By Charlotte Michael Versagi
This article initially appeared in the November/December 2012 issue of Massage & Bodywork.
Right now, more than 350,000 Americans experience symptoms associated with multiple sclerosis (MS), including weakness, spasm, loss of coordination, and impaired cognition. As a massage therapist, you can be sure that someone with MS will walk through your door and be desperate for help.
What is MS?
MS is an inflammatory disease of the central nervous system (CNS) in which the myelin sheath deteriorates, resulting in the destruction of nerve fibers. The origin is unknown, but we do know:
• There are multiple autoimmune, environmental, and genetic factors that can trigger MS.
• A person with a history of serious viral or bacterial infection is more prone to be affected.
• Usual onset is between 20 and 40 years of age.
• It occurs twice as often in young women than in young men, but after 30, both genders are equally affected.
• Every year, 25,000 new cases are diagnosed in the United States.
Once diagnosed, MS patients typically follow a clinical course of flares and remissions. Although complete asymptomatic remission does occur, it is rare. Debilitation directly relates to the form of MS, genetic history, environmental factors, and how aggressively and consistently the disease is treated. The average life expectancy after diagnosis is 25–30 years, and complications can include minor to severe decrease in quality of life, contractures, mild to complete debilitation, secondary infections, clinical depression, and altered self-image. There is no cure.
What’s Happening in the Body?
The pathophysiology of MS is fairly straightforward. Normally, nerve signals travel at lightning speed within the CNS via fibers from the brain to the spinal cord and back again. These delicate nerve fibers are surrounded and protected by a fatty, slick coating called the myelin sheath. Innumerable signals—for gross and fine muscle movement, smell, vision, and so on—allow graceful and efficient function.
Demyelination is damage to the myelin sheath from disease or injury, after which signals do not travel smoothly. As the body attempts to repair the damaged sheath, scar tissue builds and hardens (sclerosis) in multiple spots along the myelin sheath—thus the term multiple sclerosis. Hardened, scarred patches of myelin sheath cause halting or stuttering signals from and to the brain, leading to symptoms like eye pain, muscle weakness, and spasticity.
Here’s an easy way to understand demyelination. Decades ago, household electrical cords were covered in a black, fuzzy, yarn-like material. The flow of electricity from a wall socket to a lamp was sometimes inconsistent as it ran through these fibers. Troublesome grandchildren (myself included) found it a great source of entertainment (and irritation for the grandparents) to jump up and down on these cords, causing a flickering—if not a total extinguishing—of the lamp’s light. Demyelination is similar. The normally smooth electrical conduction from the brain (wall socket) to the body (lamp) “flickers” because the smooth flow of nerve signals (electricity) has been interrupted.
The CNS has both motor and sensory nerves. This means if you pick up a hot cup of coffee, the motor nerves in your hand provide the strength and coordination to grasp and hold the cup, while the sensory nerves provide information to the brain, registering, “Aha—hot liquid.” In MS, nerve damage can result in both motor and sensory abnormalities.
Stages or Forms of MS
There is no single clinical portrait of a typical MS patient; in fact, patients are often misdiagnosed because some of their symptoms are associated with conditions such as fibromyalgia, lupus, and scleroderma. Even CNS tumors can mimic the symptoms of MS. In addition, the clinical course of the condition varies widely and is highly dependent on the initial form of MS. Patients usually linger for years or decades in the stage at which they are diagnosed before gradually progressing to a more serious form. Rarely is MS diagnosed as malignant, in which case the condition worsens rapidly and leads to an early death.
Patients with benign MS:
• Can continue to live relatively symptom-free for decades.
• Experience longer survival than with other forms of MS.
• Experience one or two early flares.
• Sometimes remain in the benign stage (15 percent of patients), but more typically progress to a more serious form of MS.
Patients with relapsing/remitting MS (the most common form):
• Experience long periods of remission, during which recovery is almost complete, interspersed with definite flares.
• Can remain in this form for life, but more often develop the next, more serious, form.
Patients with secondary progressive MS:
• Follow a similar clinical pattern as relapsing/remitting MS, but healing during remission is less successful.
Patients with primary progressive MS:
• Experience constant, low-grade flares that allow very little time to heal.
• Often steadily decline.
Patients with malignant MS (the rarest form):
• Experience severe flares that rapidly progress into severe disability or death.
How Are MS patients Treated Medically?
After the initial diagnosis is confirmed and a baseline MRI is taken, serial MRIs (multiple scans taken at consistent intervals to track disease progression or remission) are used to determine the treatment plan and the progress of the disease. Although a holistic approach to MS incorporating gentle cardiovascular exercise, strength training, high-quality nutrition, stress reduction, and an increase in the quality and quantity of sleep is important, the primary treatment for the condition is largely pharmaceutical.
While steroids can quiet flares, drugs that limit the immune system’s response to inflammation, reduce flares, and prolong periods of remission are now most commonly used to treat MS. Interferon betas allow many patients to live almost symptom-free. These drugs, which are immunomodulators, help manage relapsing MS and reduce the development of brain lesions (injury to nerves in the brain caused by demyelination). Chemotherapeutic agents, also called antineoplastics, quiet the immune system but are reserved to treat the most severe cases of MS. Drug cocktails (combinations of two or more medications) can address a variety of symptoms, yet all of these medications have serious, long-term, adverse side effects.
How Can Massage Therapy Help?
The careful administration of massage therapy techniques can help relieve muscle cramping, spasm, spasticity, and hand and foot paresthesias. Secondary limb and joint compensatory stiffness, contractures, and localized edema can be addressed with effective soft-tissue and range of motion (ROM) techniques. Depression can be reduced and an altered self-image can be improved by compassionate bodywork.
Because of the mercurial symptomatic picture presented by most clients with MS, therapeutic goals will shift frequently. Given both the musculoskeletal involvement of MS and the understandable accompanying stress, the following three general goals can be combined with the client’s specific concerns: 1) relieving musculoskeletal pain, spasm, and stiffness on the affected and compensating sides of the body; 2) reducing stress; and 3) helping maintain thoracic capacity and efficient breathing patterns.