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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 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 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. Welcome back to the Missing Link podcast and as always, thank you so so much for tuning in. Today we are going to be talking about functional exercise. This is something that I think is very important to talk about and understand because it can be the difference in getting stronger but not improving your function and getting stronger and improving your function. So we're going to dive into that deeply today. Before we do that, I just wanted to share a fun tip About Me I grew up not only exercising but playing on lots of different sports teams, so my parents were always very active. My dad was a rugby player for most of my childhood and when he couldn't play anymore he reft rugby. He also coached us in soccer from the time that I was how young can you start playing soccer? Whatever that age is is when I started playing maybe four or five and I have vivid memories of my mom exercising at home and power walking every morning. She would go super early before we even left for school and she would make it back home in time to send us off to school. So so I grew up seeing exercise as a way of life and therefore I stayed consistent with exercise as well. I played soccer all throughout middle school, high school and even all four years of college. And I also was a cheerleader in high school all four years as well as two years of collegiate cheerleading as well. And I just found both so fun. I loved being competitive in both of them in soccer and in cheerleading. So it was a really great time. And then I eventually hit a point during PT school where it was just too stressful keeping up with any type of exercise routine, let alone a sport. And I just dove into my studies and loved PT school but didn't maintain a super healthy lifestyle because I just had so much going on which made it very challenging for me to jump back on the exercise wagon. Once PT school was all said and done, I had a job. So physical therapy school is three years long, it's a doctorate program and that program really wipes you out, as I mentioned. So I went three years without exercising and then an additional year when I was just getting my feet wet as a new physical therapist didn't really add anything in. So four years had gone by where I didn't exercise. And even though I grew up with a lot of influence all around me, I felt like, well, I don't know what to do. What do I do now? Do I go for a walk? Do I go to the soccer field and bring a ball and do something? And so that brings me to my topic today of what functional exercise is. And functional exercise is going to look different for everyone. The definition of functional exercise means breaking down the activity that is challenging for you into as many movements as possible. And those movements are now your exercises. If that sounds confusing, don't worry, I'm going to give you a great example. But I always can tell when one of my clients is not doing functional exercise. And I'll give you two things that I hear frequently from my clients that gives me the indicator that they haven't than doing functional exercise. So the two things I'll hear, and if you've said this before, you don't have to raise your hand, but you might identify with this. So the first thing that I hear is, you know, I've been to physical therapy before and it didn't really work for me or I've been doing my physical therapy exercises and they're not really working, they're not doing anything. And my follow up question is, okay, well what exercises are you doing? Or what did you do in physical therapy? And they would say they gave me a lot of exercises and they put me on the bike and I even got so good I could bike for 20 minutes on the resistance level of three or four. And immediately I think to myself, okay, not functional. Because my next question is great and do you have a goal of biking better or do you bike throughout your day? And they'll say, well, no, I want to walk better. And that's a perfect example of a non functional exercise. So I do like recumbent bikes and stationary bikes. Don't get me wrong, they are great for cardio exercise and improving leg strength in a seated position. But the biggest downfall of bikes, any bike, is that people feel that it will help them with their walking, that if you can bike longer or bike with more resistance, that it will also improve your walking. And that is simply not true. Think about it, when you're biking, you are in a seated position, especially a recumbent bicycle you are sitting down. How in the world is any strength that you gain or endurance that you gain in a seated position going to transition you to a standing position? It doesn't work that way when you have Ms. Our brains and our nerves and our muscles don't have the same carryover as someone without Ms. So you might have full strength seated on a bike. As a pt, we rate strength out of five, so you might have five out of five strength seated on the bike, but you go to stand up and that strength that you had is non existent. And I'm just talking about the bike here, but it doesn't even have to be the bike. Maybe you're doing traditional physical therapy exercises like the straight leg raise or the clamshell or bridging or the side lying leg raise. A common thing in all these exercises that I'm mentioning is they are all exercises lying down and they are great for strengthening your quads and your glutes and your hamstrings. But again, with ms, there's no carryover. You might have full strength lying down and therefore you might actually notice improved function with moving around in bed, but that will not help you with walking. So one of the ways to do functional exercise is to do the exercises in the same position that your goal is in. The other thing that is an indicator to me when someone tells me that they are exercising and I can tell that it's not functional exercise is they will say, Dr. Gretchen, I've been going to the gym for a year or six months or whatever the timeframe is, or I've been exercising for this long and I still can't walk better. Or, you know, I'm getting so much stronger. I can tell, I can see it in my body, but I still can't climb the stairs. Or it's still hard for me to lift my leg to get into the car. Or getting into and out of bed is still just so challenging. And that tells me, yes, you are gaining strength, which is great, but strength does not mean function. So if your goal is to just get stronger and you don't necessarily care if that translates into improved movement, well then great, that's fine. That's a good goal to have. But this episode is mostly for the people who want to get stronger so that their movement improves as well. So let's jump into it, shall we? So again, the exercises that you should be doing are totally dependent on your goal. So I'm sure in future episodes I'll give many more examples. But I don't want to make this episode like five hours long. So I'm going to give my favorite example of walking. So a lot of people come to physical therapy to see me as an Ms. Specialist and