How To Prevent Falls When You Have Ms

Multiple sclerosis (MS) impacts the systems of the body that support balance and coordination. This means it can also come with an increased risk of falling. While preventing falls is important with MS, it’s also important to keep moving. The muscle weakness that results from too much inactivity can actually increase the risk of falls. Instead, you can lower your risk of falling by understanding your specific risks and taking proactive steps to address them. With simple exercises and home modifications, you can reduce your risk of falling while also maintaining your mobility and freedom of movement. How MS Increases Fall Risk How MS Raises Fall Risk “MS affects the brain and spinal cord pathways that control balance, sensation, vision, and quick corrective movements,” says Rab Nawaz Khan, MBBS, MPH, a speciality doctor (SAS) in general, stroke, and rehabilitation medicine at the Aneurin Bevan University Health Board in Wales. “Even mild changes in these systems can make uneven ground, stairs, or quick turns much riskier than they are for someone without MS.”e60dc2a1-f33c-4a05-9b50-8e3e8e5976294503dca4-8279-43bf-90dc-956ebb4e42a4 According to Kimberly Hopkins, DPT , an outpatient physical therapist at Gaylord Specialty Health in Wallingford, Connecticut, the nervous system is responsible for much of this instability. “Someone may look steady and walk independently without an assistive device, yet their nervous system is working harder behind the scenes,” she says. “Messages between the brain and the body are often delayed, distorted, or inconsistent.” In addition to delays in communication between muscles and the brain, other factors can increase the risk of falls in MS. These include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976295ab5bae1-dbcd-4bf5-bad1-73a44300cb80 Muscle weakness in the legs Foot drop, or difficulty lifting the front part of the foot Sensory loss that prevents your brain from feeling where your feet are in relation to the floor (proprioception) Visual impairments like optic neuritis or double vision Cognitive fatigue that slows reaction time Spasticity, muscle stiffness, or spasms Heat sensitivity, which can trigger a spike in MS symptoms “ Spasticity can cause stiff, scissoring steps and toe catching,” says Hopkins. “Vision changes and slowed thinking add risk because people misjudge steps, obstacles, or timing.” Strategies to Decrease Your Risk How to Decrease Your Fall Risk While the idea of falling because of MS symptoms can be scary, there are simple, reliable ways to reduce falls: with exercise, environment, and equipment. “The most consistent wins come from targeted strength and balance training, gait training, and smart use of assistive devices,” says Dr. Nawaz Khan. For Hopkins, an effective program focuses on five key areas: Strength Balance Proprioception, or the body’s sense of where it is in space Reaction time Flexibility Strength and Balance Exercises Physical therapists and fitness trainers can help you improve your balance and strength, making falls less likely to occur. They may use a number of methods, including: Balance Training Exercises like tai chi or specific balance exercises can improve your balance when standing and walking. Functional Training Many falls happen during "sit-to-stand" movements or when turning around quickly. A PT can help you learn to make these transitions more safely. Strength Building Core exercises and lower-body resistance training can help with balance and staying upright. Stretching Managing spasticity through daily range-of-motion routines. Hopkins suggests balance training with dynamic and varying terrain and environments, as well as focusing on “real-world” tasks. She also suggests practicing transitions, such as getting up, sitting down, changing direction. Nawaz Khan notes that incorporating exercises into your routine is key. “I recommend linking exercises to an existing habit, like after morning coffee or after brushing teeth, and using a simple checklist,” he says. “If fatigue is a major driver, we build pacing, cooling strategies, and rest breaks into the plan so it feels doable.” Nawaz Khan points out that activity should be matched with your day-to-day symptoms and energy levels. “The rule is challenge without chaos, meaning you should feel worked but not unstable,” he says. It’s also important to plan for your lifestyle. “Home programs should be focused on fitting into the person’s life vs. the other way around,” says Hopkins. They can also be simple. “Talk to a physical therapist and work on adding one simple strength or balance