I was recently contacted by Fiza Mahmood and Toni Kodner of the St. Louis Gateway Area Chapter of the National Multiple Sclerosis Society and asked to speak on a conference call about massage therapy and multiple sclerosis. Although my familiarity with the condition and experience with clients with MS is limited, they thought my expertise with a variety of conditions and efforts to stay informed would be relevant enough, so I agreed and became very excited about this unique opportunity.

A special thanks to my "team." 

Over the past few years, I’ve developed an amazing network of well-informed and science-minded massage therapists, physical therapists, and related professionals. I posted in a few forums, asking if anyone had information, and my “team” went to work, helping me prepare for this presentation. They found research articles, shared their experience in working with clients with MS (including one massage therapist whose wife has MS), asked relevant questions, brought up interesting points, and helped me to understand better some of the research and even how to find the research to begin with. Many individuals contributed, but in particular I’d like to thank Keith Eric Grant, PhD., who is both a working scientist and a massage therapist, for finding studies, giving tips on how to find studies, and giving information to help understand them once the studies are found. I’d also like to give a special thanks to Ruth Werner for sending me the section on MS from her book, A Massage Therapist's Guide to Pathology; Disease Handbook for Massage Therapists.

You can read the discussions yourself on the following FaceBook pages:

Professor Moyer's Massage Therapy and Meditation Laboratory Research Group www.facebook.com/groups/343343539076668/permalink/660429754034710/

Advanced Practice Professional Massage Therapy Community of Practice https://www.facebook.com/groups/596878557062703/permalink/688787234538501/

Dermoneuromodulation https://www.facebook.com/groups/5704079529/permalink/10152555169859530/

Studies on massage and MS

Here are links to a few studies. Very little research has been done on massage therapy and MS. What research has been done has usually been small and not always well designed. While some studies suggest that massage therapy may help with physical symptoms, it seems the greatest benefit comes from decreasing anxiety and depression and improving self-esteem. This list provides links to abstracts only. I'll add links to full texts if and when they become available.

Massage therapy and exercise therapy in patients with multiple sclerosis: a randomized controlled pilot study.

http://www.ncbi.nlm.nih.gov/pubmed/23828184

Main measures: Pain, fatigue, spasticity, balance, gait and quality of life were assessed before and after intervention.

RESULTS: Massage therapy resulted in significantly larger improvement in pain reduction (mean change 2.75 points, P = 0.001), dynamic balance (mean change, 3.69 seconds, P = 0.009) and walking speed (mean change, 7.84 seconds, P = 0.007) than exercise therapy. Patients involved in the combined massage-exercise therapy showed significantly larger improvement in pain reduction than those in the exercise therapy (mean change, 1.67 points, P = 0.001).

CONCLUSIONS: Massage therapy could be more effective than exercise therapy. Moreover, the combination of massage and exercise therapy may be a little more effective than exercise therapy alone.

The effects of massage therapy on multiple sclerosis patients' quality of life and leg function.

http://www.ncbi.nlm.nih.gov/pubmed/24949078?dopt=Abstract

Results. The results displayed no significant changes in 6MWT (measured walking) distances or HAQUAMS (quality of life) scores. However, the participants perceived improvement in overall health as expressed in written comments. Conclusions. Massage is a safe, noninvasive treatment that may assist MS patients in managing the stress of their symptoms.

Multiple sclerosis patients benefit from massage therapy.

http://scholar.google.com/scholar?cluster=18101128664802870970&hl=en&as_sdt=0,28

Abstract: Twenty-four adults with multiple sclerosis were randomly assigned to a standard medical treatment control group or a massage therapy group that received 45-minute massages twice a week for 5 weeks. The massage group had lower anxiety and less depressed mood immediately following the massage sessions and, by the end of the study, they had improved self-esteem, better body image and image of disease progression, and enhanced social functional status.

A pragmatic investigation into the effects of massage therapy on the self efficacy of multiple sclerosis clients.

http://www.ncbi.nlm.nih.gov/pubmed/24411144

Study results support previous findings indicating that massage therapy increases the self-efficacy of clients with multiple sclerosis, potentially resulting in a better overall adjustment to the disease and an improvement in psycho-emotional state. The increase in self-efficacy after 4 weeks of treatment suggests that positive response occurs more rapidly that was previously demonstrated. The improvement in self-efficacy endured 4 weeks after the end of the treatment series, which suggests that massage therapy may have longer term effects on self-efficacy that were not previously noted. Lack of inter group difference at the eight week follow up reinforces the notion that on-going treatment is required in order to maintain the positive changes observed.

