Multiple sclerosis doesn’t attack your joints directly the way arthritis does, but it affects them in several indirect and significant ways. Nearly 88% of people with MS experience musculoskeletal pain, with the knee being the most commonly affected joint (55.7%), followed by the wrist (43.5%) and neck (41.7%). The joint problems in MS come from a chain reaction: nerve damage changes how your muscles work, which changes how you move, which puts abnormal stress on your joints over time.
Why MS Causes Joint Pain Without Joint Disease
MS damages the protective coating on nerves in your brain and spinal cord. That nerve damage disrupts the signals controlling your muscles, which means the muscles around your joints stop working in their normal coordinated rhythm. Instead of turning on when needed and off when not needed, muscles may stay tense, fire at the wrong time, or weaken altogether. Your joints pay the price.
In a cross-sectional study of MS patients, over 60% reported chronic pain in their lower limbs and upper limbs during the preceding year. Hip pain and ankle pain each affected about 37% of participants, shoulder pain hit nearly 35%, and back pain affected 38%. More than half said the pain interfered with their daily functioning at least some of the time. This isn’t the sharp, hot inflammation you’d feel with rheumatoid arthritis. It’s more of a mechanical consequence: joints being pulled, loaded, and moved in ways they weren’t designed for.
How Walking Changes Strain Your Hips and Knees
One of the clearest examples of how MS affects joints is what happens when you walk. In a healthy stride, your ankle does most of the heavy lifting during the push-off phase. But MS often weakens the muscles that power that ankle push-off, reducing the force your ankle can generate. Your body compensates by shifting that workload up to the hip.
Research on gait in MS found that even the less impaired leg shows this pattern: the ankle produces less mechanical work while the hip generates more to pick up the slack. This “hip strategy” keeps you moving, but it loads your hip joint more than normal with every step. Over months and years, that extra demand can lead to wear, fatigue, and pain in the hip and surrounding muscles. Your knee joint, which normally absorbs shock during walking, also faces altered forces when ankle weakness changes your stride length and speed.
Spasticity and Joint Stiffness
Spasticity, one of the most common MS symptoms, is a major driver of joint problems. When your brain and spinal cord can’t properly regulate muscle tone, muscles stay partially contracted even when they should be relaxed. That constant tightness pulls on joints, restricting their movement.
If spasticity goes unmanaged, it can progress to contractures, which are permanent shortenings of the muscle and connective tissue around a joint. A contracture locks the joint in a fixed position, sometimes making it impossible to fully straighten your arm or extend your leg. This is preventable with regular range-of-motion work, but it requires consistent attention. Moving each affected joint through its full range of motion regularly is one of the most important things you can do to keep joints mobile.
Bone Loss and Joint Stability
MS also weakens the bones that support your joints. People with MS have higher rates of low bone mineral density and osteoporosis compared to the general population. Several factors drive this: reduced physical activity, less time bearing weight on your legs, lower vitamin D levels (common in MS), and repeated courses of high-dose steroids used to treat relapses.
Weaker bones mean less structural support for joints, and they raise the risk of fractures. Since people with MS already fall more frequently due to balance and coordination problems, the combination of fragile bones and frequent falls is a serious concern. A hip fracture or vertebral fracture can dramatically reduce mobility and accelerate disability progression.
Can MS Treatments Damage Joints?
High-dose steroids, commonly used to treat MS relapses, carry a known risk to bone and joint health. The most serious concern is avascular necrosis, a condition where bone tissue dies because its blood supply is cut off, most commonly in the hip. This has been documented in people receiving repeated courses of high-dose steroids for autoimmune conditions, including MS. In one study of MS patients who had received cumulative steroid doses between 20 and 60 grams, 23% showed signs of avascular necrosis in the hip on MRI. However, the study did not find a clear relationship between higher total steroid doses and greater risk, suggesting the picture is more complex than simply “more steroids, more damage.”
If you’ve received multiple rounds of steroid treatment and develop new, persistent hip or groin pain, it’s worth mentioning your steroid history to your care team.
Overlap With Autoimmune Arthritis
Having one autoimmune disease raises your chances of developing another. In a longitudinal study of MS patients, 17.2% had at least one additional autoimmune condition. Rheumatoid arthritis specifically appeared in about 0.7% of the MS population studied, which is roughly in line with general population rates. So while the overlap exists, true inflammatory arthritis as a co-occurring condition in MS isn’t especially common. If your joints are swollen, red, and warm rather than stiff and achy, that’s worth investigating separately since it may point to something other than MS-related mechanical strain.
Managing Joint Strain With MS
The most effective approach to protecting your joints with MS is a layered exercise strategy. At the foundation is daily stretching, ideally 10 to 15 minutes, to maintain flexibility in muscles and tendons. Each stretch should be held for 20 to 60 seconds and should target the muscle groups most affected by spasticity or weakness. Passive range-of-motion exercises, where someone else moves your joints through their full arc, form the base when active movement is limited.
The next layer is active movement against gravity to maintain enough muscle strength for daily tasks like standing, walking, and gripping objects. Progressive resistance training, using weights, machines, or elastic bands, sits at the top. The principle is straightforward: perform a small number of repetitions with relatively high resistance until the muscle fatigues, rest adequately between sets, and gradually increase the load over time.
For people with significant leg weakness, water-based exercise is particularly useful. Buoyancy reduces the effect of gravity, allowing you to practice standing and walking movements that would be impossible on land. For those who can’t stand at all, a standing frame can help train the torso and limb muscles while also protecting against the cardiovascular problems that come with prolonged immobility. Passive range-of-motion exercises for the areas closest to paralyzed muscles remain important even when active exercise isn’t possible.
Stretching before and after any exercise session helps manage spasticity and protects joints from the strain of working with tight, uncoordinated muscles. The goal across all of these strategies is the same: keep your joints moving through their full range, maintain the muscle support around them, and prevent the compensatory movement patterns that lead to pain and damage over time.