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Background: Multiple sclerosis (MS) affects more than 2.5 million people worldwide. Despite this, there is still a lack of knowledge on the exercise-induced pseudo-exacerbation that occurs in patients with MS. Therefore, the purpose of this case report is to critically evaluate the evidence which guided exercise prescription for a patient with relapsing remitting multiple sclerosis (RRMS). Case Description: The patient was an 80-year-old female with RRMS who attended a rural outpatient physical therapy clinic after becoming non-ambulatory. The patient had not ambulated for 5 months due to excessive fatigue and subsequent deconditioning. She presented with decreased strength and balance. Intervention: Physical therapy focused on regaining the ability to ambulate and complete functional tasks such as standing and reaching. An essential component to safely do this was to re-evaluate the patient’s symptoms at the beginning of each session. After 4 months of physical therapy the patient had reached many of her goals. She was able to ambulate short distances with a two wheeled walker (2WW) and stand at the counter to place objects on cabinet shelves. Outcome Measures: The patient’s level of function had not significantly changed as measured by the self-reported Lower Extremity Functional Scale (LEFS). Her balance had improved via the Berg Balance Scale (BBS). Her ambulation distance and speed, as measured by the Timed 25-Foot Walk (T25FW), also improved. Discussion: This case report demonstrates the importance of carefully monitoring patients with MS symptoms during each physical therapy session. The fatigue assessment was used to adjust the patient’s exercise dosage to help her safely reach her physical therapy goals while also being able to engage in meaningful activities outside of her physical therapy sessions.