Complementary and alternative therapies for treating multiple sclerosis symptoms: a systematic review.

http://www.ncbi.nlm.nih.gov/pubmed/10859602

Abstract: Multiple sclerosis (MS) is a chronic disease of the central nervous system without a known cure. Thus the role of complementary and alternative therapies (CATs) for the management of symptoms lies in palliative care and this is borne out by the popularity of these treatments amongst MS sufferers. This review is aimed at determining whether this use is supported by evidence of effectiveness from rigorous clinical trials. Database literature searches were performed and papers were extracted in a pre-defined manner. Twelve randomized controlled trials were located that investigated a CAT for MS: nutritional therapy (4), massage (1), Feldenkrais bodywork (1), reflexology (1), magnetic field therapy (2), neural therapy (1) and psychological counselling (2). The evidence is not compelling for any of these therapies, with many trials suffering from significant methodological flaws. There is evidence to suggest some benefit of nutritional therapy for the physical symptoms of MS. Magnetic field therapy and neural therapy appear to have a short-term beneficial effect on the physical symptoms of MS. Massage/bodywork and psychological counselling seem to improve depression, anxiety and self-esteem. The effectiveness for other CATs is unproven at this time. In all the CATs examined further investigations are needed in the form of rigorous large-scale trials.

Abdominal massage for the alleviation of constipation symptoms in people with multiple sclerosis: a randomized controlled feasibility study.

http://www.ncbi.nlm.nih.gov/pubmed/20940182

The results of this small study suggest a positive effect of the intervention on the symptoms of constipation, and support the feasibility of a substantive trial of abdominal massage for the alleviation of the symptoms of constipation in people with MS.

PubMed search “Multiple sclerosis and massage”

http://www.ncbi.nlm.nih.gov/pubmed/?term=%22multiple+sclerosis%22+AND+massage

General information on MS

Below are some links to information about MS recommended by some commenters:

http://reviews.jbjs.org/content/2/7/e3 http://www.msdiscovery.org

http://www.mymsaa.org/about-ms/treatments/

http://www.mymsaa.org/about-ms/treatments/

‪http://www.mymsaa.org/about-ms/treatments/

‪http://www.nationalmssociety.org/

Comments from massage therapists

Following are some comments by massage therapists regarding their experience:

“I have treated a number of MS clients. I am going to tell you a little of my clinical experience as you requested.

I have found that a significant difference can occur with footwork to encourage dorsiflexion, which is typically part of their problem with walking. This has been consistent with most MS clients I have treated.

My experience has been that it helps them for 3 to 7 days, then returns to pre treatment condition.

Spasms as involuntary contractions are common. If a contraction does not pass quickly, recripical inhibition or contract relax techniques are often helpful (just as in non MS clients)

They can have large sudden and unexpected spasms particularly in the lower limbs (my experience)

Often when working in one area, they will experience spasms in another area directly related to the actual palpation. In a few cases it was like an on/off switch. Push button A and B responds.

Most wanted deep work and responded very will to MFR (myofascial release) approaches during session and the following day(s).

I hope that helps.” Bert Davich, LMT

“My massage therapy school had an in reach for people with MS. Most of us had over 100h of experience treating MS before graduating. I don't see it as much in the private setting now due to cost barriers for patients but from what I remember ‪Bert Davich described it well. Slow sustained pressure and strokes seemed to relieve HT muscles in the short term and lasted for 3-9 days.

I have worked with a number of MS clients across the full spectrum (mild to severe symptoms), all who found massage to be beneficial primarily for pain reduction and stress/anxiety management. My experience was that people in wheelchairs found massage helpful to help manage postural/positional concerns and spasticity in more severe cases of MS. 

Sutherland-Chan School and Teaching Clinic in Toronto has an MS Massage Specialty Clinic. You might want to try to get in touch with them for more info.

This clinic is for people with multiple sclerosis and focuses on their particular needs; for example, improving circulation and mobility, boosting energy and mood, improving sleep, reducing pain and improving everyday functions. Most are in wheelchairs or use ambulatory aids and need various types of treatment adaptation. Clients are usually referred to us through the MS Society, but this is not mandatory." Michael Reoch, RMT

‪http://www.sutherland-chan.com/teachin.../specialty-clinics/ Specialty Clinics | Sutherland-Chan School www.sutherland-chan.com

"As a side note, interestingly a lot of my MS clients love and get the most relief from deeper pressure treatments. Not sure why this is? I have experimented with DNM/gentler treatments with two of my pressure-loving MS clients recently and neither found any change in symptoms (even though they were both keen and interested to try it out). Relief came when we went back to the deeper stuff.”  Tina Gio, LMT

“I spent early five years with a person who had chronic progressive MS.....she wanted touch, I studied from books, practiced on her, she loved it and eventually told me to go to massage school......so, this is all her fault.”  Rhonda Henry, LMT