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Gait variability - how someone's way of walking can change with MS

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This paper is a review of how the way that someone walks can vary more if they have MS. Factors that can vary include step length and the angle of the hip, knee or ankle. When walking further, other factors, including fatigue, play a part.


Many people with MS have some difficulties with walking. These difficulties may have a significant impact on quality of life for someone who is more severely affected. However, for some people, the changes in their walking are more variable and subtle but may result in more stumbling or tripping than usual.

How this study was carried out

This paper is a review of previously published research on how gait (the way someone walks) varies in people with MS. It aims to draw together all the available data to explain why people with MS, on average, experience more variability in their gait than people who do not have MS.

Walking is a complicated process which involves coordinating several systems:

  • the central nervous system (to send messages from the brain to move the muscles and to monitor and coordinate movement and balance)
  • the many muscles involved in walking and the underlying skeleton (which all need to move in the correct sequence)
  • the cardiovascular system (so that the heart can pump oxygen and nutrients around the circulation to power movement)

All of the time, the brain is monitoring what is happening so that it can refine movements and keep the body upright.

What was found

The researchers divided their analysis into gait variability during a short walk or a longer walk.

Most research had looked at short walks (less than 10 metres/33 feet). It had been found that, over a year, there was quite a large (20%) natural variation in walking ability on the 25 foot walk performance test so this was considered as the background level of variability. If the variation was more than 20% over a year then this represented a significant change in someone's walking. Those with greater disability had more variation in their walking.

Particular aspects of walking that seemed to vary were step length, the time taken for each step and the angle of the hip, knee or ankle. Step width was not affected.

On longer walks (typically six minutes long), other factors came into play towards the end of the walk. In particular, people who used walking sticks or other assistance had much greater variation in step time, length and width in the last two minutes of the test as compared with the first two minutes. The authors suggest that this may be due to changes in stability and increasing fatigue.

What does it mean?

The authors suggest that variations in walking are due to a combination of factors:

  • there may be an increase in background noise in the signal passing down the nerve to the muscle
  • Fatigue (for longer walks)
  • Decreased muscle strength
  • Difficulties with balance and proprioception (the ability to unconsciously know the position of the body, its posture and how it is moving)
  • Spasticity (muscle stiffness)
  • Cognitive difficulties especially lack of attention

Gait variability is associated with falls in the elderly and the same may be true for people with MS. In addition, having a more variable gait will probably use more energy to walk a given distance as it will be necessary to correct the foot if it has been placed poorly. Using more energy is likely to lead to fatigue and fatigue, in turn, leads to increased gait variability which needs even more energy. This gives rise to a vicious cycle where walking further becomes increasingly difficult.

Socie MJ, Sosnoff JJ.
Gait variability and multiple sclerosis.
Mult Scler Int. 2013;2013:645197.
Read the full text of this paper

More about walking difficulties

Walking problems vary considerably from one person with MS to another. Common difficulties are:

  • Unsteadiness on walking or turning
  • Slower, shorter steps
  • Less confidence
  • Needing support from walls, furniture, other people or walking aids
  • Tripping and stumbling
  • A heavy feeling in the legs when stepping forward
  • Weakness of the leg when weight is on it
  • Difficulty placing the foot on the ground

The reasons behind difficulties with walking vary widely. They include spasticity (muscle stiffness), spasms and muscle weakness. Sometimes, the causes are less obvious such as numbness, which can make it difficult to feel the floor properly, or sight problems, including double vision.

Being able to walk is central to many activities of every day life so it is important to consult a health professional such as a GP, MS nurse or physiotherapist about any walking difficulties. Treatment will depend on what is causing the underlying problem.

You can read more about walking difficulties in the A to Z of MS.

Research by topic areas...

Symptoms and symptom management

Stepleman LM, Decker M, Rollock M, et al.
Depression screening in Black Americans with multiple sclerosis.
Psychol Health Med. 2013 Mar 20.[Epub ahead of print]

MS relapses

Meca-Lallana JE, Hernández-Clares R, León-Hernández A, et al.
Plasma exchange for steroid-refractory relapses in multiple sclerosis: an observational, MRI pilot study.
Clin Ther.2013 Mar 26. doi:pii: S0149-2918(13)00110-0. 10.1016/j.clinthera.2013.02.027.[Epub ahead of print]

Disease modifying treatments

Zarbin MA, Jampol LM, Jager RD, et al.
Ophthalmic evaluations in clinical studies of fingolimod (FTY720) in multiple sclerosis.
Ophthalmology. 2013 Mar 23. doi:pii: S0161-6420(12)01262-6.10.1016/j.ophtha.2012.12.040. [Epub ahead of print]

Jokubaitis VG, Spelman T, Lechner-Scott J, et al.
The Australian multiple sclerosis (MS) immunotherapy study: a prospective, multicentre study of drug utilisation using the MSBase platform.
PLoS One. 2013;8(3):e59694.
Read the full text of this paper

