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The photo shows a woman with MS doing physiotherapy with her physiotherapist to relax her leg muscles.

Treating and managing MS tremors

Treating and managing MS tremors is an ongoing process. There’s no single approach that works for everyone, so you’ll probably need to try different things to find what works best for you. It might include physiotherapy and occupational therapy. Drug treatments and surgery help some people with MS tremors.

What can I do to manage my tremors?

To manage your tremors, you might need to try different approaches at different times, and as your needs change.

Keep a tremor diary

A tremor diary can be a good way to find out what works. Record how your tremor is, what makes it worse and what helps. That way, health care professionals know what treatment options are working and what else you could try. If a particular health professional can’t suggest things to help, they should be able to refer you to one with different expertise.

If writing or typing into a diary isn’t easy, a voice app on a phone or computer could write down what you say.

Rehabilitation for MS tremors

Rehabilitation for MS tremors brings together nursing, physiotherapy, occupational therapy and other care professionals in a team approach. On its own, rehabilitation can’t make tremor disappear, but it can reduce the effects.

Specialists like physiotherapists, occupational therapists and speech and language therapists can assess the day to day problems that tremors and other movement difficulties are causing for you. Then they can work with you to help find ways to make them interfere less with daily activities. There are a number of areas a therapist might focus on, including:

  • posture and balance
  • alignment
  • core stability

Posture and balance

The positions we use for sitting, standing and lying down – our posture – can affect the muscles we use and the range of movements we can make. This can have an effect on tremors.

Having the right support for your torso while you’re sitting down is important.

If you sit in a chair that’s too big, you might use too much effort to balance and hold yourself upright. This can lead to tension in your muscles. Or you can over-use muscles that aren’t designed for the job of balancing. And if the arm rests are too high, this can restrict how you use your arms.

So having a chair that’s the right size and is properly supportive can relax your muscles and calm your tremors, as well as making your movements more coordinated.

A therapist can also check your posture during activities to help reduce tremors. Having more support and making fewer movements during an activity can help control your tremors. This could help with eating, for example.

Alignment

Alignment is how physiotherapists describe muscles working well together. Good alignment helps with posture. It can help with balance.

Being upright is one way to improve your alignment. If you use a wheelchair, or you spend a lot of your time sitting, you might be able to sometimes stand using supportive equipment. A physiotherapist will help with this and make recommendations about how to do it safely.

Physiotherapists and occupational therapists can both help with alignment. A physiotherapist can help you develop stable and controlled posture. An occupational therapist can help you learn to do daily tasks in ways that keep your body as aligned, well balanced and supported as possible. Both can help you get the right support from a chair.

Muscle strengthening

If you spend a lot of time sitting dow, your muscles can get weaker. That can male tremor and ataxia worse. Specific exercises and training might help. For example, balance exercises to improve core stability. Or ‘task-orientated’ training, where you practise an everyday skill like lifting a drink. As much as possible, it’s important to keep muscle power and range of movement in all your limbs (your arms and legs).

Core stability

If you improve your core stability, it can reduce tremor in your limbs (your arms or legs). ‘Core stability’ is how we control our balance and posture with the muscles around our torso – the core of your body. A physiotherapist can help you improve your core stability. They can suggest exercises that target those muscles. Core stability exercises are usually done sitting or lying down.

You might find exercise like Pilates or yoga helps with your core stability.

Watch our videos for seated, standing and laying down yoga and Pilates

Practical tips for day-to-day living

You might have found your own solutions for particular activities – like using your ‘good’ arm to steady your shaky one, or propping your elbows on the table to eat without spilling your food.

Sometimes, these are the right fixes for the problem. But an occupational therapist can help you check they won’t lead to other issues later on. They can also suggest extra ways to manage, and to reduce the amount of effort involved.

The tips below are just a sample of practical solutions. Your occupational therapist can discuss what might work best for you.

The Disabled Living Foundation has information about the kinds of equipment available.

  • Make sure your clothes don’t have fiddly zips or buttons. This can make getting dressed easier.
  • If you wear make-up and your tremor makes it difficult to apply, consider getting an eyelash tint. This will make it look as if you’re wearing mascara.
  • In the kitchen, lots of things can help with eating and preparing food, including: non-slip working surfaces, electrical labour-saving gadgets, two-handed cups, and specially designed cutlery, crockery and kitchen utensils.  A wire basket within a saucepan can make it easier to drain boiled vegtables. Read more about adaptations in the home. 
  • You might find it helps to change the foods you eat. Sometimes, finding a way to still eat what you love could be as simple as using a different shaped pasta. Or you might decide a sandwich is easier to manage than spaghetti or soup. 
  • Using pre-chopped or frozen vegetables reduces the amount of preparation you need to do.
  • If you find it difficult to hold a drink without spilling it, you could use a straw so you don’t have to lift it.
  • You could try sitting to do things, instead of standing. For example, to prepare food. A ‘perching stool’ could be particularly helpful. It’s designed so you can ‘perch’ on it do everyday tasks.
  • When you’re using a computer, voice-activated software can help if you find typing difficult. Adaptive technology like a larger keyboard or a mouse with reduced sensitivity might also help.
  • You could try weighted wristbands or weighted cutlery to help dampen down a tremor, at least for a while. They're not a fix for everyone, though. Because they're heavier, they can add to fatigue. 
  • Weighted pens are also available, and some people find them helpful.  
  • A Lycra splint could help stabilise and control movement in the part of your body affected by tremor. The Lycra splint is usually a tight fitting sleeve glove, sock or leggings. You need an assessment for a Lycra splint. It's fitted by an experienced therapist. They might be part of an ‘orthotics’ service – specialists in prescribing splints and supports.

