Multiple sclerosis and muscle stimulation

What is multiple sclerosis?

Multiple sclerosis — abbreviated MS — is a chronic inflammatory disease of the central nervous system. By central nervous system we mean the brain and spinal cord, the areas that control your body's functions, from movement and sensation to thinking.

The long projections of nerve cells — called axons — are covered by a protective sheath known as the myelin sheath. This sheath plays a role similar to insulation on electrical wires: it allows nerve impulses to travel quickly and without interference along nerve pathways. If the insulation is damaged, the signal scatters and doesn't reach its target properly.

In multiple sclerosis exactly this happens. Your immune system — which normally defends you against pathogens — becomes dysregulated and begins to attack the myelin sheath. This condition is called an autoimmune disease because the body attacks itself. Because the myelin sheath is damaged, nerve signals travel more slowly or may not reach their destination at all, which causes the characteristic symptoms of the disease.

The exact cause of MS is still not completely understood, but researchers have identified several factors that may play a role.

The most common symptoms of MS

MS is called the disease of a thousand faces for a reason. Symptoms can be extremely varied and differ from person to person. The most common include:

• Muscle weakness and muscle stiffness (spasticity): Muscles become tense and stiff, making movement difficult.
• Fatigue: Pathological, disproportionate tiredness that is not explained by the activity performed.
• Balance and coordination problems: Walking becomes unsteady and dizziness is common.
• Numbness and tingling: Sensory disturbances in the limbs or trunk.
• Visual disturbances: Blurred or double vision due to inflammation of the optic nerve.
• Incontinence: Difficulty controlling urine or stool.
• Pain: Muscle- and nerve-originating pain.

Why is regular exercise vital in MS?

MS is not yet curable, but its symptoms can be managed and its progression slowed. Alongside medication, one of your most important tools is regular exercise. This is not merely a recommendation — it is essential!

Why? Because muscles that are not used quickly begin to atrophy. MS already makes movement more difficult, and if a sedentary lifestyle is added, a vicious circle develops: you move less, your muscles weaken, so movement becomes even harder, and so on. Regular exercise breaks this cycle!

Benefits of exercise in MS

• Preservation of muscle strength: Active muscles lose strength more slowly.
• Reduction of spasticity: Regular movement helps relax stiff muscles.
• Improved balance: Targeted exercises improve balance sense.
• Improved mood: Exercise releases endorphins, reducing the risk of depression.
• Reduction of fatigue: Paradoxically, regular training reduces pathological fatigue.

Useful tools for home exercise

For people with MS it is particularly important that exercise be gentle but effective. The following tools are excellent for this purpose:

• Elastic resistance bands and loops: These rubber bands provide variable resistance and help build muscle strength without having to lift heavy weights. You can use them sitting or lying down, and easily adjust the resistance to your current condition.
• Home ergometers: A stationary bike or elliptical trainer is an ideal tool for maintaining endurance. These devices are safe because you can use them sitting or holding on, which reduces the risk of falling. You can also control the load yourself.

The limits of voluntary movement

No matter how much you know exercise is important, MS can limit that movement. The essence of the disease is that nerve pathways originating in the brain are damaged, so voluntary movement commands do not reach the muscles properly.

What does this mean in practice? You may want to move your leg, but the muscle does not respond properly to the command. Or if it does respond, it fatigues faster than in a healthy person. Spasticity — abnormal muscle stiffness — makes things even harder because the muscle does not allow full range of motion.

This means that voluntary movement — however important — is not always sufficient on its own. This is where adjunct therapies come in, one of the most effective of which is electrical muscle stimulation.

Muscle stimulation: when muscles receive the impulse directly

Electrical muscle stimulation — EMS/NMES or Kotz stimulation — is a treatment method that acts directly on the muscles, bypassing the damaged nerve pathways.

How does it work? Normally your brain sends electrical signals through the spinal cord and nerves to your muscles, which then contract. In MS, this pathway is damaged. A muscle stimulator, however, delivers electrical impulses directly to the motor endplates of the muscle via electrodes placed on the skin, so they can activate the muscle even when the "upper" neural pathways from the brain are impaired.