I will ask them, what is one of your goals? And usually the first thing they'll mention is something related to walking. And I think that's a great goal. It's doable and there's specific things that you can do. But a lot of people will say walking is their goal, as if walking is just one swift movement. It's a challenging movement, but it's just one swift movement, and that's not the case. So walking is many, many movements put in together to be one swift movement. So I want you to visualize with me for a second. I want you to picture yourself sitting, standing, or maybe not you, but picture someone standing with their feet about shoulder distance apart. And one foot is forward and one foot is back. Not excessively so, just the width of a regular step length. Okay? Now if this person that you're envisioning wants to take one single step forward, these are the things that they need to do. So they need to shift their weight forward onto the front leg. Then since there's less body weight on the back leg, they need to bend that back knee. Then they need to swoop their toes up to prevent foot drop. Then they need to bring their knee all the way up towards the ceiling. Then they need to straighten the knee, Then they need to put the heel down. And all while that was happening, while that one leg was moving forward, they were standing on one leg. Whether you are using an assistive device or not, you are still standing on one leg. So that's seven different things. So you need to weight shift forward, bend the knee, swoop the toes up, bring the knee up, straighten the knee, put the heel down, and balance on one leg. If you're having a hard time visualing this, I will say that I have a few different YouTube videos on this, so. So feel free to head over to my YouTube page. My handle is DrGretchenHolley and you'll be able to see visuals as well as exercises for this. So my point being, if your goal is walking better, you shouldn't necessarily just practice walking. You need to be practicing those seven things. You might find that some of those movements that I mentioned are somewhat easier for you and maybe others are more challenging. But let me share with you that if anything in there is challenging, even if they're all fairly easy, except for one movement that can still affect your walking, and we didn't even mention arm swing, which also plays a role in that, and coordination, which also plays a role in that. But just for these strengthening exercises, if you practice walking just as one swift movement, you want to get better at it. So you're going to practice walking for five minutes, you are so much less likely to actually improve your walking. The way to improve your walking with functional exercise is to make each of those seven movements their own exercise. So I'll give you another example. One of those seven movements was bringing your knee up towards the ceiling. So I call this a marching exercise. Now, you can practice this marching in a standing position. That's extremely functional, because when you're walking, you're standing. So practicing any of these exercises in a standing position is going to be a great option. However, at first, that might be too challenging for you. So you can actually practice this in a seated position. But it's still the same exercise. You're still marching. If that's too challenging, you can practice it laying on your back. If that's too challenging, you can practice it laying on your side. I'm a huge, huge fan of modifying an exercise. So we find a way to modify it so that you can do it successfully. Because the easier it is, the more repetitions you'll be able to do, the more repetitions you can do, the more opportunities you're giving your brain to strengthen that neural pathway, which is the whole point. So we do that with every movement. So we listed seven movements. So we do an exercise, and we find what position we can do it best in. Then we work our way to making it even more functional. So for that marching, let's say standing was too hard at first. Well, let's just get stronger with marching in a seated position first. Then once you're stronger, we'll do it in a standing position. Or one of those other seven movements was bending your knee so that your heel comes up towards your butt. So again, you can practice that in a standing position. If that goes well, great. That's a functional exercise to help you walk better, because you need to do that movement in order to walk forward. If doing that exercise in a standing position is too challenging, well, then you can do it seated. Bend your knee back in a seated position. If that's too challenging, you can lay on your side or on your stomach. So again, there's always a way to modify it. But the first step in doing the appropriate exercises to help you reach your goal is to break it down into as many movements as possible. And I'll give you More examples in future episodes. But this is a great example. Walking requires these seven movements. So these seven movements should be your exercises. And I just want to close out this episode by answering a question that I get frequently, which is, Dr. Gretchen, if there was one best exercise, just one thing that I should be doing, what is it? My answer is always the same, which you might find shocking at first until I tell you what my answer is, because everyone with Ms. Is different and there truly is no one best exercise. So my answer is first a question I will ask you what is one thing that you are really struggling with right now that you want to be easier? And then whatever it is they say, whether they say they're trying to stand up with more strength from a low position, or they're trying to sit down without plopping, or they're really working on hand strengthening, whatever it is, when they tell me that, my answer is, well, then do that as an exercise, that is the most beneficial way to exercise. It's very functional. So if your goal, if this person who is theoretically asking me this question says, you know, I really just want to be able to stand up with strengthen my legs from any surface, well, then my answer is practice that. That is now your exercise. And of course, there's things to know about positioning your body to make yourself even more likely to be successful with that movement. But practice it. And if it's too challenging, make it easier. Meaning don't start practicing from a low surface, start practicing from a higher surface. If you have a higher bed, practice standing up from there or a higher couch or chair. Start from a higher surface and as you gain strength, lower the surface. I hope you found this episode helpful. Functional exercise is where it's at in order to get stronger and have that strength also translate to improved function and improved mobility throughout your day. So I hope I've encouraged you to think about the goals that you work towards and how you can make those goals into functional exercises. Thanks for listening and I hope you tune in next time. Thank you for listening to today's show. I am so grateful to have you as a listener. 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 loved this episode and think of 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.