ELLIE'S BLOG on Living Well with MS

Pain and fatigue can have many causes in MS. The primary cause of pain is due to nerve pain. And the primary cause of fatigue is also due to MS itself. But  pain and fatigue in MS can also be due to orthopedic problems caused by overuse or over exertion. This is where posture comes in. Posture itself is usually not the primary cause but is very often a secondary cause. And unless checked it can develop into a chronic secondary problem.

Our body has been built to be upright.  To stand erect, to walk erect and to sit with our trunk erect.  And the most efficient use of our body is to follow the design with which we were made.  When we deviate from this our body has to work harder. And we are much more apt to develop muscle soreness and fatigue just for starters.

I have been thinking about this and my own posture a lot lately.  I became acutely aware of this about a month ago when I was in a relapse.  My relapse started in my trunk muscles and I had pain not just discomfort.  As I exercise daily I was aware that the repetitions I was able to do with my trunk muscles was dramatically less than it had been. In contrast the repetitions of the exercises I could do with my legs and arms had not changed at all. So when I was standing,walking or doing activities with my arms I was doing so with poor trunk support. This was a strong lesson and a reminder to me on the importance of a strong trunk in maintaining the upright position.

It was also a reminder on the importance of being aware of my body and my posture. It helped me to understand part of my fatigue in walking even though my legs had shown no loss of repetitions.  When your trunk is weaker your body works harder to keep yourself up right when you are walking. Therefore I gave myself a break and used my wheelchair a little more and was able to maintain my functional level a little bit better.

Eventually my leg and then my arms also lost the ability to do as many repetitions as my trunk had. So I was walking less and doing less and my back pain did decrease.  Now I am certain that some of the pain I had in my trunk muscles and my fatigue was related to my MS relapse. But I also firmly believe that standing and walking etc,with weaker muscles was also a factor.

As those of you who follow my blog know I had a wonderful remission in January.  Since that time I have been able to walk with my wheeled walker in my home and sometimes outside short distances. For several years before that I used mostly my electric wheelchair in my home as walking was limited to five or six steps.

As a physical therapist I am very aware of the importance of trunk muscles in maintaining an upright position and good posture. When I bought my wheelchair I made sure it had a good solid back and seat to maintain me easily sitting with good posture. But when I was able to walk those four or five steps many times I would use the wall or furniture as an assist.  And at the  time I had noted that this is when my back hurt if I overdid this. Which I then tried to avoid. Helping to avoid this was making sure that I did not lean forward but that I stood up right when I took my 4-5 steps.  And of course my morning exercises always have included strengthening my trunk muscles.

When I was working as a physical therapist I was always very aware of not hurting my back and I believe that it has carried over into my coping well with MS.  I also think my early experiences of being a very tall girl(5'11&quot has been influential.  My mother was afraid of my developing round shoulders so I used to have to walk around the house with a book on my head to remind myself to stand up tall. And then my college experience also centered on good posture.

As a freshmen in college in 1953 at a school of physical therapy and physical education we all had posture pictures taken of us in our underwear.  We then had our posture analyzed and given any remedies needed to improve it.  And our ability to maintain good posture all day was reinforced by posture spies to report our misdemeanors.  I'm sure that seems archaic and it certainly would never happen today.  But there are some good lessons I learned on ways to assist myself in maintaining good posture.

What I find helpful in maintaining good posture and preventing back pain and fatigue are:

1. Keep your trunk muscles as strong as they can be-do trunk exercises.
2. Maintain good flexibility - have a good stretching program. 
3. Be really aware of your body and how you are sitting, standing and walking.
4. Made a habit of checking  yourself out periodically (are you slouching, leaning forward when you walk, is your chin jutting forward ? 
5. Use the appropriate assistive devices and make sure that your assistive devices your walker,cane or crutches are of a proper height and that you are using them appropriately.
6. Sit only in well supporting chairs and that definitely includes your wheelchair. 
7. When you stand up take a  moment to be sure you're  standing erect. And if your back feels stiff, lean back for a stretch then back upright and then take that walk . 
8. And not to be forgotten -don't push yourself and take that nap when you need it !

These lessons that I have learned over the years have been very helpful to me.  I think if you try them you'll find that they can really truly make a difference with secondary pain.  And you'll have an added bonus of feeling better about yourself. Your going to look better, and you'll find your whole life will improve.

                                                                  ellie