If you’re living with multiple sclerosis (MS), you know how unpredictable it can be. One day you’re managing just fine, and the next, your body feels weaker, foggier, or less steady. Those sudden shifts can bring up a lot of questions, like: Is this a relapse? What should I do next? Can you prevent an MS relapse?
By the way, have we met? I’m Dr. Gretchen Hawley, a physical therapist and MS-certified specialist. I created The MSing Link, an online program and book designed to help people with MS build strength, improve mobility, and feel more confident through targeted, doable movement. My goal is to help you feel more in control, even during the harder moments.
Today, I’ll walk you through what an MS relapse is, how it’s different from a pseudo-relapse, and what the latest research says about reducing your risk. My hope is that by the end, you’ll feel more informed and encouraged—whether you’re navigating relapses now or looking for ways to support your health moving forward.
A relapse (sometimes called a flare, attack, or exacerbation) is when new MS symptoms appear—or old ones come back or get worse—and the cause is inflammation in your brain, spinal cord, or optic nerves. For most people with relapsing-remitting MS (RRMS), relapses are part of the disease.
They can also happen in secondary progressive MS, but not as often. Every relapse looks a little different. You might notice fatigue that suddenly feels unbearable, numbness or tingling that wasn’t there before, or changes in your vision, balance, or strength.
During a relapse, the immune system mistakenly attacks the protective covering of your nerves (called the myelin sheath). This causes inflammation and damage, which slows down or blocks the signals your brain is trying to send to your body.
Symptoms might include:
Not all relapses come with clear symptoms. Sometimes, new lesions form in the brain or spinal cord without you noticing anything right away. These are called silent relapses and are often only picked up on an MRI. They’re one of the reasons why regular monitoring is so important, even when you feel okay.
Relapses can last anywhere from a few days to several weeks or months. In between relapses, you might go through periods of remission, where symptoms improve or feel stable. In relapsing-remitting MS, these periods can last for months or even years before another relapse happens.
This is such an important distinction, and it’s one I talk about often with members of The MSing Link.
A true relapse happens because of new inflammation in the brain, spinal cord, or optic nerves. These typically require medical treatment and don’t go away quickly.
A pseudo-relapse is when existing symptoms temporarily get worse. It can still feel very real, but it’s not caused by new damage. Instead, it’s often triggered by something like:
Pseudo-relapses usually go away within 24 to 48 hours, especially once the trigger is managed. They don’t cause new lesions or long-term damage, but they do deserve attention and care.
Not sure which one you're dealing with? Here are three questions you can ask yourself:
If you answered “yes” to any of those, it might be a pseudo-relapse. But if symptoms last beyond a few days or feel new, don’t wait—reach out to your doctor. Your health comes first.
Let’s talk about the hopeful part: yes, in many cases, you can lower your risk of relapses.
Researchers and doctors are learning more every year, and one of the most exciting advances has been the use of B-cell-depleting therapies, which target a specific part of the immune system that plays a role in inflammation.
According to Dr. David Hafler at Yale School of Medicine, FDA-approved treatments like Ocrevus® (ocrelizumab) and Kesimpta® (ofatumumab) can be up to 98% effective at preventing new relapses, especially when started early.
These medications aren’t for everyone, but it’s powerful to know that the earlier MS is diagnosed and treated, the better the long-term outcomes can be.
Here are some simple, everyday things you can do to support your body and work to prevent an MS relapse:
These steps might sound small, but over time, they can make a big difference in how your body feels and functions.
If you suspect a relapse, the first thing I want you to know is: you’re not doing anything wrong. Even if you’re doing everything to stay healthy or asking yourself, “Can you prevent an MS relapse,” the reality is that relapses can still happen—and that’s not your fault.
If symptoms come on suddenly, try waiting 24 to 48 hours to see if they improve on their own. If they’re lingering or getting worse, contact your medical provider.
Here’s what treatment might look like:
Your doctor may also refer you to a specialist, depending on your symptoms:
This is a question I get all the time, and the answer depends on how you’re feeling. During a relapse, there might be days when your body needs complete rest, and other days when you feel like moving a little. If you feel up for it, gentle seated exercises can help keep your muscles engaged and support your energy.
Here are a few of my favorite MS exercises for relapse recovery or high-fatigue days.
Remember: even just 3-5 reps is progress! You don’t need to do a full workout. Just moving a little, when and how your body allows, can support your recovery.
If you’ve ever felt frustrated, overwhelmed, or unsure during or after a relapse, please know that you’re not alone. Relapses can happen to anyone with MS, even when you’re doing your best. But with the right support, information, and a plan that works for your body, you can feel more prepared and confident in managing whatever comes your way.
For guided, MS-specific exercises that support you through every phase of your journey, my online program, The MSing Link, is here for you. It’s designed to help you build strength, improve balance, and feel more in control of your mobility—all from the comfort of your home.
If you have questions about relapses or how to support your body with MS, feel free to message me on Instagram @doctor.gretchen.
Dr. Gretchen Hawley's The MSing Link offers a comprehensive guide to taking control of your MS symptoms and improving your mobility through MS-specific exercises and strategies.
6000+ copies sold in over 13 countries!
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As a physical therapist & Multiple Sclerosis Certified Specialist, I have spent the last 10 years teaching people with MS how to feel more confident & empowered through MS-specific exercises and strategies.
If you want support and encouragement, plus a healthy dose of tough love, come follow me on Instagram (@doctor.gretchen) or on YouTube @DoctorGretchenHawley. It's where I share daily tips, tricks, and information about new offers — plus, you’re bound to feel more empowered, hopeful, & motivated after watching each post and video!
Questions? Email me at Hello@DoctorGretchenHawley.com
