Is Pilates Safe for Multiple Sclerosis (MS)? What a Physical Therapist Wants You to Know
What Is Multiple Sclerosis (MS)?
Every movement in your body begins with an electrical signal. These signals then reach your muscles, telling them when to contract, relax, and produce movement.
In a healthy nervous system, your brain sends electrical messages through nerve pathways in the brain and spinal cord. Nerve structures are like electrical cords. Just as a wire has insulation around it to help electricity travel efficiently, nerve fibers are wrapped in a protective coating called myelin. This myelin allows messages from your brain to travel quickly to your muscles.
In Multiple Sclerosis, the immune system mistakenly attacks this protective insulation, disrupting how efficiently these messages travel throughout the body. When these messages from brain to muscle are affected, it can show up in many different ways, including:
Muscle weakness
Fatigue
Changes in balance and coordination
Numbness or tingling
Muscle stiffness or spasticity
Vision changes
Difficulty with walking or performing everyday activities
If you know someone living with MS or are familiar with the disease, you may or may not have noticed that one person’s symptoms can look very different from someone else's. Part of this is because MS exists on a spectrum and is categorized into four subtypes, each with its own pattern of symptom progression. If you'd like to learn more about the different types of MS, you can read more here.
Is Exercise Safe for People with Multiple Sclerosis?
For most people living with MS, exercise is safe and encouraged. However, how much, how hard, and when you exercise matters.
One side effect of MS is that heat and overexertion can amplify symptoms. This might look like increased weakness, heaviness in the legs, blurred vision, dizziness, or feeling more unsteady than usual.
A few strategies can help make exercise feel more manageable:
Exercise during the cooler parts of the day.
Stay well-hydrated and keep your environment cool.
Incorporate rest breaks and pace activities as needed.
Focus on consistency rather than pushing to exhaustion.
More exercise is not always better. We're training for resilience, not exhaustion. Just like medication has a dosage, exercise has a dose, too.
I hope this doesn’t scare you or your loved one with MS to avoid exercise. Exercise for someone living with MS should be individualized, adaptable, and dosed appropriately for current symptoms and energy levels. In my sessions, we're looking for the right amount of challenge, the sweet spot where your body can build strength without a change in symptoms. Working one-on-one with a PT or coach/instructor trained in neurological conditions can be very valuable to your quality of life.
Why Pilates Works Well for People Living with MS
The list of benefits seems endless, but here are my top 5 reasons why people living with Multiple Sclerosis should practice Pilates.
1. Posture
Improved upper back mobility & rib cage expansion → More efficient breathing → Better oxygen delivery during activity → Reduced unnecessary energy expenditure → Improved endurance
What does this mean? If breathing mechanics are inefficient, everything feels harder. Improving the mechanics of breathing can make everyday tasks feel less taxing.
2. Motor Control
This is huge in MS. In Pilates, we develop awareness of where the body is in space, a concept we call proprioception. We focus on the quality of the movement through the entire range of motion, particularly in the positions where the body tends to lose alignment, substitute with compensatory strategies, or lacks the strength and coordination to move efficiently.
What does this mean? Pilates teaches your body how to move intentionally instead of relying on compensatory patterns that can make movement feel more effortful.
3. Movement Variability
This is such an underappreciated aspect of Pilates for neurological populations! One movement or muscle group can be performed in a variety of positions and with different Pilates apparatus. This allows for graded exposure (i.e., baby steps) to new challenges and opportunities to adapt to changing demands. I find that clients across all populations are generally very challenged with coordination-based exercises and enjoy the chance to be curious with new movements.
4. Improved Circulation and Muscle Pump Activity
Exercising on the Pilates reformer creates a rebound effect and joint decompression by way of weighted springs gliding the carriage, the part of the machine you have contact with. It creates a rhythmic movement and a muscle pumping action that helps improve lymphatic circulation. When our bodies use oxygen through our circulatory system more efficiently, many symptoms of fatigue subside.
5. Balance and Fall Prevention
Research consistently shows that fear of falls and fall incidents act as the biggest barrier to exercise for people with Multiple Sclerosis. In Pilates, we challenge balance in transitional movements, like rolling from sidelying to sitting or moving from low to high kneel, in single-leg exercises, and when shifting weight between various surfaces and body parts. Regardless of the apparatus chosen for your session, Pilates places a strong emphasis on being able to stabilize one region of the body while another part moves. This means your body is learning to stay steady and controlled while performing the movements that make up everyday life.
When your body moves with better alignment, breathing mechanics, and coordination, everyday activities often require less energy expenditure.
How Pilates Can Be Modified During an MS Flare-Up?
A flare-up doesn't automatically mean you need to stop moving, but it may mean you need to change what your normal exercise routine is.
A good rule of thumb is to pay attention to your symptoms. If movement is causing profound weakness, dizziness, worsening balance, vision changes, or a substantial increase in fatigue that doesn't improve with rest, it may be a sign that your body needs additional recovery and you should discuss your symptoms with a healthcare provider before proceeding with exercise.
On the other hand, if you experience these mild symptoms, modified exercise may actually make you feel better and are not contraindicated:
Stiffness
Mild fatigue
Feeling “off"
Being less active because of your symptoms
Unsteadiness
Some of my favorite classical Pilates exercises can be modified and tolerated for this population, particularly during symptom flares:
Breathing and rib cage expansion exercises
Pelvic clocks or gentle pelvic tilts
Bridging
Mermaid stretches
Feet in straps
When Should Someone with MS See a Physical Therapist?
Pilates can be a valuable piece of living well with MS, but when symptoms begin affecting your safety, mobility, or day-to-day function, a physical therapist should be involved in your care.
Consider seeing a physical therapist if:
You've experienced a fall, near-fall, or feel increasingly unsteady on your feet.
Your symptoms are becoming more severe, lasting longer, or taking longer to recover.
You're noticing new weakness, changes in walking, increased fatigue, or difficulty performing everyday activities.
Your current exercise routine no longer feels appropriate or your symptoms are becoming more difficult to manage.
Physical therapists also play an important role in communicating with your healthcare team. If there are meaningful changes in your function or symptoms, your PT can collaborate with your neurologist and other providers to discuss current symptom management.
Getting Started with Pilates for Multiple Sclerosis in San Diego
Living with MS doesn't mean you need to avoid exercise or push through exhaustion. The right exercise program should adapt to your symptoms and help you move with greater confidence.
I’m Camille, and I'm a Doctor of Physical Therapy and Pilates instructor. I specialize in one-on-one, individualized care. My sessions combine principles of rehabilitation and Pilates to help clients improve movement quality, strength, balance, and confidence while respecting symptom fluctuations and energy levels.
If you've been diagnosed with MS and aren't sure where to start, you don't have to figure it out alone. Whether you're newly diagnosed, returning to exercise after a flare-up, or looking for guidance on how to move safely and confidently, an individualized approach can make all the difference. I’d love to be a part of your team. MS looks different for everyone, and your exercise program should too.