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M.S. and Fatigue

Updated: Jun 30, 2023

Multiple sclerosis can and will present differently in everyone. Symptoms most people associate with MS can include difficulty walking and balance problems. What many people don’t know about MS that the most common symptom is something you cannot see, and can be the hardest to explain: fatigue

Being tired is one thing, but MS fatigue is more than that. 80% of people with MS experience this type of fatigue. It comes on suddenly, it can worsen throughout the day, can worsen when it is hot/humid, and often has nothing to do with whether you got a good night’s sleep or not. Even harder, this is an invisible symptom, meaning family and friends may not always understand the magnitude of its effect on your life.

Why does this happen?

MS fatigue, also known as lassitude, does not have an exact cause; however, many factors can contribute to this overwhelming fatigue.

  1. Insufficient sleep: I know I said lassitude often has nothing to do with whether or not you got a good night’s sleep, but not getting enough sleep certainly won’t help. This can often be due to sleep being interrupted by other symptoms, including bladder urgency, muscle spasms, or pain.

  2. Abnormal muscle tone: If you have increased muscle tone or spasticity, this can add resistance to your movements, therefore increasing the energy required to move throughout the day.

  3. Depression/Anxiety: This can be common in those with MS. Depression and anxiety can and will be draining for anyone regardless of an MS diagnosis, but combined with other factors, further increase lassitude in those with MS.

  4. Medications/Medication interactions: MS-specific medications can have side effects that increase fatigue, as well as medications for other health conditions.

  5. Heat exposure: The longer time spent in hot/humid climates can exponentially increase your fatigue for the remainder of the day, even after you have cooled off.

Well… this is depressing

Yes, all of this can seem very overwhelming. But, there are ways to manage all of these factors to decrease lassitude!

The 4 P’s


Decide what needs to be done today and what can wait. Instead of making one big to-do list, make smaller to-do lists for each day of the week and do a little each day. Spread household chores out over the week instead of trying to do them all in one day. If you have a social event night, maybe avoid doing tiring chores that day so you can rest up before the fun begins! Prioritize not only the things you need to do but also what you want to do.


Plan ahead to avoid making extra work for yourself. Try to get everything you need to accomplish a task in one trip to avoid getting up and walking back and forth multiple times. This will conserve your energy to complete the task you need to. Planning also means planning your day so that you are accomplishing the most challenging tasks during times when you have the most energy. This might be early in the day for some, later in the day for others. Don’t forget to plan your rest as well… it’s just as important as anything else!


Pace yourself. Trying to get everything done as fast as possible might seem like the best choice, but you will pay for it later (maybe for a couple of days). Moving too quickly can also increase your risk for falls and injury.


Think smart, not hard. Meaning, think about your body positioning when completing a task. Excessive bending or reaching can drain your energy and increase fatigue levels and shortness of breath. Adaptive equipment can be extremely helpful in these situations to avoid over-exerting. These can include using a reacher to get objects from the ground or off of a tall shelf, using a shower bench to sit and conserve energy during a shower, or using a sock aide to help get those pesky compression stockings on.

Energy conservation is the key to combating lassitude. It can allow you to complete your tasks throughout the day without paying for it later and leaves you energy to do the things you enjoy. Still overwhelmed? Develop a team that can help you combat your fatigue!

  • Physical therapist: Ever felt more tired on days you do nothing? There is actually something to that. A physical therapist can create an exercise routine to improve your strength and endurance, which can actually help decrease your fatigue!

  • Occupational therapist: OTs are wonderful resources to provide for energy conservation, and can help you determine the adaptive equipment that would be best for you.

  • Neurologist: Talk to them (or your primary care provider) about your medications to see if certain medications or interactions between medications may be impacting your fatigue.

  • Dietician: A dietitian can help you create a diet plan that may increase your energy.

  • Sleep Specialist: If you feel you may have an underlying sleep issue, a sleep specialist can help treat this, increasing your restful sleep and decreasing your fatigue.

Take home message: Listen to your body, take breaks as needed, and prioritize what needs to get done, whether that be household chores or a social event. Doing what is best for you and your body is the most important.

Interested in starting physical therapy? Wellness 360 specialized in neuro rehab! With multiple programs, including 1-on-1 sessions, group classes, and an online Wellness on Demand platform, we have multiple tools to help you reach your fitness goals. To learn more about Wellness 360, visit our website at


Meet Nicole Lanzafame, PT, DPT.

Nicole is a physical therapist with experience in neurological disorders, as well as general orthopedic conditions. Nicole is passionate about treating the neuro conditions, including M.S. Nicole is certified in PWR and is a Rock Steady Boxing coach, and also participates in continuing education through NeuroCollaborative’s NeuroSpark program.

Nicole loves dancing, singing, and spending time with family, friends, and her dog Sammy

You can schedule your physical therapy visits with Nicole by calling 585-259-0782 or by emailing us at


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