Kinesitherapy for Multiple Sclerosis and Fibromyalgia

---

After both experiencing worsening pain following kinesitherapy, we decided to try hydrotherapy. At that time, my partner was already struggling to walk and had to use a wheelchair due to the severe pain from her fibromyalgia. We began hydrotherapy in a warm climate, committing to it for three months. After a few weeks, we started to notice a difference and were able to walk short distances with less pain. Now, after a year of hydrotherapy, we are able to walk several kilometers with reduced pain and fewer complications from our conditions.

Hydrotherapy can be a highly effective therapeutic approach for people with multiple sclerosis (MS) and fibromyalgia, as it combines the benefits of water-based exercises with the support and resistance water provides. The properties of water can help alleviate some of the difficulties MS and fibromyalgia  patients face with traditional exercise.

• Buoyancy: Water supports the body’s weight, reducing the strain on muscles and joints, making it easier to perform movements without overexertion.
• Reduced Muscle Spasticity: The warmth of the water can help to relax muscles, reducing spasticity, a common symptom in MS and Fibromyalgia.
• Improved Balance and Mobility: Exercising in water enhances balance and coordination, allowing people with MS and Fibromyalgia to practice movements in a controlled environment without the risk of falls.
• Cooling Effect: Hydrotherapy helps prevent overheating, which is crucial for MS and Fibromyalgia patients who are sensitive to heat. The coolness of the water helps regulate body temperature, reducing the risk of heat-triggered symptom flare-ups.
• Increased Endurance: Water provides natural resistance, helping improve strength and endurance without causing the fatigue associated with land-based exercises.
• Pain Relief: Water can reduce joint pain and stiffness, offering relief to those dealing with chronic pain associated with MS and Fibromyalgia.
   

Hydrotherapy provides a low-impact, effective way for people with MS and Fibromyalgia to exercise and manage symptoms, especially when mobility and balance issues limit other forms of activity.

Beta-blockers are sometimes used in the treatment of Postural Orthostatic Tachycardia Syndrome (POTS), a condition that affects the autonomic nervous system and leads to a rapid increase in heart rate when moving from a lying to a standing position. POTS is often associated with symptoms such as dizziness, lightheadedness, fatigue, and sometimes fainting upon standing.

How Beta-Blockers Help with POTS:

• Heart Rate Reduction: In POTS, the heart rate increases abnormally when standing. Beta-blockers can slow the heart rate by blocking the effects of adrenaline, helping to prevent the excessive tachycardia (rapid heartbeat) that POTS patients experience.

• Symptom Management: By reducing heart rate, beta-blockers can also alleviate symptoms like palpitations, lightheadedness, and chest discomfort that occur with POTS.

• Improving Blood Circulation: Some beta-blockers may improve blood flow by relaxing blood vessels, which can help with the dizziness and fatigue caused by poor blood circulation in POTS.

Common Beta-Blockers Used for POTS:

• Propranolol - Often prescribed at a low dose because it’s non-selective and can reduce the heart rate and adrenaline response.

• Metoprolol or Atenolol - These are selective beta-blockers that specifically target the heart and are often used in POTS patients who need more control over their heart rate.

Things to Consider:

• Dosing: For POTS, beta-blockers are typically prescribed at lower doses than for hypertension or heart conditions, because a higher dose may reduce heart rate too much or worsen symptoms like fatigue and low blood pressure.

• Effectiveness: Not all patients with POTS respond well to beta-blockers. Some may find them very effective for controlling heart rate and symptoms, while others may experience worsening fatigue or low blood pressure.

• Side Effects: Potential side effects of beta-blockers include fatigue, cold extremities, dizziness, and, in some cases, worsening orthostatic symptoms if blood pressure drops too low.

TALK ALWAYS WITH YOUR HEALTHCARE PROVIDER!!