It is important to understand: the muscle does not know where the impulse comes from. Whether the signal originates in your brain or from a stimulator device, the muscle contracts using exactly the same mechanism. The same metabolic processes occur, the muscle develops and strengthens in the same way, and it fatigues in the same way. If the contraction is the same, the effect is the same!

How does muscle stimulation help manage MS symptoms?

Reduction of spasticity (muscle stiffness)

In MS muscles often become stiff and tense, which hinders movement and can cause pain. Traditionally, strong manual mobilization is used to relieve this stiffness, which can be uncomfortable and traumatize the tissues. Electrical stimulation is a much gentler solution. Stimulation increases blood flow, relaxes the muscle and surrounding tissues, and reduces excessive activity of the motor nerve. As a result, the frequency of involuntary muscle spasms decreases and movement restriction is alleviated.

Maintenance of muscle strength and mass

The essence of a muscle is contraction. If a muscle does not contract for a long time, it begins to atrophy. Through muscle stimulation your muscles work regularly, even if you can no longer move them sufficiently voluntarily. This helps maintain muscle mass and strength.

Improvement of range of motion

Because of spastic muscles you often cannot use the full range of motion of your joints — for example your elbow or knee may not fully extend. Muscle stimulation can relax the muscles, allowing your range of motion to increase.

Treatment of incontinence

Incontinence — difficulty holding urine or stool — can be a secondary symptom of MS. It is caused by weakening of the pelvic floor sphincter muscles and disruption of their motor nerves. Functional muscle stimulation-treated MS patients report improvement in bladder and bowel function in 75–85% of cases.

Support for respiratory muscles

In wheelchair-bound MS patients the activity of the arm and chest muscles decreases, which can lead to breathing difficulties and an increased risk of respiratory infections. Functional stimulation helps maintain the strength of the abdominal and trunk muscles, improving coughing ability and respiration.

Prevention of pressure ulcers

Reduced mobility increases the risk of pressure ulcers (bedsores). By preserving muscle mass and tone, pressure is distributed more evenly over the skin, which reduces this risk.

What to expect from muscle stimulation — and what not to expect?

It is important to have a realistic view of what muscle stimulation can do! Electrical muscle stimulation does not cure multiple sclerosis. It does not restore damaged nerve pathways and does not eliminate the underlying cause of the disease.

What it can do is help you maintain your mobility for longer. That makes a huge difference to quality of life!

In the early stages of multiple sclerosis stimulation may even produce improvements for a while. Muscles can strengthen, spasticity may decrease, and mobility can improve.

As the disease progresses, it increasingly helps to slow the progression of symptoms. That too can be a very valuable outcome! If muscle stimulation helps you preserve your ability to walk for years longer, or delays the need for a wheelchair, that is a huge gain for your quality of life.

Technical notes

Warning! Multiple sclerosis attacks the central nervous system, and the type of paralysis it causes is central paralysis. Do not apply the so‑called denervated current treatment for this condition! Denervated current treatment increases muscle stiffness and spasticity, which can present as a clear deterioration from the patient's perspective.

For MS treatment, EMS/NMES (muscle stimulation) is appropriate, and the suitable waveform is a biphasic square wave.

Summary: the combined power of movement and muscle stimulation

Multiple sclerosis is a challenge, but it doesn't mean you must give up the fight for your mobility. Regular exercise — using elastic bands, resistance loops, or an ergometer — is essential for preserving muscle strength and quality of life.

When voluntary movement meets its limits, electrical muscle stimulation is an effective adjunct therapy. It delivers impulses directly to muscle fibres, bypassing damaged nerve pathways. It does not cure the disease, but it helps maintain muscle function, reduce spasticity, and preserve mobility for longer.

If you live with MS, talk to your doctor and therapist about the possibility of muscle stimulation. With the right device and regular use you can do a lot to maintain your independence and quality of life for as long as possible.