Sometimes a condition can scare a therapist.
Just the other day a buddy looked at me and said “if I had someone book in with multiple sclerosis, I wouldn’t have a clue what to do, so I’d just refer out.”
We had specific classes and clinical training at school where we helped people with MS as well as their care-givers.
It’s not really that scary and the patients were always super appreciative.
A little knowledge goes a long way and making sure you understand how a condition is affecting a patient makes a world of difference in helping them.
Of crucial importance is also understanding what the patient expects or needs from a treatment.
What Is MS?
The one thing I remember from college about Multiple Sclerosis was how there was “multiple sclerotic plaques on the brain”.
Turns out my memory didn’t totally fail me.
MS is an autoimmune disease of the central nervous system where the myelin sheath of nerves are attacked, deteriorate and harden. Using an MRI, plaques in the white matter on the brain and spinal cord are seen.
Since the nerves are attacked information cannot be transmitted properly across them, depending on the level of damage. When the nerve sheath is hardening and scar tissue forms it can cause complete disruption of nerve impulses if there is enough scar tissue formed.
There are four types of MS:
- Clinically Isolated Syndrome (CIS)
- An attack that lasts for minimum 24 hours, but does is not enough to have a MS diagnosis.
- Relapse Remitting MS (RRMS)
- The most common form of MS, where neurologic symptoms are present, but then can have full remission with no symptoms.
- Primary Progressive MS (PPMS)
- Worsening neurologic function from onset of symptoms, without remission.
- Secondary Progressive MS (SPMS)
- Progressively worse neurologic function that comes on after an initial relapse remitting course of MS.
It usually appears between the ages of 20-40, affecting females twice as much as males.
Recently there have even been elite level athletes diagnosed with MS.
Initial Symptoms are wide and vary from person to person but can include feelings of heavy/weak muscles, abnormal sensations or double vision.
However as the condition progresses, so do the symptoms.
Emotional problems like depression and mood swings, chronic pain, mobility issues, weakness and spasticity are all common problems when a patient has MS.
However the National Multiple Sclerosis Society points out that some secondary issues of concern are a result of inactivity. Issues with bone density, ineffective breathing and muscle wasting can all be a problem, but if the primary symptoms are treated effectively, these secondary concerns can be avoided.
The MS Society Of Canada points out that living a healthy lifestyle including exercise and a healthy diet, getting appropriate sleep and stress management are all important parts of dealing with these primary symptoms.
And lo and behold, they also recommend massage therapy as one of the tools to manage these primary symptoms! Nice to see we’re getting recognized!
Massage Therapy And Multiple Sclerosis
When we look at some of those symptoms that were pointed out, there is such a positive effect we should be able to have for a patient with MS who comes to see us.
There has been so much discussion around the biopsychosocial model in massage and I’d be hard pressed to think where this would be more appropriate.
Think of how much life is going to change for someone recently diagnosed with this. No wonder emotional problems like depression and mood swings are mentioned as some primary symptoms for someone with MS.
Thankfully there are things we can do to help.
One study showed the use of yoga and physical therapy improved audiovisual reaction time, anxiety and depression in people with chronic MS (although it is a small study and like everything else I read, more research is necessary).(1)
Part of the interventions used (in addition to yoga, counselling and physiotherapy) were machines that would engage a patients limbs in passive or active resisted movement. So, for those of us who do not have exercise in our scope of practice, having patients move both actively (if possible) and passively on the table can be a help with these patients.
While exercise is important, studies have shown that massage could be more effective than just exercise when the two are compared. In this study the massage group had larger improvements in pain reduction, balance and walking speed compared to the group who engaged in exercise alone. (2)
However the combination of exercise and massage had a greater reduction in pain than those who only took part in an exercise program.
The real goal in providing therapy for people with MS (and any patient really) should be to improve quality of life. One research paper actually pointed out that massage provided a limited amount of improvement in the study patients, but it was hard to tell if the improvement was a result of the massage, the social interaction during the massage or a combination of the two.(3)
There goes that biopsychosocial model rearing its ugly head again!
Like I said, overall our goal will be to improve quality of life. If you have someone come in needing treatment who has MS, find out what their goals for treatment are. Make sure to have them communicate with you throughout the treatment about pressure, especially in areas where they may be experiencing decreased sensation. Massage therapy can have a profound effect for patients with this condition and your demeanor can either improve or decrease that effect. Whether it’s MS or any other condition, remember, you’re treating the person, not the condition. Do a little homework and meet that patient with confidence in knowing what you do works for them. There is no need to refer out just because you’re scared of a particular condition. Even if you’re not sure and you don’t have time before the treatment to do some homework, just ask your patient what’s going on with them and how you can help, I’m sure they’ll let you know.
- Chobe S, Bhargav H, Raghuram N, Garner C. Effect of integrated Yoga and Physical therapy on audiovisual reaction time, anxiety and depression in patients with chronic multiple sclerosis: a pilot study. Journal Of Complementary & Integrative Medicine [serial on the Internet]. (2016, Sep), [cited January 23, 2017]; 13(3): 301-309. Available from: SPORTDiscus with Full Text.
- Negahban H, Rezaie S, Goharpey S. Massage therapy and exercise therapy in patients with multiple sclerosis: a randomized controlled pilot study. Clinical Rehabilitation [serial on the Internet]. (2013, Dec), [cited January 23, 2017]; 27(12): 1126-1136. Available from: SPORTDiscus with Full Text.
- Schroeder B, Doig J, Premkumar K. The effects of massage therapy on multiple sclerosis patients’ quality of life and leg function. Evidence-Based Complementary And Alternative Medicine: Ecam [serial on the Internet]. (2014), [cited January 23, 2017]; 2014640916. Available from: MEDLINE with Full Text.