If beta-blockers aren’t helping you manage your POTS (Postural Orthostatic Tachycardia Syndrome), there are several reasons this could happen, and alternative approaches may be needed. Here are some possible explanations and suggestions to consider: 

Ineffective Dose or Type of Beta-Blockers:

• Low dose: Beta-blockers are usually prescribed at lower doses for POTS to avoid dropping blood pressure too much, but it’s possible that the dose you’re taking isn’t sufficient to control your heart rate.

• Type of beta-blocker: Different beta-blockers (e.g., propranolol, metoprolol, atenolol) affect the body in unique ways. If the beta-blocker you're using is not selective enough or doesn’t suit your symptoms, trying another type might help. For example, short-acting propranolol has been found effective in some POTS patients, while atenolol is more cardio-selective and may work differently.

Low Blood Pressure Worsening Symptoms:

Beta-blockers can reduce blood pressure, which can be problematic for POTS patients who already have low blood pressure (hypotension). This can worsen dizziness, fatigue, and lightheadedness when standing. If your blood pressure is too low while on beta-blockers, other medications or treatment approaches might be more suitable.

Autonomic Dysregulation Beyond Heart Rate:

POTS involves more than just elevated heart rate—it also affects blood vessel constriction and blood flow. Beta-blockers primarily target heart rate but might not be addressing other autonomic dysfunctions that cause symptoms like dizziness, fainting, and fatigue. In these cases, additional treatments could be necessary.

Re-Evaluating Diagnosis or Comorbidities:

If you have other conditions alongside POTS (like Ehlers-Danlos syndrome, autoimmune disorders, or mast cell activation syndrome), they might be complicating your response to beta-blockers. In this case, a tailored treatment plan that addresses these other issues might be necessary.

REMINDER!! TALK ALWAYS WITH YOUR HEALTHCARE PROVIDER!!

 During a 4 km walk, one year ago my heart rate would reach 234 beats per minute (BPM), making the activity extremely difficult and uncomfortable. Now, after improvements in my condition and treatment, my heart rate remains at 129 BPM while doing the same walk in the same location. This significant reduction in heart rate during the same activity has made the walk much easier and safer for my overall health. 

How Propranolol Works in POTS:

• Slows Heart Rate: By blocking the effects of adrenaline, propranolol reduces the exaggerated heart rate increase that is characteristic of POTS when standing.

• Short-Acting Relief: Some studies suggest that low-dose, short-acting propranolol can be particularly effective for POTS patients, providing relief without causing excessive fatigue or dropping blood pressure too much. The benefit often comes from using small doses (e.g., 10-20 mg) as higher doses might lead to side effects like dizziness or fatigue due to overly reduced heart rate.

Propranolol Dosage in POTS:

• Low dose (usually 10-20 mg once or twice daily): This is often recommended because it can reduce heart rate without significantly lowering blood pressure, which is critical since many POTS patients already struggle with low blood pressure.

• Higher doses (40-80 mg or more): Higher doses may reduce heart rate too much, causing fatigue, dizziness, or worsening of orthostatic symptoms (e.g., fainting when standing).

Potential Benefits of Propranolol in POTS:

• Heart Rate Control: It helps reduce palpitations and the discomfort of a racing heart when standing.

• Symptom Reduction: Some patients experience a decrease in lightheadedness, fatigue, and chest pain once their heart rate is under control.

Potential Drawbacks:

• Blood Pressure Drop: If you already have low blood pressure, propranolol can worsen symptoms like dizziness or fainting, especially at higher doses.

• Fatigue and Weakness: Propranolol can slow the heart rate too much, leading to excessive fatigue, sluggishness, or difficulty with exercise and daily activities.

• Individual Variability: Some POTS patients find propranolol very effective, while others experience minimal benefit or worsening of their symptoms (e.g., worsened fatigue).

Key Considerations:

• Start with low doses to minimize side effects and assess how it impacts both heart rate and blood pressure.

• Monitor symptoms closely, particularly for worsening fatigue, dizziness, or low blood pressure.

• Discuss with your doctor if propranolol doesn’t work for you, as there are other medications or combination therapies that may be more effective for your specific case of POTS.

REMINDER!! TALK ALWAYS WITH YOUR HEALTHCARE PROVIDER!!