Multiple Sclerosis Relapse Recovery: Physiotherapy and Returning to Exercise

An MS relapse can temporarily or persistently change strength, balance, walking, sensation, coordination, fatigue or other neurological functions. Rehabilitation after a relapse therefore needs to begin with what has changed rather than assuming the previous exercise programme should simply restart at the same level.

First: make sure the relapse is being medically managed

If you have new or worsening neurological symptoms, contact your MS nurse or appropriate medical team. Physiotherapy can support physical recovery, but it does not replace assessment of whether symptoms represent a relapse, infection, another medical problem or a treatment issue.

Reassess current function

A useful starting point is to compare what you can do now with your previous baseline. This may include transfers, standing, walking, stairs, balance, hand function, exercise tolerance and the amount of recovery needed after activity. The aim is to identify the current starting level rather than chase the old one immediately.

Rebuild everyday movement before chasing fitness

For some people, the first rehabilitation goals after relapse are basic: getting out of bed more efficiently, tolerating sitting, transferring safely, standing, walking indoors or completing personal care with less effort. These are legitimate rehabilitation targets and may provide the foundation for later strength or aerobic training.

Use graded strength and activity

As symptoms stabilise, exercise can be progressed in stages. This might begin with bed-based or seated movement, move into supported standing and functional strengthening, and later return to walking, resistance training, cardiovascular exercise or gym work. The exact pathway depends on the person's post-relapse function.

Fatigue can change the pace of progression

After relapse, fatigue may limit how much useful exercise can be completed at once. Shorter sessions, planned rest, alternating demanding and easier tasks and monitoring recovery later in the day can help establish a more sustainable dose. Progress is not only the amount completed; it can also be better quality, less support or faster recovery after the same task.

When to ask for physiotherapy

Consider requesting physiotherapy input if you have lost mobility, had falls, are struggling to regain strength, need a new walking aid, have persistent balance problems or are unsure how to restart exercise safely. A neurophysiotherapist can assess the pattern of change and help prioritise the most useful rehabilitation targets.

UCLH's MS management information describes specialist physiotherapy support for mobility and balance difficulties and wider symptom management within the MS team.

Related MS physiotherapy resources

Multiple Sclerosis Physiotherapy & Exercise Resource Centre links to exercise, fatigue, foot drop and balance guidance.

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.