MS: Many Stories – From the MStranslate Community

Welcome to part 3 of a series of articles being written by MStranslate community member, Andrew.  You may remember Andrew from a video we featured in late 2016, introducing the potential benefits of pilates for people living with multiple sclerosis.  If you missed that feature, it can be revisited here.  Further, if you haven’t yet read parts 1 and 2 of this series, we’d encourage you to read them here and here, before proceeding with the insights below.

Why your muscles are tight

Apart from fatigue, the most common issue with MS is the tightness and lack of control over your muscles. Of course, not all muscles are the same. There are skeletal muscles, Cardiac muscle and smooth muscles. The first two are similar in structure and are made up of strands of thick and thin protein fibre called striated muscle. The strands bind to each other to create contraction and then release, sliding past each other, to create relaxation. Knowing how this happens if you have MS helps determine if you can enjoy any form of exercise and massage because you may need to influence it.

Smooth muscle is different to striated muscle. The action is different. You will find smooth muscles involved with the eye, the blood vessels, the respiratory tract, the alimentary canal, the urinary bladder, the uterus of women and the walls of organs that need to change shape to accommodate an expansion as well as contraction.

Pilates does not aim to influence those muscles, although indirectly it might. It is concerned with the skeletal muscle. You can work the cardiac muscle but the aim is controlling movement by influencing skeletal muscle.

Smooth muscle contractions are involuntary movements controlled by the autonomic nervous system. This system involves the spinal cord hence trauma to the myelin sheath can result in poor communication between the brain and the smooth muscle. This is fundamental for beat to beat control of systemic blood pressure and, very importantly, maintaining the supply of oxygen and nutrients as well as transporting end products in a process called tissue perfusion.

Whether you have problems with the tears in your eyes or your salivary glands right down to your reproductive organs you should look at the spine as it controls the communication for both the sympathetic and parasympathetic nervous systems and the action of the related smooth muscles.

Consequently the health of your spine and how flexible it is has a massive influence on the quality of the signalling functions it controls. The movement of your spine is controlled by skeletal muscle. Regaining control of that movement through Pilates will indirectly influence the quality of the action of smooth muscle.

Skeletal muscle

There are hundreds of skeletal muscles in the body. All with impossible latin names. As the name suggests, Skeletal muscles connect to the bone. If they connect to a part of bone with no joint it is called the origin. If the other part connects to a joint or a bone that can shift it is called an insertion. Muscles that originate below your shoulder might insert at your elbow. Contracting and relaxing these muscles moves your skeleton.

So what drives the movement of the phases of muscle contraction and relaxation? This is where ATP becomes involved again.

This is not supposed to be a science lecture so I’ll try to keep it simple.

Cells are full of holes called ion channels. Two elements, in particular, leak in and out of the cell: sodium and potassium. A fundamental role of ATP is to facilitate the maintenance of an equilibrium between them. If there is insufficient ATP the cell will gradually become clogged with Sodium. When the cell floods with Sodium it triggers the release of its stores of calcium that then pass through another ion channel (called the Ryanodine receptor) and signal the strands of striated muscle to lock together in a contraction phase. The bonds they form are called Rigor Bonds and they are immensely strong. Ironically, it is ATP that signals the bonds to break allowing the muscle strands to slide past each other in relaxation. So, not enough ATP ultimately triggers your skeletal muscles to lock up and lack of ATP means there is no signal for them to release. You are stiff.

What normally triggers a cell to flood with sodium to start a contraction is a neurotransmitter called acetylcholine. There are other neurotransmitters. They can be amino acids, Gasotransmitters like nitric oxide, Monoamines like dopamine or Seratonin or other molecules that can be made in or pass through a neuron to produce a response in a target. Acetylcholine is the primary neurotransmitter to trigger what has been described. Using antidepressants seems a relatively inefficient approach to me. It is how you control the release of calcium from the  cell and its role in Rigor bonds that is the issue.

There are a couple of common methods employed to influence this process. You can slow how fast Potassium leaves the cell with a potassium channel blocker such as Baclofen. Potassium has to flow out for Sodium to flow in. You can stop the neuro transmitter from reaching the target cell by using Botox or you can block the Ryanodine receptor so the calcium has less avenues to leave the cell using Dantrium (or magnesium or alcohol).

Whatever way you do it once you release a muscle you will discover how weak it has become. You can be so surprised by that weakness you think what you have done has made you worse. The truth is you have created the flexibility by releasing the rigor bond and can now exercise more efficiently. Like a Cosmonaut who has landed after a year in space, you are just profoundly weak at the start because you are not used to it.

My own preference is to block the Ryanodine receptor using Dantrium and a little magnesium. Baclofen has too many side effects and Botox sometimes misses the target. Dantrium is powerful, global and really works. You will be profoundly weak when you start using it. However, it didn’t really weaken you, it just showed how weak you actually are by making the extent of muscle contraction more normal. The answer to that weakness is to build eccemtric muscle strength and that is where Pilates excels.

The other thing to consider is the possibility of an Ischemic attack. As I mentioned earlier the autonomic nervous system operates through the spine. It has two components: The Sympathetic and Parasympathetic systems. They balance each other but in the event of a spinal trauma that balance can be awry. Signals can be misinterpreted by the brain and vasodilation can be affected leading both to hypertension and hypotension. If the blood vessels narrow, organs and muscles can be starved of oxygen affecting glycolysis at that site resulting in Pyruvate forming lactic acid rather than ATP for the Krebs cycle. This starvation of oxygen, if it persists creates an ischemic insult. The issue with ischemia is ATP will break down into its purines in the muscle cell. The muscle cramps. In the heart it would be angina. In other parts of the body it will be given a name ending in Syndrome. Reversing Ischemia is difficult if it is caused by a chronic condition.

Pilates

Pilates is a very special form of exercise. Normal strength building exercises rely on building bigger muscles by repetitively contracting the muscle. If you have MS that’s the last thing you want to do. You have enough problems with contraction already. Pilates focuses on building strength with the muscle in an elongated state.

When Joseph Pilates developed the method he called it Contrology. Each movement is deliberate and targeted at building durability in the extended muscle. A weight lifter will focus on contraction to lift the weight. The Pilates Instructor is interested in the control involved in returning weight to the start position as the muscles extend. That emphasis is why it is so loved by ballet dancers.

This note is way too long already. You will get an idea from the video. Eccentric exercise is a key plank in recovery when muscles are released. There is no point sitting in a chair, popping a pill and waiting for normality to return. You have to drive this process by relearning how to use your muscles.

Pilates is endlessly interesting, fun and addictive because you can start at any level. Some things you will excel at and others leave you completely confused but if you do it several times a week it will change your life.