Muscle Function and Physical Performance in Multiple Sclerosis

Multiple sclerosis is characterised by central nervous system inflammation and demyelination, which lead to neurodegeneration and impaired neural drive to skeletal muscle. As a result, individuals with the condition often experience reduced muscle strength, diminished rate of force development and altered muscle composition. These neuromuscular deficits manifest early in the disease course and accelerate with ageing, contributing to asymmetries between limbs and compounding functional decline. Impaired muscle power and endurance underlie gait disturbances, balance deficits and increased risk of falls, while fatigue further limits daily activities. Objective assessments—from isokinetic dynamometry and force‐plate jump analysis to measures of voluntary activation—have revealed that both maximal voluntary contraction and rapid force production are compromised. Understanding these deficits has underpinned the development of targeted interventions, including tailored resistance training, blood flow restriction protocols and neuromodulatory approaches, all aimed at preserving or restoring muscle function and enhancing physical performance across the spectrum of disability.

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Muscle Function and Physical Performance in Multiple Sclerosis publication trend

The graph below shows the total number of articles in muscle function and physical performance in multiple sclerosis across all publications each year (not limited to Nature Index journals).

Technical terms

Neuromuscular function: The integrated performance of nerves and muscles during voluntary contraction.

Maximal muscle strength (Fmax): The greatest force a muscle group can voluntarily produce in a single effort.

Rate of force development (RFD): The speed at which force can be generated from the onset of muscle contraction.

Countermovement jump (CMJ): A vertical jump test involving a preparatory downward movement to assess explosive lower-limb power on a force plate.

Expanded Disability Status Scale (EDSS): A clinician-rated scale that quantifies disability in multiple sclerosis on a scale from 0 (no disability) to 10 (death due to MS).

References

1. The combined deleterious effects of multiple sclerosis and ageing on neuromuscular function. Experimental Gerontology (2023).
2. Sensitive Identification of Asymmetries and Neuromuscular Deficits in Lower Limb Function in Early Multiple Sclerosis. Neurorehabilitation and Neural Repair (2024).
3. The Association of Age, Sex, and BMI on Lower Limb Neuromuscular and Muscle Mechanical Function in People with Multiple Sclerosis. Biomedicines (2024).
4. Effects of Muscle Function and Limb Loading Asymmetries on Gait and Balance in People With Multiple Sclerosis. Frontiers in Physiology (2018).
5. Multiple Sclerosis Affects Skeletal Muscle Characteristics. PLOS ONE (2014).
6. Brain and Muscle: How Central Nervous System Disorders Can Modify the Skeletal Muscle. Diagnostics (2020).
7. Understanding the Deterioration of Gait, Postural Control, Lower Limb Strength and Perceived Fatigue Across the Disability Spectrum of People with Multiple Sclerosis. Journal of Clinical Medicine (2020).
8. Feasibility of Low-Load Resistance Training Using Blood Flow Restriction for People With Advanced Multiple Sclerosis: A Prospective Cohort Study. Physical Therapy (2023).