Since about 2012 there has been increasing evidence to support the role of physiotherapy as part of treatment for people with FND, especially those with functional movement disorders and limb weakness.

People with FND very often have fatigue, weakness or pain which they find is made worse by exercise.

For many patients, the problem is not so much that they don’t do any activity, its that the activity they do is quite cyclical. So, one day you might be feeling a bit better, you rush round doing all the jobs you couldn’t do before because you were feeling so ill, but then you feel much worse again either later that day or the next day

When your symptoms get worse again, its demoralising, you feel back to square one. The graph below shows what happens.

… You will still have days when you feel as if you’re “back to square one”. But if you’re improving slowly overall, thats the main thing …

… Yes, activity makes the symptoms worse but no, you are not causing more damage. …

The principles of rehabilitation in this situation are to recognise that you probably are doing a bit too much on the good days and not enough on the bad days.

Set yourself a modest task, it might be a walk to the shop, it might just be a small job in the house. Make it something that is a bit less than you would do on your best day but more than you would do on your worst.

If you stick to the SAME level of activity every day, hopefully you’ll find that after a while, perhaps a few weeks, this SAME level of activity may make you just a little less tired than it did before, or cause just a little less pain.

You will still have days when you feel as if you’re “back to square one”. But if you’re improving slowly overall, thats the main thing (see graph below)

This is all ‘easier said than done’.

Physiotherapists and Occupational Therapist can often be very helpful in these situations. They are used to working with the day to day limitations that patients have regardless of their cause. They may be able to design a graded exercise program that suits your particular symptoms and help you work through it. Graded Exercise Therapy has been shown to be helpful for some people with chronic fatigue and pain. You can read some more detailed information about it here.

Graded increases in activity is not for everyone and no one should feel forced in to it. Some people need to stabilise their activity first using pacing techniques before they are ready to think about graded exercise

Physiotherapists may also have a critical role in helping advise employers- so for example a return to work can be phased in partnership with the employer. Read more about work related issues here.

Psychologists may also be useful in helping you cope with the inevitable ‘ups and downs’ that go along with attempting this kind of rehabilitation.

What often goes wrong is that increasing activity leads to increasing symptoms, which makes the person think that they must be making their condition worse, causing damage to their back or muscles. The important thing here is that you’re not causing damage if you do it slowly. Yes, activity makes the symptoms worse, but no – you are not causing more damage.

The more activity you do, hopefully the less symptoms you will get (eventually).

For detailed consensus recommendations regarding physiotherapy for functional motor disorders click on this link which takes you to a 2014 article written by physiotherapists, neurologists, occupational therapy and neuropsychiatrists with experience of treating people with FND.

You may wish to share this with your physiotherapist to see if it gives you both new ideas.

There are some useful videos showing how physiotherapy works on the FND videos page. Ive also reproduced some of them below

I also recommend Eva’s Story from a MotionRehab a private provider in the UK. I don’t endorse any private providers on this site but this film gives a great insight in to how creative physiotherapy that uses the person’s experience of “good” movement – in this case Eva is an amazing dancer – can help with recovery. https://www.motionrehab.co.uk/evas-story/

If you want to hear about FND physio from a professional, there is no one better than Glenn Nielsen, Senior Lecturer in Physiotherapy at St George’s Hospital, London. Glenn has led the field globally with new approaches to physiotherapy for FND including the recommendations on this page.

Here he is talking about FND to an audience of MS specialists, who need to know about FND because it can co-exist with MS sometimes or be mistaken for it.