Who can help with MS tremors?

MS tremors might be a short-term symptom, or could last longer. You’ll find your own ways to live with MS tremors, but there are people and strategies that can help. That could include other people with tremors, care professionals and the MS Society.

Support from other people living with tremor

Talking to other people and hearing their experiences of living with tremor can help. Your MS nurse might know about any support groups in your area and be able to find further support for you and your family.

Find local and online support from the MS Society

Support for tremors from health and social care professionals

As well as your GP and MS team, you might get help with managing  tremors from a:

  • physiotherapist
  • occupational therapist
  • speech and language therapist
  • counsellor
  • dietitian
  • a social care professional

Your GP can refer you to these specialist care professionals. If your tremor makes daily tasks difficult, they can also refer you for a social care assessment for possible adjustments or support at home. Or you can get in touch with your local council yourself.

Find your local council at gov.uk

How can a physiotherapist help?

A physiotherapist can help with tremors by assessing your movement and posture and finding ways to improve them. For example, with exercises for muscle strength and balance. They can help you find safe, effective ways to do everyday movements and activities which make it easier to manage your tremors.

How can an occupational therapist help?

An occupational therapist can help you to find techniques for coping with tremors day to day. This might include general advice such as:

  • try to plan movements in your head before doing them
  • try to work in sequence and give conscious thought to how you move
  • try to concentrate on one thing at a time
  • plan and prioritise what you want to do, and build in rest breaks
  • minimise stress
  • keep as fit as you can, and try to eat healthily
  • make sure you are sitting in a supported position
  • find ways to manage fatigue

How can a speech and language therapist help?

If you have tremor in your lips, tongue or jaw it could affect how you speak. It might interfere with breath control, which affects phrasing or volume, or with how you pronounce sounds.

If it’s needed, a speech therapist can also offer advice on assistive technology like communication charts, speech aids and computer-assisted alternative communication systems.

How can a dietitian help?

A dietitian can help make sure you can eat and drink what you need, even if tremors make it harder. If you have lasting tremor, you might find you need to eat extra calories so you don’t lose too much weight.

Constant tremor not only uses up calories, it can also make it difficult to prepare and eat food. As a result, it’s quite common for someone with tremors like this to be underweight.

If this affects you, adding high-energy foods and drinks to your diet can help. Your GP or MS nurse can give advice, and they can refer you to a dietitian if necessary.

Read more about diet and nutrition

How can a counsellor help?

A counsellor could help you manage the emotional effects of living with tremor. It might be particularly helpful if anxiety is making tremors worse. You can ask your GP or MS nurse for a referral.

Unfortunately, there might be a wait for counselling through the NHS. And you’re likely to get a limited number of appointments. GPs can also recommend a private counsellor, or counselling from voluntary organisations in your area.

Support from the MS Society

There's lots of information on our website about MS and the care and support available. And our MS Helpline gives emotional support and information to anyone living with MS, including family and friends.  

We also host free virtual support events using Zoom, so you can learn more about MS and connect with other people. Events include information webinars, conversation cafes and wellbeing courses and skills sessions.

Drug treatments for MS tremor

There are no drugs specifically for treating MS tremor. But sometimes drugs licensed for other conditions are prescribed to help with MS tremor.

How you approach drug treatments for tremor will probably depend on how severe your tremor is, what impact it’s having on you, and what the side effects might be. If your tremor severely affects what you are able to do, you may find that even a small impact for a short time makes a significant difference.

Your GP, neurologist or rehabilitation consultant can discuss the options with you, explaining possible benefits and side effects.

The most commonly used drug treatments for MS tremor include:

  • propranolol (a beta-blocker)
  • gabapentin (an anti-convulsant)
  • and clonazepam (a benzodiazepine)

Botulinum toxin (botox) is occasionally used to treat MS tremor that affects the head or face. It has a temporary effect of paralysing the muscle that’s causing the tremor.

Some people taking natalizumab (Tysabri) as a disease modifying therapy have noticed improvements in their MS tremor.

Research into cannabis-based drugs hasn’t shown them to work well for MS tremors.

Surgery for MS tremors

Surgery might be an option if your tremor is severe, and the other treatment options haven’t worked for you. Talk to your neurologist about whether these treatments or procedures might be right for you.

Surgery which could help some people with MS tremors include:

  • Thalamotomy - surgery to block the message sent from the brain which is causing the tremor
  • Deep brain stimulation - calms the tremor with a small electric current

Thalamotomy and deep brain stimulation can both reduce head and limb tremor in people with MS. But they don’t work for everyone. And for some people whose tremor is reduced by surgery, symptoms can reappear to some level, months or years later.

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