With a big hat tip to the ALS ice bucket challenge, we at FYZICAL thought we would take a closer look at the role of the physical therapist for the patient with ALS (amyotrophic lateral sclerosis or Lou Gehrig’s Disease).
While exercise and physical therapy are commonly seen as helping to strengthen muscles and improve neurological and orthopedic conditions there is still little research on Physical Therapy and the effects on progressive neurodegenerative diseases like ALS. That aside, there are some universal truths to exercise prescription that can be of benefit for patients with ALS.
First off, exercise provides stress relief as well as physiological and psychological benefits. In earlier stages of ALS, especially when coming to terms with a diagnosis, these can be very important components to coping and moving forward.
Second, stretching and range of motion can decrease spasticity and prevent contractures that can develop and be quite painful in later stages of the disease progression. Early and continued daily stretching can combat this. It is also recommended that assisted stretching be continued in later stages of the disease as the patient becomes less mobile.
Finally, strength training can prevent muscle atrophy. Strength training tends to be the big debate when it comes to physical therapy for a patient with ALS. The truth on the other side of this is that over-fatiguing a muscle can further weaken it and many therapists worry that muscles already weakened by ALS will have no benefit from strengthening. Based on these truths, any strengthening program for someone with an ALS diagnosis should be approved by a doctor and supervised by a physical therapist, preferably with experience treating this population.
So, what does all this mean for the patient???
There are some key components for exercise and therapy for those with ALS and they should be re-assessed at different stages of the disease.
In early stages, walking or bicycling can provide some positive exercise effects. Stretching should become part of the daily routine and a mild general strengthening routine as approved (never to point of muscle fatigue).
As the disease progresses stretching and range of motion will become more and more important and may require caregiver assistance.