Massage and Bodywork Magazine for the Visually Impaired - The Benefits of Massage Therapy for Parkinson's

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July/August 2016 Issue

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The Benefits of Massage Therapy for Parkinson's

By Jerrilyn Cambron, PhD
[Somatic Research]

For those with Parkinson’s disease, the brain slowly degenerates because the neurotransmitter dopamine stops being produced. As dopamine production slows, the patient has a significant reduction in control over his or her movements. As rigidity sets in, so does pain. According to the Parkinson’s Disease Foundation (www.pdf.org), more than half of all patients with Parkinson’s disease have associated pain, with some pain expression overshadowing the symptoms of the disease itself.
Many people with Parkinson’s disease seek complementary and alternative care in addition to conventional medicine. Massage therapy is commonly sought, with some neurologists advocating this form of care for alleviation of muscle rigidity, joint contractures, and associated pain. Yet, there are no randomized clinical trials to support the use of massage therapy for treatment of symptoms associated with Parkinson’s disease. Over the past few years, however, several smaller studies have been published demonstrating the positive effects of massage for clients with this disease.

Case Report 1
In a recent case report, a 63-year-old woman with Parkinson’s disease presented to a massage therapist with pain due to rigidity and tremors.1 She was diagnosed 14 years prior and regularly sought care from her neurologist. She used a walker, had a stooped posture, and had fallen several times. Because of her incapacitation, a home-care nurse assisted her twice a day for activities of daily living such as dressing, grooming, and cooking. Symptomatically, the patient had slurred speech, blood pressure fluctuations, headaches, nausea, and almost constant constipation. She was prescribed a levodopa medication, as well as secondary medications to manage the resultant side effects of levodopa. Most likely, the patient was Stage 4 on the Hoehn and Yahr Scale, indicating a fully developed, severely disabling disease.
The patient had greatly diminished cervical and upper extremity range of motion and experienced cervical pain on active motion and on palpation. Cervical and upper extremity muscle testing revealed weakness and the associated reflexes were a Grade 4 (clonus). The patient sought massage therapy for relief of the rigidity and resting tremors, as well as for the resultant pain in her back, neck, head, left upper thoracic and shoulder area, left hand and foot, and occasionally left leg.
Sixty-minute massage therapy treatments were rendered on a weekly basis for five weeks. The treatment was provided by a massage therapy student in her fifth semester of a six-semester program. Each treatment started with moist heat and an abdominal massage to assist in management of the patient’s constipation. Treatments mainly focused on a reduction of sympathetic nervous system activity in order to increase relaxation and, therefore, reduce muscle rigidity. Slow, deep, continuous strokes, coupled with low, smooth, passive range-of-motion stretches of the neck, upper extremities, and upper back were included, along with skin rolling and friction massage at origins and insertions of spastic muscles. Deep strokes and muscle kneading of the thoracic and lumbar areas and left leg were completed for relaxation and reduction of rigidity and pain. The treatment concluded with a face and scalp massage to instill relaxation.
Pre- and posttreatment measures for resting tremor, postural tremor, and rigidity were taken during each of the five weekly visits. Nearly every visit demonstrated improvements in the resting tremor and postural tremor. However, rigidity was not improved during the sessions, except slightly during the first visit.
Overall, the patient did improve in terms of resting and postural tremors over the five treatments. No comments from the patient were included in the case report, so we do not know if she subjectively thought the treatments were helpful or not. There were also no final comments about her constipation, so we cannot determine if the massage was beneficial for that complaint.

Case Report 2
In a similar case series, 10 patients with Parkinson’s disease sought massage care in addition to their conventional medication.2 The patients were 55 to 85 years old (average 70 years) and varied from Stage 2–4 on the Hoehn and Yahr scale, indicating moderate to severe disability. Most subjects had gait disturbance with some also having frozen shoulder.
A 30-minute traditional Japanese massage was provided to each subject by the same licensed massage therapist who had 20 years of experience. For each subject, the massage was conducted through the clothes and mostly included kneading to the neck, back, and associated limbs, starting on the less severe side and then moving to the severe side. Each subject received an individualized massage based on his or her areas of complaint.
A 20-meter walk test (10-meter walk and return) was administered before and after the massage to the four patients with gait disturbance who were able to walk unassisted. The 20-meter walk times improved for all patients, including one patient whose time was 95.0 seconds before the massage and 21.5 seconds after the massage. Also, one wheelchair-bound patient who only ambulated with the aid of her daughter before the massage was able to walk unassisted 10 meters to her wheelchair after the massage.
Changes in shoulder range of motion were also measured before and after massage for the three patients with frozen shoulder, demonstrating improvements from 10 to 25 degrees in flexion and from 5 to 35 degrees in abduction. After the massage, all of the previously frozen shoulders demonstrated nearly full range of motion.
Five of the patients also demonstrated hypophonia, defined as difficulty in speaking loudly or clearly. Patients were asked to assess the severity of hypophonia before and after the massage based on a 100-millimeter visual analog scale, with the left end of the spectrum indicating no hypophonia symptoms and the right end indicating the most severe symptoms. The average premassage measure of severity was 53 out of 100 and the postmassage average was 34.2, indicating a statistically significant change in the ability to speak.
Other changes in symptoms before and after the massage included individual improvements in the heaviness of lower and upper extremities, lassitude of the whole body, fatigue, shoulder stiffness, and muscle pain.
Overall, this case series demonstrated multiple subjects’ improvements in walking, speaking, and shoulder movement. Interestingly, the treatment was only a one-time, 30-minute traditional Japanese massage, rather than a weekly 60-minute Swedish massage over five weeks like the previous study.
Future large-scale, randomized clinical trials with comparison groups are needed to determine the most effective treatment style and timing for patients with Parkinson’s disease, as well as the most likely symptom to be improved in order to confirm the results of these two studies.

Notes
1. Y. Casciaro, “Massage Therapy Treatment and Outcomes for a Patient with Parkinson’s Disease: A Case Report,” International Journal of Therapeutic Massage & Bodywork 9, no. 1 (March 4, 2016): 11–8.
2. N. Donoyama and N. Ohkoshi, “Effects of Traditional Japanese Massage Therapy on Various Symptoms in Patients with Parkinson’s Disease: A Case-Series Study,” Journal of Alternative and Complementary Medicine 18, no. 3 (March 2012): 294–9s. doi: 10.1089/acm.2011.0148.

Jerrilyn Cambron, DC, PhD, MPH, LMT, is an educator at the National University of Health Sciences and president of the Massage Therapy Foundation. Contact her at jcambron@nuhs.edu.



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