Balance and Walking in Multiple Sclerosis: Physiotherapy and Exercises

Balance and walking difficulties in Multiple Sclerosis do not have one single cause. Strength, sensation, vision, vestibular symptoms, coordination, spasticity, pain, fatigue and confidence can all contribute, which is why a useful rehabilitation plan normally starts by identifying what is actually limiting the person.

What might a physiotherapy assessment look at?

Assessment may include standing balance, transfers, leg strength, stepping, turning, walking speed, foot clearance, use of aids, response to head movement or dual tasks and how performance changes when the person becomes fatigued. Falls history and the home environment are also important.

Balance exercises

Balance work can begin with supported sitting or standing and progress through weight shifts, narrower foot positions, reaching, stepping, heel-to-toe positions, single-leg tasks, obstacle negotiation and changes of direction. The challenge should be enough to require adaptation but not so difficult that every repetition becomes a near fall.

MS Trust balance guidance includes options such as feet-together balance, heel-to-toe balance, stepping, single-leg balance and sit-to-stand, with exercises selected according to ability.

Strength and balance are connected

Weakness around the hips, knees, ankles and trunk can make balance recovery more difficult. Strengthening may therefore sit alongside balance practice rather than being treated as a separate programme. Sit-to-stand, step-ups, calf work, hip strengthening and appropriately selected gym exercises can all support functional mobility.

Walking practice

Walking rehabilitation may focus on step length, foot clearance, turning, speed, endurance, confidence or the use of an appropriate aid. Some people benefit from short, high-quality walking bouts separated by rest; others need a greater focus on endurance or strength. The best approach depends on what changes first as walking becomes difficult.

Falls and mobility aids

Using a walking aid is not a failure of rehabilitation. In some situations it improves safety, confidence and energy efficiency enough to let the person remain more active overall. The correct aid and height should be assessed rather than chosen only by appearance or convenience.

Fatigue and dual-task walking

Walking may become more difficult when fatigue is high or when attention is divided by talking, carrying something or navigating a busy environment. Rehabilitation can include graded dual-task practice, but safety should come first and tasks should be progressed deliberately.

Related MS physiotherapy resources

Multiple Sclerosis Physiotherapy & Exercise Resource Centre links balance and walking with fatigue, foot drop and wider exercise progression.

When to seek individual advice

MS is variable and exercise needs to be adapted to the individual. New or worsening neurological symptoms, a suspected relapse, repeated falls, sudden changes in walking or significant new weakness should be discussed with your MS nurse, neurologist, GP or other appropriate healthcare professional. A physiotherapist can assess movement, strength, balance and mobility and tailor rehabilitation to your needs.

Explore the complete MS guide

The Complete Multiple Sclerosis Physiotherapy & Rehabilitation Guide is a 353-page digital resource with 91 progressive exercises, video demonstrations and detailed sections on fatigue, strength, balance, walking, foot drop, spasticity, relapse recovery, wheelchair and seated rehabilitation, gym exercise and self-management.