exercise,” Hopkins adds. Home Modifications There are several simple home modifications you can make to reduce the risk of falls, and many don’t require major renovations or a big investment. “Clear one risky area within the home and take baby steps. Don’t overwhelm yourself with too many changes at once,” says Hopkins. An occupational therapist can help you identify opportunities for simple changes in your own home. These can include: Removing throw rugs, clutter, and electrical cords from high-traffic areas of your home Increasing the brightness of lighting in hallways, and using motion-sensor night-lights for bathroom trips Installing grab bars in the shower and near the toilet, and using nonslip mats on the floor and in the shower Hopkins suggests using tape to mark step edges or room transitions to help avoid trips and stumbles. Some simple furniture rearrangement can also help improve the flow of movement from one room to the next. “Decluttering walkways, securing cords, and using a stable chair for dressing are simple wins,” says Nawaz Khan. “Keeping frequently used items at waist height reduces risky reaching or step-stool use,” Nawaz Khan adds. “Even changing footwear to supportive, nonslip shoes indoors can help.” Assistive Devices Physical and occupational therapists can help you identify whether an assistive device might be helpful, as well as how to use it. Assistive devices can include: Mobility aids, like a cane, walker, or trekking poles AFOs (ankle-foot orthoses), or specialized braces that help manage foot drop by keeping the foot elevated during a stride Smart footwear, like shoes with firm soles and adequate heel support instead of floppy slippers or high heels It’s important to be proactive about assistive devices: Don’t wait for a fall to occur before you consider them. “I frame aids as tools that protect independence, not a sign of failure,” says Nawaz Khan. “The goal is to prevent a fall that could take away months of mobility .” Assistive devices can also reduce fatigue, pain, and fear so you can do more safely, Nawaz Khan points out. “Using an aid is not a failure, but a tool and avenue to move more, live more, fall less, and stay safe,” says Hopkins. Partnering With Your Healthcare Team Work With Your Healthcare Team Hopkins recommends sharing your fall prevention plan with family, friends, and medical providers. ”Talk openly about concerns or if you have had a fall or ‘near-fall’ and build a support system,” she says. Here are some topics to discuss at your next appointment: Medication Review Ask if any of your current prescriptions (for pain, bladder, or sleep) cause dizziness or drowsiness as a side effect. Bone Health Discuss your bone density; if you do fall, strong bones prevent serious fractures. Ask if you’re a candidate for bone mineral density scan or if you should have your vitamin D level tested. Gait Assessment Ask for a formal evaluation by an MS-specialist PT to assess your walking pattern, particularly if you’re having increased pain or balance problems. Vision Check Ensure your glasses or contact lens prescription is up-to-date, and mention any changes you’ve noticed in your vision or eyes. Nawaz Khan and Hopkins both suggest talking to your team about your calcium levels, osteoporosis risk, and steroid exposure, as steroid use can weaken bones over time.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f2cfcbd6-c387-46ee-b921-e9872da43f3ce60dc2a1-f33c-4a05-9b50-8e3e8e5976293a929646-9be4-4854-b506-447c9ce9f617 Nawaz Khan and Hopkins note that certain conditions may increase fall risk, including: Diabetes Heart disease or rhythm issues Low blood pressure Arthritis Sensory deficits or paresthesias (tingling, numbness, or “pins and needles”) Sleep apnea Inner ear issues Vision or hearing loss Mental health issues, such as depression or anxiety It’s important to discuss this potential overlap with your care team. “I also watch for urinary urgency because rushing to the bathroom is a common fall scenario,” says Nawaz Khan. Hopkins also notes that fatigue and balance can change daily, and being aware of that is important. The Takeaway Because people with multiple sclerosis are at an increased risk of falling because of MS's effects on balance and coordination, addressing this proactively is important to maintain mobility. Simple balance and strength exercises and home modifications can significantly reduce the risk of falls. Assistive devices can help you prevent falls and maintain your independence. Talk to your healthcare providers about your medications, vision, and bone health as part of a comprehensive fall prevention strategy.