Here is My Question:
Under what circumstances is Trendelenburg sign / gait seen in the MS setting? Does it ever occur with footdrop? In a patient catching toe when walking, is the catching possibly related to the hip drop? What would cause Trendelenburg sign if related to MS? What are the differential diagnoses? 

Answer:
The Trendelenburg sign is a term used to describe a type of gait deviation. It can be seen in anyone, and is associated with weakness of the hip abductor muscles. It can occur with foot drop, but both can occur independently of each other as well. A Trendelenburg sign is not the cause of a foot drop. Foot drop either occurs due to weakness in the tibialis anterior muscle, spasticity of the plantarflexors (calf muscles) or sometimes can be more pronounced with weakness of the hip flexors (not abductors). Differential diagnosis would be muscle strength testing (MMT) of the lower extremities, to determine which muscle groups are weak.
 
Sarah Frank, PT, DPT, MSCS
Outpatient Rehab
Mt. Sinai Rehabilitation Hospital
490 Blue Hills Ave.
Hartford, CT 06112

Here is My Question:
Having MS for almost 30 years, I know very well the importance of PT, exercising and stretching. Due to some health problems I have not been doing my calf stretches. My calf muscles are very, very tight. I was just getting back to my stretching routine, when I started getting pains in my right inner upper leg. It is now also in my lower back. Can this be from lack of stretching? I have had tests, and it is not my hip nor a bladder-kidney infection. Can it possibly be muscle related from tightness ? Thanks

Answer: 
The pains you are feeling can definitely be related to muscle tightness in the muscles of the inner thigh and in the back; especially if you spend the majority of the day sitting. Also, if you are altering the way you walk because of the stiffness in your legs, that could also be a potential cause of the increase in tightness. If you are someone who has spasticity, you may also be experiencing an increase in spasticity to those regions. If any of  these are the reason for your pain, stretching will help!
 
​Sarah Frank, PT, DPT, MSCS
Outpatient Rehab
Mt. Sinai Rehabilitation Hospital
490 Blue Hills Ave.
Hartford, CT 06112

Recently we had a question about tips for exercising in the heat.  We had a few more tips come in so we added them...so here they are...

http://www.healthcarejourney.com/q--a-for-virtual-ms-center/exercising-in-the-summer-and-ms

Here is My Question:
What would be considered "normal" amount of trips/falls? In the past 30 days I have broke a finger at the joint, broke a toe, and acquired a nasty burn while cooking.. I use a variety of mobile devices depending on the day's needs. I try to find balance between doing what I can without aid, and using aid when it is necessary. How does one challenge themselves, and not get hurt so often? I am not willing to "throw in the towel", and feel if I don't fight with all I have, I will be full time wheel chair sooner than necessary. Am I thinking incorrectly?

Answer:
The honest answer to your question is that no falls would be the “normal” amount of falls for someone to have. Having had 3 falls in one month is concerning, especially because you have had some injuries as a result of the falls.

My first recommendation is to ask yourself a few questions:

1. Do you have any new MS symptoms?
2. What are you doing when you have fallen?
3. What time of day is it?
4. Are you tired?
5. Are you walking in a cluttered or busy area?
6. Are you distracted?
7. Have you had any medication changes in the last month?

I also recommend you call your neurologist and report the recent increase falls as well as your injuries.  If you are having new MS symptoms you should report those as well. If you aren’t having new symptoms, it is still important to determine the potential causes of your falls, so you can correct them! There are a lot of different reasons why you may be falling, and it is important to determine what the reason is. The neurologist can rule out a medical cause of the falls (MS exacerbation or medication changes) and can also refer you to a physical therapist. A physical therapist can help determine non-medical reasons for why you might be falling (muscle weakness, impaired gait or impaired balance) and teach you ways to help prevent falls in the future.

Often times preventing a fall can be as simple as making modifications to your environment, or being more mindful of what you are doing.  Sometimes it’s a matter of using the “right device/aid” depending on the task you are doing! I certainly can understand your mindset of “not wanting to throw in the towel” but there are definitely ways you can be safer without giving up and becoming wheelchair bound!!!

The following link will provide a PDF brochure from the National MS Society which provides excellent information about minimizing risk of falls!  It provides information on reasons why people fall and how you can modify your environment and daily activities to minimize your risk of falling!  It is a wonderful resource, but would best be used in conjunction with physical therapy!

http://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Brochure-Minimizing-Your-Risk-of-Falls.pdf

Falls are not something to be taken lightly! As I tell my patients; you have enough to manage with your MS alone, you don’t need any broken bones or head injuries on top of that!!!! I hope this helps answer your question, and gives you faith that you can be safe without giving up your mobility and independence! Hope this helps.

Sarah Wargo,PT,DPT,MSCS
Outpatient Rehab
Mt. Sinai Rehabilitation Hospital
490 Blue Hills Ave.
Hartford, Ct. 06112