance Training for Real Life: Practical Examples (08:19–18:30)

a. Getting Dressed While Standing

• Breakdown of movements:
  • Side-to-side weight shifting
  • Bending down (mini-squat to one side)
  • Lifting the leg while maintaining balance
• Progression:
  1. Practice just shifting weight onto one leg.
  2. Add bending down (on loaded leg).
  3. Add lifting the opposite leg.
  4. Gradually decrease assistance (using a chair, wall, or bed as needed).
• Key Insight:

  "...If you have difficulty with getting dressed, those are just three balance exercises that you would progress to over time that can dramatically help with getting dressed while standing."
  (Dr. Gretchen Hawley, 12:34)

b. Walking on Uneven Surfaces

• Traditional mistake: Practicing only on wobbly gym tools (Airex/foam/wobble boards).
• Practical solution:
  • Practice walking slowly on actual uneven surfaces: grass, sand, sidewalks, gravel, cobblestone.
  • Use appropriate mobility aids as needed (cane, trekking pole, rollator).
• Key Insight:

  "Practicing walking in a real life situation with an uneven surface under your feet is going to let your muscles, your brain and your neural pathways get stronger and improve their balance in that real life situation."
  (Dr. Gretchen Hawley, 15:14)

c. Turning Your Head While Standing or Walking

• Common problem: Losing balance when turning the head (e.g., responding to a name in public).
• Functional exercise:
  • Stand comfortably, turn the head side-to-side and up-and-down.
  • Progress by turning faster or through a larger range.
  • Practice keeping balance during head motions and while stepping or shifting weight.
  • Only perform as tolerated, especially if prone to dizziness.
• Memorable Moment:

  "There are so many situations in our daily life where we have to turn to look while we're either standing or moving. So a really great exercise for this would be to stand... and practice turning your head to one side and then to the other side."
  (Dr. Gretchen Hawley, 16:34)

4. When Traditional Exercises Still Have a Role (18:31–20:12)

• Context-specific value: There are cases when stance exercises (e.g., tandem) matter—such as for those who have a "scissor gait" and inadvertently move into tandem stance while walking.
• Modification: Rather than just static holding, practice shifting weight forward and backward in tandem stance to better approximate real walking challenges.
• Philosophy:

  "The best thing that you can do is do the thing that's hard as an exercise. And if it's too hard, make it a bit easier at first."
  (Dr. Gretchen Hawley, 20:00)

5. Mindset Shift: Breaking Down Complex Tasks (20:13–21:53)

• Advice:
  • Instead of repeating the full (or failed) movement, break down the challenging activity.
  • Start by practicing only its simplest components.
  • Progress gradually by adding complexity and putting the components together.
• Encouragement for listeners:

  "Hopefully you feel like, okay, it wasn't me. It wasn't my MS. I was just doing the wrong exercises because they weren't given to me. Now I feel confident with this approach that I can start improving."
  (Dr. Gretchen Hawley, 21:45)

Notable Quotes & Memorable Moments

• "You could get really great at all these exercises... But you go into a real life situation like walking on uneven ground, and your balance is the same, it's just not any better."
  – Dr. Gretchen Hawley (06:10)
• "Do the thing that's hard as an exercise, but modify it or pare it down. Just do part of the task so that you can get stronger with that first and then make it harder from there or choose an additional exercise from there."
  – Dr. Gretchen Hawley (20:05)
• "I hope you feel encouraged and motivated and excited if you were in that boat of, 'Yes, I know exactly what you're talking about. I've done those traditional exercises and they didn't help.'"
  – Dr. Gretchen Hawley (21:37)

Timestamps for Important Segments

• 00:00: Introduction — The balance exercise frustration in MS and common real-world challenges
• 04:16: Breakdown of typical, non-functional balance exercises
• 08:19: Functional alternatives: Dressing, uneven ground, head turns
• 18:31: When traditional exercises might be relevant
• 20:13: Breaking down tasks and mindset shift for progress
• 21:37: Empowering conclusion, invitation to the Missing Link program

Takeaway

Dr. Gretchen Hawley makes a compelling case that for MS warriors, balance training must directly address the real-life activities and challenges faced every day. Functional, task-specific exercises—not just gym drills—are key to regaining confidence, mobility, and independence. Breaking down tasks into manageable parts allows meaningful progress, and everyone can start with modifications tailored to their current ability. The episode is both practical and encouraging, closing with the affirmation that, with the right strategies, real-life balance can get better—starting now.