Physiotherapy Role in Multiple Sclerosis Management: Review Article

Multiple sclerosis (MS) is a chronic, immune-mediated disorder of the central nervous system characterized by progressive impairments in mobility, balance, strength, fatigue, and participation in daily life. While pharmacological disease-modifying therapies primarily target inflammatory activity, they exert limited influence on established disability and many functionally relevant symptoms. Physiotherapy therefore represents a cornerstone of non-pharmacological management across the MS disease spectrum. This narrative review synthesizes peer-reviewed evidence published examining the role of physiotherapy in MS management. Key intervention domains include exercise-based therapies (aerobic, resistance, and sensorimotor training), mobility and gait rehabilitation, balance and fall-prevention strategies, spasticity and upper limb management, robot-assisted training, and telerehabilitation and home-based models of care. Across disease phenotypes and disability levels, physiotherapy interventions are consistently associated with improvements in gait performance, balance, walking endurance, fatigue, depressive symptoms, and health-related quality of life. Technology-assisted approaches, particularly robot-assisted gait training and telerehabilitation, demonstrate promise for individuals with advanced disability and for improving access to care. Despite these benefits, gaps remain regarding long-term outcomes, standardization of intervention dosage, and evidence for non-ambulatory populations. Physiotherapy remains an essential component of multidisciplinary MS care, supporting functional capacity, independence, and well-being, and should be integrated early and sustained across the disease course.