If you're like many people with multiple sclerosis (MS), you may experience walking or gait problems. Perhaps you've felt a little unsteady or off-balance at times. Or maybe your knees buckle unexpectedly. If so, you aren't alone.

Walking problems affect most people with MS at some time in their life, leading many to avoid activities they once enjoyed. But you have options. There are many things you can do to improve your mobility, maintain independence, and live a fuller, more active life.

"Just like numbness or vision changes, difficulty walking is a symptom of MS," explains Karen Blitz, D.O., director of the Multiple Sclerosis Center at the Cushing Neuroscience Institutes in New York and director at the North Shore-LIJ Multiple Sclerosis Care Center. "And although we can't predict how each person's mobility will be affected, we do know that how you manage the problem can make a difference. People who advocate for themselves and take an active role in their treatment have the power to improve their symptoms."

What Causes Mobility Problems?

There are many types of mobility problems that can occur in people with MS, depending on what part of the brain is affected. Common issues include:

• Lack of balance or coordination

• Spasms or stiffness in the legs

• Leg weakness, which can lead to buckling knees or "foot drop"—difficulty lifting one or both feet fully while walking

• Sensory problems such as numbness of the foot

• Fatigue that can decrease walking stamina

Dr. Blitz advises anyone experiencing a mobility problem, however small, to get evaluated by a physical therapist who specializes in MS-related issues. Seeking help early can not only improve your quality of life, but also prevent more serious mobility problems from developing.

"Ask your neurologist for a referral to a physical therapist who focuses on people with MS," says Dr. Blitz, who has the unique perspective of having worked as a physical therapist before becoming a neurologist. "Although your doctor is an expert in treating MS as a whole, a physical therapist is specifically trained to evaluate and treat gait dysfunction."

Reaping the Benefits of Therapy

Once the underlying causes of your mobility problems are evaluated, the physical therapist can develop exercises tailored to your needs. These may be focused on increasing leg strength, improving balance, and boosting endurance. If your mobility is limited by fatigue, you can learn energy-conserving techniques.

"Some people with MS believe exercise is dangerous," notes Dr. Blitz. "On the contrary, there's usually no reason that someone with MS shouldn't exercise as long as they stay hydrated and avoid overheating. In fact, exercise is one of the best ways to stay mobile."

Embracing Assistive Devices

In addition to exercise, a rehabilitation specialist or physical therapist can recommend and teach you how to use assistive devices that aid in mobility. There are many to choose from, based on your individual needs.

For example, people who have foot numbness can benefit from using a cane. People with fatigue may benefit from attending an endurance training program or possibly using a scooter. For those with foot drop, a brace called an ankle-foot orthotic (AFO) can help with walking. There are also newer devices that send electrical signals to the nerves responsible for signaling muscles to lift the foot.

"Some people are fearful that if they start using an assistive device, their mobility problems will get worse. Not so," says Dr. Blitz. "By having the tools to use when you need them, you'll be able to improve your walking ability and do more of what you love."  

Exploring the Use of Medication

Although medication shouldn't take the place of physical therapy and exercise, it may help some walking problems. Medications such as baclofen and tizanidine (Zanaflex) can reduce leg spasms and stiffness. And a new drug called Ampyra (dalfampridine) has been shown to improve mobility in some people with MS. Your doctor can tell you if you're a good candidate for drug therapy.