Walking poles are potential tools in the walking arsenal that people with MS might want to consider. These are adjustable-length ski pole–like shafts made of very light metal (such as titanium, carbon fiber or aluminum) with handles (called grips). Many have adjustable wrist straps and tips designed for walking on flat, steep or rugged terrain. Because they are used in pairs, poles—which lie between a cane and a walker on the continuum of assistive devices—offer increased balance, steadiness and support, according to Sue Kushner, PT, MS, associate professor of Physical Therapy, Slippery Rock University, Penn., who has spent much of her career working with people who have MS. “You can move a little faster, because bilateral support gives more stability and speed,” she said.
Studies suggest that poles reduce the force on joints and help distribute the body’s weight better, meaning less work for the legs, knees, feet, hip and back. Less stress on the lower body translates into less fatigue, a frequent symptom of MS.
“If you use poles instead of a cane, you may conserve energy,” Kushner said.
Courtesy of Jayah Faye Paley,
Jayah Faye Paley grew up in Florida, and when she moved to northern California in her 30s, took up mountain hiking. She found she “didn’t have the natural footing of people who grew up with it.” She does not have MS.
One day she met a fellow using poles, who was, she said, “poetry in motion on the trail.” She was so taken with both him (they married in 2003) and the poles that she made a career of teaching people to use them optimally. An ACE-certified personal trainer, Paley has created two training DVDs, including one for people with mobility challenges. “With minimal training—usually less than an hour—you can walk more fluidly and with a natural pattern because you recruit and strengthen the muscles that support and elongate the spine,” she said.
Other benefits, Paley added, are confidence and focus. “You are walking for exercise, not just strolling—the poles are consistent reminders to move better.”
“Talk to your physical therapist before you try them,” physical therapist Sue Kushner cautioned. Then choose poles based on your height, weight, hand size, issues (balance, for example) and your fitness or mobility goals.
“Make sure they’re the proper height—about waist level, a little higher than a cane—and a comfortable weight. If you’re using them all day, you do care about their weight, especially if you have any weakness in your wrist muscles,” Kushner added.
One drawback is that you can’t carry much with poles in both hands. However, a backpack is one possible solution.
Good poles cost about $90 to $140 and should last a lifetime.
Walkers: What’s Your Bad Weather Plan?
If walking is your favorite exercise, now is the time to plan ahead so winter doesn’t disrupt your regimen. Here are a few recommendations:
- In snowy or icy weather, avoid walking outdoors—even to take Fido out. A sudden tug on a slick sidewalk can send you flying. If you twist an ankle or tear a ligament, it can lay you up for a couple of months, plus you’ll have to do rehab. If you’re already weak, it might even put you into a wheelchair.
- Consider the great indoors! Mall-walking. Nearby gyms or YMCAs. Some offer monthly memberships that you can use during winter weather. Public schools or colleges. Call to find out if they are open to walkers in the evening.
- Consider using a walking device for extra assistance when it’s cold.
- Always choose supportive footwear with a good tread.
- Take advantage of clear days to get out; look for parks where walking paths have been cleared.
- Depending on your balance and skill level, cross-country skiing or ice skating can be fun and challenging ways to take advantage of winter weather.
The good news about planning a pregnancy when you have MS is that there’s no evidence that MS has any effect on fertility; pregnancy usually reduces exacerbations (although flares do tend to increase postpartum); and good outcomes are the norm.
Nevertheless, making the decision to get pregnant can be complicated, primarily because of the physical challenges of MS, says Barbara Green, MD, director of the West County MS Center, St. Louis. “I also suggest women think about and discuss with their partners the emotional and financial challenges of raising a child, which could affect work and managing the disease.”
Meds, pregnancy and MS
None of the disease-modifying drugs (DMDs) are approved for use during pregnancy, and most should not be taken for a few months beforehand. “The risk time is when you’re attempting to conceive,” noted Dr. Green. Plan a discussion with your neurologist about when to stop DMDs—and when, after delivery, to begin them again.
“Until recently, most studies were neutral about whether breastfeeding was protective in preventing relapses,” says Dr. Green. “But a new study quotes a beneficial effect on relapse. People with non-aggressive disease may be able to wait to resume DMDs, which can’t be taken while nursing.”
Include any symptom-management medications in the discussion with your doctor. From bladder problems to fatigue, pregnancy can make MS symptoms worse, yet many meds are not safe for pregnant women. “We advise people on non-pharmaceutical approaches: getting enough sleep, adjusting work schedules and exercising,” says Dr. Green.
“Symptoms during pregnancy are probably not MS—tiredness doesn’t mean your symptoms are coming back,” says Eileen Davis, APN, who has worked with people with MS for 12 years in New Jersey and New York. Keep exercising, she recommends, “so you aren’t carrying unnecessary weight post-pregnancy, which can affect symptoms such as falling.”
Connect the team
Connect your obstetrician and neurologist to coordinate your care. Visit www.nationalMSsociety.org/pregnancy for “Pregnancy, Delivery and the Post-Partum Period” to share with health-care professionals. If anesthesia is part of your birth plan, arrange a meeting with the anesthesia team. All forms of anesthesia are considered safe for women with MS.
Don’t wait to plan for what happens after delivery. Tap family and friends about helping with housework, food and, of course, watching the baby!
OK to Mix Pregnancy and MS
Research continues to confirm it’s OK to mix pregnancy and MS. A study published online in Annals of Neurology June 27, 2011, compared 432 births to women with MS and 2975 births to women without MS, confirming previous findings that, overall, the women with MS had normal pregnancies. The mean birth weight and gestational age of babies did not differ and women with MS were not at greater risk of adverse deliveries, including Caesarean sections.
It was the first study where researchers were able to control for other factors that could affect outcomes, such as disability levels, obstetrical history and body mass index.
Resources on MS and pregnancy
Check out the Society’s collection of videos, books, booklets and Web pages that you can download, or call us for free print copies.
“MS and Starting a Family”—Momentum, Winter 2010-2011 (click “Back Issues”).
The National MS Society follows Kara from her first trimester…
…all the way through to the birth of her baby boy.
Sixty-second videos packed with information on
- Beginning MS Therapy after Pregnancy
- Relapses During Pregnancy
- Breastfeeding with MS
- Support During and After the Pregnancy