Neurology Now:
doi: 10.1097/01.NNN.0000324753.04181.b2
Features: Massage

Healing Touch

HAUPT, JENNIFER

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Jennifer Haupt writes health and lifestyle articles for Women's Day, AARP: The Magazine, Cure, and Reader's Digest. You can visit her at jenniferhaupt.com.

For more information on massage, see Resource Central on page 37.

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Abstract

Massage therapy may offer pain relief for a number of neurological conditions.

Like many of the approximately 400,000 people in the U.S. who have multiple sclerosis (MS), Roberta Evans spends much of her day sitting down. The lack of movement and constant pressure on her back and leg muscles impedes circulation, and often by the end of the day pain is shooting up her calves and thighs. Although she can only afford massage by a trained therapist once every other week, she looks forward to both the physical and emotional relief it provides her.

“My therapist spends a half-hour on my back and a half-hour on my backside, waking up different parts of my body,” explains Evans, 71, who lives in Seattle, WA and has had MS for 35 years. “By the end of the session, my circulation has improved and I feel like I have real legs again for the rest of the day. It's absolutely wonderful.”

According to a survey conducted by the American Massage Therapy Association of people who had at least one massage in the last five years, 30 percent report that they did so for reasons of pain management, injury rehabilitation, migraine control, or overall wellness.

Of course, it pays to be cautious. “While massage may reduce pain and improve well-being, it may also exacerbate some conditions,” explains Sunil Mathews, M.D., a neurologist at North Texas Neuroscience Center in Irving, TX. Dr. Mathews recommends using massage as an additional treatment to physical therapy only after consulting your physician. “In patients with hypersensitive nerves, massage could worsen the pain. And patients with numbness may not be able to give accurate feedback to the massage therapist, resulting in pressure that is too deep and could possibly cause more tissue damage.”

Generally, though, massage therapy appears to have few serious risks if appropriate cautions are followed and you make sure that your therapist is familiar with your physical condition.

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HOW MASSAGE WORKS

Research shows that people who suffer with MS—as well as migraine headaches, Parkinson's disease, and HIV-related neuropathy—may experience benefits from massage therapy, including a reduction in pain, increase in range of movement, and improved emotional state.

The Touch Research Institute at the University of Miami has conducted several studies during the past 10 years to examine the benefits of massage therapy for patients with MS. In one study, patients who received 45-minute massages twice a week for five weeks experienced improvements in mood and body image as measured by a series of self-reported questionnaires. Another study in which MS patients received 11 weeks of reflexology treatments (manual pressure on specific points in the feet and massage of the calf area) showed significant improvements in urinary symptoms, spasticity, and paresthesias (sensations of tingling, pricking, or numbness of a person's skin) as measured by a series of self-reported questionnaires. “The key to effective massage therapy is manipulating the soft tissue to get muscles to lengthen without tearing them or causing more damage,” says Tiffany Field, Ph.D., director of the Touch Research Institute.

Massage clearly relaxes tense and painful muscles, improving the flow of blood to the muscle and related nerves. However, massage may work for a number of other reasons that are not yet fully understood. A recent study by the University of Auckland in New Zealand and the Cancer Prevention Research Centre at the University of Queensland in Australia found that people suffering from migraines who received weekly massage therapy sessions for five weeks experienced improved levels of restful sleep, which has a role in reducing pain and improving healing.

A number of studies conducted by the Touch Research Institute have also shown that massage therapy may enhance well-being by stimulating the release of serotonin, a natural pain-killing and mood-elevating endorphin, and reducing the level of cortisol, a stress hormone that produces pain.

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“Massage may be effective through several possible mechanisms,” says Allen Bowling, M.D., Ph.D., clinical associate professor of neurology, University of Colorado at Denver and Health Sciences Center and Rocky Mountain MS Center. Dr. Bowling is also the author of Complementary and Alternative Medicine and Multiple Sclerosis, 2nd Edition (Demos, 2007). “First, massage may provide relief for conditions that are worsened by muscle stiffness, including headaches, neck pain, and low back pain. There's also a school of thought that massage may be used to decrease the number of pain impulses received by the brain from specific pressure points in the body.”

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FAST, SHORT-TERM RELIEF

The biggest benefits of massage therapy can be felt on the day of your session. “I'm definitely walking with more ease after my massage session, and as the days go by I become progressively stiffer,” says Kate Gibbs, 55, who lives in Edmonds, WA, and was diagnosed with MS in 1998.

Like Gibbs, most patients report that the relief they obtain from massage is relatively short-term but can last for up to one week. A study recently conducted by the University of San Francisco and the Quan Yin Healing Arts Center in San Francisco examined the benefits of acupuncture and massage therapy for 16 HIV patients who reported neuropathy in their face and extremities. After 16 weeks of the combined therapies (10 sessions total), participants showed a nearly 10 percent increase in their vitality and energy as measured by a 36-item scale of physical and psychological symptoms. Some patients also reported a decrease in their neuropathic symptoms, with relief lasting an average of two to three days.

“Several people reported a decrease in tingling and numbness of their hands and feet, and most reported feeling more relaxed,” says Evelyn Ho, Ph.D., lead investigator of this study and assistant professor of communication studies at the University of San Francisco. Dr. Ho is a health-communications researcher who specializes in complementary medical research.

