This is a guest post by Dr Emily Splichal, a Podiatrist, Human Movement Specialist and Global Leader in Barefoot Science and Rehabilitation. She is also the CEO of Naboso Technology, manufacturers of textured mats and insoles to improve function by stimulating the nervous system. Always consult with your doctor before beginning new exercises.

Whether we consciously realize it or not we all want to move better, feel stronger and stay pain-free.   We all seek the ability to do the activities we enjoy – whether that be going for a long walk with a loved one or running in a local 5K.

For those living with Multiple Sclerosis, a compromise in balance and a fear of falling can prevent a person from participating in the movements they once loved.   Balance impairment is one of the most common movement symptoms associated with Multiple Sclerosis, with peripheral neuropathy and foot drop further adding to a sense of instability. 

Current movement science research and product innovation provide new approaches for improving stabilization and enhancing movement confidence, thereby enhancing the quality of life.  This article will focus on how approaching balance and movement programs from a sensory perspective can often be effective.

Below are the top three sensory stimulation pathways, along with simple exercises, which can be used daily to optimize balance and stability for those living with MS.

Sensory Gateway #1 – Vision

According to the MS Society, vision problems are some of the most common symptoms associated with MS, and are a large contributor to instability and fall risk.  The most common eye complications include optic neuritis, diplopia, nystagmus and internuclear ophthalmoplegia.

Our eyes which are designed to move and accommodate for light, provide us the sensory detail about our environment and allow us to navigate during dynamic movement.  A decrease in visual acuity has been associated with impaired balance and delayed accuracy in motor patterns.

A 2018 study by Herbert et al. demonstrated the benefit of integrating eye movement exercises and visual stimulation in improving balance for those with MS. The study that focused on the BEEMS (balance and eye motion exercises for MS) integrated daily eye movement exercises for improved sensory integration and brain balancing.

It is suggested to integrate 5 minutes of the below exercises into one’s daily routine. 

Vision Stimulation #1 – Eye Tracking

This exercise may be done seated or standing, depending on level of stability.  Begin by hold your finger arm’s length in front of your face. Slowly move your finger up, down and side to side in front of you, moving just your eyes along with your finger.  Try not to move your head and remember to hold a soft gaze as you do this eye exercise.   Perform for 30 seconds with each hand.

Vision Stimulation #2 – Peripheral Vision Training

For this vision exercise, sit somewhere comfortable where you can see something in the distance.  As you look into the distance, start to wave your hands quickly to the side of your head to notify your eyes that your peripheral vision exists.  Do not look at your hands waving, keep looking into the distance.   Perform for 1 minute. 

Vision Stimulation # 3 – Saccade Training

Saccades are rapid, ballistic movements of the eyes that abruptly change the point of fixation. Again this exercise may be performed seated or standing. Start by looking straight ahead. Only moving the eyes look to the left and spot an object. Immediately look to the right and spot another object. Keeping moving the eyes to the left object then to the right object, slowly picking up pace. Perform for 20 seconds. Rest. Repeat 3x

Sensory Gateway #2 – Vestibular 

Often referred to as the gateway to the brain, the vestibular system is the first sensory system to develop in utero.   This sensory system is critical to how our brain and body relate to gravity.

 In MS, vestibular disturbances typically present as vertigo, balance disorders, and the presence of nystagmus (rapid involuntary movements of the eyes).  When considering the impact of potential vestibular disturbances, it is important to understand if the disturbance is in the peripheral or central vestibular system.

 The vestibular system can be divided into two main systems: the central system (the brain and brainstem) and the peripheral system (the inner ear and the pathways to the brainstem).   A 2008 study by Zeigelboim et al. found that vestibular disturbances related to MS were disruptions in the peripheral system, with a higher prevalence in female patients.

 Below are three vestibular exercises that can be integrated into any balance program. 

 Vestibular Stimulation #1 – Head Turning

Similar to some of the exercises for the visual system, vestibular training involves turning the head with the eyes.  Start in a seated or standing position.  Turn the head and eyes to the left, spotting an object.   Immediately turn the head and eyes to the right, spotting another object.   Continue shifting the head and eyes from the left to the right for 20 seconds.   Rest and then repeat looking up and down and on a diagonal. 

Vestibular Stimulation #2 – Sit to Stand

Start seated in a chair that you can comfortably sit on the edge.   Fix your gaze on an object directly ahead of you.   Holding the gaze shift from a seated position to a standing position and then slowly return to the seated position.   Repeat 10 times.

Vestibular Stimulation #3 – Sit Stand Turn.

As a progression from exercise #2, the sit stand turn will further challenge the vestibular system by turning the whole body. Similar to exercise #2, fix the gaze on an object when going from a sit to stand. Once standing, slowly turn the entire body clockwise until you make one complete turn. Upon returning to the start position, re-fix the gaze on the object and slowly return to a seated position. Perform 5 times clockwise and 5 times counterclockwise.

Sensory Gateway #3 – Touch 

The final sensory system for improving balance is touch.  Our hands and feet are some the most sensory sensitive areas of the body, allowing us to connect our visual input with the external world.   

Neuropathies and disruptions in peripheral proprioception are often associated with MS and should be addressed before the onset of symptoms.   To fully benefit from touch stimulation it is important to understand what stimuli our skin responds to. 

The power of touch is associated with the uniqueness of the nerves of the plantar foot.  The skin of the feet contain nerves called mechanoreceptors.   These mechanoreceptors are sensitive to different stimuli including texture, skin stretch, pressure, and vibration. 

By integrating products that feature these stimuli one can expect an improvement in balance, posture and gait.  

Touch Stimulation #1– Textured Insoles

Texture or two-point discrimination is one of the most effective ways of reconnecting to your feet.   A 2016 study by Hatton et al. demonstrated an improvement in gait patterns in MS patients wearing textured insoles.  When worn daily, subjects have associated textured insoles with improved foot sensation and balance coordination.   Naboso Technology has developed the first commercially available textured insoles designed to improve balance, posture and gait. 

Touch Stimulation #2– Plantar Foot Release

Daily release of the feet on a lacrosse ball or foot roller is an easy and effective way to improve balance.   Chatchawan et al. demonstrated an immediate improvement in balance after foot massage.   The foot release can be performed seated or standing with a slow increase in pressure to the bottom of the foot.   Try to roll out all areas of the bottom of the foot for a total of 5 minutes per foot. 

As you begin to integrate the above exercises into your program, remember that consistency is the best-kept secret to seeing a benefit. Just 5 – 10 minutes a day, every day, can translate to better balance. Try to make all of the above tips a part of your lifestyle and soon you will be on your way to movement confidence.