Other treatments

Paoloni M, Giovannelli M, Mangone M, et al.
Does giving segmental muscle vibration alter the response to botulinum toxin injections in the treatment of spasticity in people with multiple sclerosis? A single-blind randomized controlled trial.
Clin Rehabil. 2013 Mar 29. [Epub ahead of print]


Taylor BV, Palmer A, Simpson S Jr, et al.
Assessing possible selection bias in a national voluntary MS longitudinal study in Australia.
Mult Scler. 2013 Mar 25. [Epub ahead of print]

Hollingworth S, Walker K, Page A, et al.
Pharmacoepidemiology and the Australian regional prevalence of multiple sclerosis.
Mult Scler. 2013 Mar 25. [Epub ahead of print]

Bove R, Secor E, Healy BC, et al.
Evaluation of an online platform for multiple sclerosis research: patient description, validation of severity scale, and exploration of BMI effects on disease course.
PLoS One. 2013;8(3):e59707.
Read the full text of this paper

Kister I, Chamot E, Cutter G, et al.
Increasing age at disability milestones among MS patients in the MSBase Registry.
J Neurol Sci. 2012 Jul 15;318(1-2):94-9.

Assessment tools

Askew RL, Kim J, Chung H, et al.
Development of a crosswalk for pain interference measured by the BPI and PROMIS pain interference short form.
Qual Life Res. 2013 Mar 29. [Epub ahead of print]

Hobart J, Blight AR, Goodman A, et al.
Timed 25-Foot Walk: Direct evidence that improving 20% or greater is clinically meaningful in MS.
Neurology.2013 Mar 27. [Epub ahead of print]

Freeman J, Walters R, Ingram W, et al.
Evaluating change in mobility in people with multiple sclerosis: relative responsiveness of four clinical measures.
Mult Scler. 2013 Mar 25. [Epub ahead of print]

Wagner JM, Norris RA, Van Dillen LR, et al.
Four Square Step Test in ambulant persons with multiple sclerosis: validity, reliability, and responsiveness.
Int J Rehabil Res. 2013 Mar 18. [Epub ahead of print]

Quality of life

Baumstarck K, Boyer L, Boucekine M, et al.
Measuring the quality of life in patients with multiple sclerosis in clinical practice: a necessary challenge.
Mult Scler Int. 2013;2013:524894.
Read the full text of this paper

Paediatric MS

Till C, Racine N, Araujo D, et al.
Changes in cognitive performance over a 1-year period in children and adolescents with multiple sclerosis.
Neuropsychology. 2013 Mar;27(2):210-9.

Psychological aspects

Firth N.
Effectiveness of psychologically focused group interventions for multiple sclerosis: A review of the experimental literature.
J Health Psychol.2013 Mar 21. [Epub ahead of print]

Ruet A, Deloire M, Charré-Morin J, et al.
Cognitive impairment differs between primary progressive and relapsing-remitting MS.
Neurology. 2013 Mar 20. [Epub ahead of print]

Physical activity

Tarakci E, Yeldan I, Huseyinsinoglu BE, et al.
Group exercise training for balance, functional status, spasticity, fatigue and quality of life in multiple sclerosis: a randomized controlled trial.
Clin Rehabil. 2013 Mar 29. [Epub ahead of print]

Pilutti LA.
Adapted exercise interventions for persons with progressive multiple sclerosis.
Appl Physiol Nutr Metab. 2013 Mar;38(3):357.

Kiselka A, Greisberger A, Heller M.
Perception of muscular effort in multiple sclerosis.
NeuroRehabilitation. 2013 Jan 1;32(2):415-23.

Sandroff BM, Sosnoff JJ, Motl RW.
Physical fitness, walking performance, and gait in multiple sclerosis.
J Neurol Sci. 2013 Mar 20. doi:pii:S0022-510X(13)00100-7. 10.1016/j.jns.2013.02.021. [Epub ahead of print]


Popescu V, Agosta F, Hulst HE, et al.
Brain atrophy and lesion load predict long term disability in multiple sclerosis.
J Neurol Neurosurg Psychiatry. 2013 Mar 23. [Epub ahead of print]

Rojas JI, Tizio S, Patrucco L, et al.
Oligoclonal bands in multiple sclerosis patients: worse prognosis?
Neurol Res. 2012 Nov;34(9):889-92.

Pregnancy and childbirth

Lu E, Zhao Y, Zhu F, et al.
Birth hospitalization in mothers with multiple sclerosis and their newborns.
Neurology. 2013 Jan 29;80(5):447-52.


Ytterberg C, Einarsson U, Holmqvist LW, et al.
A population-based study of fall risk factors among people with multiple sclerosis in Stockholm county.
J Rehabil Med. 2013 Mar 27. doi: 10.2340/16501977-1129. [Epub ahead of print]


Carrieri L, Sgaramella TM, Bortolon F, et al.
Determinants of on-the-job-barriers in employed persons with multiple sclerosis: The role of disability severity and cognitive indices.
Work. 2013 Mar 26. [Epub ahead of print]

Chiu CY, Chan F, Bishop M, et al.
State vocational rehabilitation services and employment in multiple sclerosis.
Mult Scler. 2013 Mar 21. [Epub ahead of print]

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