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DO-IT-YOURSELF MASSAGE

Massage treatments seem to be most beneficial when performed regularly. “The routine of getting a massage on a regular basis was a positive in the lives of most participants,” observes Dr. Ho of the San Francisco study. And one way to help your body maintain these benefits between appointments with your massage therapist is to learn a few simple self-massage techniques.

“My leg muscles often stiffen up so much so that I have trouble walking, but I've learned to use some of the same techniques at home that my massage therapist uses,” says Gibbs, who has been going to weekly hour-long massage sessions for three years. “My therapist taught me how to press along my legs and recognize the muscle that's causing the problem. There's usually a deep ache, like a bruise. I can press on that point and move the limb in a way my therapist taught me, and the muscle will often soften up and stop hurting.” (See box on next page.)

But exercise caution and stay alert to your body's signals. “If something doesn't feel right or you experience sharp, shooting pain, stop doing it and wait until your next massage appointment,” cautions Randi Kofsky, a certified massage therapist and the lead massage therapist on the University of San Francisco study on HIV patients with neuropathy.

Self-massage to the head, face, and neck can also help alleviate pain during a migraine attack. Sandra Koehler, a certified massage therapist in Blackwood, NJ, who works with migraine patients, suggests gentle finger pressure across your eyebrow line and underneath your eyes as well as gentle rotating pressure to your jaw and temple.

When pain radiates to the back of the head and down the neck, Koehler suggests tying two tennis balls in a sock, lying down with your chin tucked down, and rolling the base of your skull across the tennis balls to ease tension.

Remember to keep it gentle, and have your physical therapist approve any massage techniques before using them at home. “While stretching the muscles of the neck and shoulders can keep the muscles working at an optimal length, extreme stretching may put too much pressure on the vertebrae of your spine and actually trigger a migraine attack,” Koehler cautions.

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WHICH TECHNIQUE IS RIGHT FOR YOU?

There are nearly 100 different massage and body work techniques. Finding the right one is a process of getting approval and recommendations from your neurologist and physical therapist. “I recommend that massage therapy is used in conjunction with other treatments,” says Dr. Mathews. “Only very gentle massage should be utilized at first, keeping in mind that if you have numbness you won't be able to feel how the treatment is affecting you.”

The most common types of massage for reducing pain include:

Craniosacral massage: Light pressure is applied to the head, neck, and spine to ease tension and compression. This type of massage is not appropriate for people with conditions that could be affected by intracranial pressure changes, such as acute aneurysm, cerebral hemorrhage, or hydrocephaly.

Lymphatic massage: Light, rhythmic strokes are used to improve the flow of lymph (a colorless fluid that helps fight infection and disease) and get rid of waste throughout the body. Lymphatic massage is often used to reduce post-surgical swelling and to help heal sports-related injuries.

Myofascial release: Pressure and body positioning are used to loosen and stretch the muscles, fascia (connective tissue), and related structures. Both physical therapists and massage therapists who are appropriately trained use this technique.

Reflexology: Specialized thumb and finger techniques are applied to “reflex points” in the hands and/or feet.

Shiatsu: Gentle finger and hand pressure are applied to specific points on the body to relieve pain.

Swedish massage: A variety of strokes and light-pressure techniques are used to enhance blood flow, remove waste products from tissues, stretch ligaments and tendons, and ease physical and emotional tension.

Trigger point massage: Pressure is applied to “trigger points” (tender areas where the muscles have been damaged or where tension accumulates) to alleviate muscle spasms and pain.

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IMPROVED QUALITY OF LIFE

A study recently conducted at Emory University School of Medicine in Atlanta, GA, found that patients with Parkinson's disease who underwent neuromuscular therapy twice a week for four weeks experienced a significant improvement in their motor scores—especially tremor scores—and their ability to do daily tasks as measured by the United Parkinson's Disease Rating Scale, which is administered by a health professional. Neuromuscular therapy relieves pain through manipulating the soft tissue at specific pressure points. The results persisted for at least one week after the last treatment.

“Fatigue is a big problem for most people with MS, and I find that I have more energy for the entire day after going to massage,” says Evans, who has been going to massage therapy for about seven years. She schedules her sessions for mid-morning, then goes on errands that she wouldn't have the energy for on other days. “I feel generally more relaxed and upbeat on my massage days—it's a nice bit of relief.”

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POTENTIAL BENEFITS OF MASSAGE

* Deep muscle and tissue relaxation

* Stress reduction

* Reduced blood pressure

* Increased flexibility

* Improved circulation

* Reduction of swelling and inflammation

* Release of toxins from the body

* Increased energy

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SELF-MASSAGE FOR NEUROPATHY

Certified massage therapist Randi Kofsky often recommends this self-massage series to temporarily relieve symptoms of neuropathy:

1. Standing in a relaxed upright position, lightly rub up and down each arm, shoulder to hand, five times.

2. Use both hands to rub each leg from thigh to foot, five times.

3. Gently squeeze the outside flesh along both arms, going up and down each arm.

4. Make a soft fist with your hand (pretend you're holding an egg) and gently tap up and down your opposite arms and shoulder region if you can reach it. Repeat with other hand.

5. Using soft fists with both hands, gently tap the hips and continue tapping down the outsides of the legs and up again.

©2008 American Academy of Neurology

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