Member question:

I was just recently diagnosed with MS, but I'm also very accepting and ready to move forward - especially in my triathlon training and I would love input and training tips. Other then feeling off-balance and weakness in my hands, I feel pretty good and am looking forward to starting the prednisone treatments so I can get started with training....that’s where I need the help…just hoping to find someone out there whom is also either going through the same thing or at least has experience in it.

Geoffrey S. Kuhlman

Member AMSSM

I appreciate your commitment to your health and your motivation to pursue triathlons with multiple sclerosis. Here are some thoughts to guide your training.

Muscle weakness, which you note in your hands, will come and go. When specific muscles feel weak, reduce exercising them and focus energy and time on other muscle groups. When the weakness subsides, work on strengthening those muscles that felt weak.

Weak muscles can become tight. With multiple sclerosis, muscles can become very tight to the point of contracture, which can be challenging to overcome. Have a stretching routine for each major muscle group. Stretch after each work out, when muscles are warm and easier to stretch. Consider yoga to work on both flexibility and balance.

Multiple sclerosis affects your balance. Be careful running on uneven surfaces where you might twist your ankle or fall. On your bike be careful with sharp turns. Incorporate balance training into your routine, such as exercises on one foot.

Fatigue is common with multiple sclerosis. Too much exercise can worsen fatigue. You will need to learn the amount of exercise your body tolerates without worsening fatigue.

Acute flare-ups of multiple sclerosis symptoms are common. During flare-ups, your body needs energy to recover. Exercise can prolong the episode. At these times, reduce exercise to prevent the flare from worsening. Focus on maintaining flexibility, improving balance, and recovering from the flare.

Finally, prednisone can be a tremendous help to control symptoms, but over time it can weaken bone and predispose you to developing stress fractures. Work with your physician to monitor your bone density, and get adequate calcium and vitamin D. Most vitamin D experts recommend 1000 mg of calcium and 2000 units of vitamin D daily.

Geoffrey S. Kuhlman, MD, FAAFP, CAQSM