There is a prolific idea in the medical community that paralysis, and nerve damage in general, is a hopeless condition that cannot be improved. In my experience, however, this simply isn’t true. Through massage and bodywork, clients with paralysis have an opportunity to push their limits and find improvements—sometimes seemingly miraculous, sometimes almost imperceptibly subtle.
My students and I have worked with limited-mobility clients all over the world—the causes of their conditions ranging from muscular atrophies and dystrophies, to multiple sclerosis, strokes, peripheral neuropathies, and more. While each client is unique and requires different massage therapy techniques and intensity in their treatment programs, across the board we have seen measurable improvement in function and subjective improvement in quality of life for those who’ve run out of options.
It is my hope that by sharing my own experiences with you that I can inspire you not to give up on clients in a wheelchair—as they probably need you more than anyone.
The client becomes the teacher
Early in my bodywork journey, I met Vered, a Jewish student born into a family of nine children in the 1950s—a very difficult time for Jews in Morocco.
At 18 months old, Vered contracted polio, a disease that was ravaging the region. Some of the infected died, while others were left paralyzed. Vered was left with partial paralysis and weakness, especially in her right leg. That afflicted leg caused shortening of her abdomen, in the space between the lower rib and the hip. The quadratus lumborum, transverse abdominis, and part of her low-back muscles were tight and pulling on the hip, drawing it to the ribs and shortening the waist. This tightening severely affected digestion. As a young girl, she would lie in bed for days upon days dealing with digestive problems. She also suffered from continuous headaches. In the mind of Vered’s physicians at the time, this girl’s continuing decline in health was inevitable.
When I met Vered in Israel, I was 19 and she was 23. Having just been through my own health transformation (see “Self-Preservation,” Massage & Bodywork, May/June 2017, page 60), I was so enthusiastic that I came to believe anything was possible—and that meant I believed Vered could improve with therapeutic bodywork.
Because her right leg was weak and immobile on land, we utilized her bathtub and had her bend and straighten her leg in the water, where she had much more mobility. I also took her to the Mediterranean Sea so she could lift her legs up and down in the water as I held her hands for stability.
Sometimes she lost her balance, but imagine her feeling of triumph when she could lift her legs in the water. The waves and tides made it more difficult to stand, and that was a great exercise for her. She learned she could lift her leg backward when she put her hands against a wall in a swimming pool. Each new limit Vered surpassed was empowering for her.
As a teenager, Vered underwent five surgeries to repair open fractures she suffered in two separate falls. Unfortunately, these surgeries were less than successful. In one, they replaced the bone of her right big toe with concrete. Their intention was to eventually cut the toe off completely. And, since her knee was unstable due to the effects of the polio, they wanted to immobilize the knee joint as well. Vered, feeling hopeless, experiencing excruciating pain, and having great difficulty moving, was on the verge of agreeing to the knee surgery. But, after starting her bodywork with me, she was convinced to decline the invasive knee surgery.
Initially, touching those postsurgical scars from Vered’s teenage years was next to impossible. The best I could do was put my hands near the surgery site to soothe the area. After the first three months, I could touch her surgical areas with oil and gentle massage; by the time we had been working together for a year, the sites weren’t sensitive anymore.
We worked with many different movements and pushed as far as we possibly could. For example, I would take the leg and rotate it, then I would shake it—like in sports massage. I would shake the foot as well. The massage and movement made a big difference to her. I would tap on the bones and then do a special massage technique that I discovered later is very effective for people with neurological problems: shake the muscle with the tips of my fingers and push it inward at the same time. This teaches the brain that there are other options for muscle movement. Of course, I was more vigorous with the leg that was less afflicted.
Vered was so innovative and motivated that she spent about five hours a day exercising. Two of those hours were dedicated to work in the water, bending and straightening her legs. We worked together for about two and a half years, and in that time, I was able to help Vered lift her foot from the ground; she didn’t have to drag it anymore. The space between her lower rib and her hip bone also expanded, so her waist became longer and her digestion improved. Her headaches also disappeared. Our daily walks, our attitudes and belief in improvement, and the work we did together made a life-changing difference for Vered and shaped my own professional work for years to come.
Universal principles for the paralyzed
Just as with all massage and bodywork clients, those with paralysis need customized care. In older clients, and those with rapidly progressing diseases, you can expect to get some improvement in function with massage, but the main focus should be to give a sense of empowerment back to the client. The “loss of control” associated with these diseases and conditions means even bringing back a small amount of control is great for the client and their families. The goal with these clients is more to improve the quality of life, not just to increase function.
In the case of younger clients, who have a good deal of vital energy, you can be more aggressive and aim for long-term goals. Improving quality of life remains the primary aim, but we can expect more quantifiable improvement in function.
Regardless of variations between each unique case, many of the principles used when working with clients with paralysis remain identical in theory:
Find Imbalances in the Body
Within the client’s body, discover where the strong muscles are doing the work for weak ones. Where there is muscle weakness, there is concurrent muscle tension in the balancing areas. Clients with limited mobility naturally overcompensate with muscles they can still easily control. Taking care of the tension in these areas is highly important. The overworked tendons and muscles need to be loosened and cared for to allow a greater, healthier range of motion. Neglecting the strong muscles allows lifelong habits of extreme tension to destroy a paralyzed client’s greatest physical assets—the muscles and corresponding nerves that still work with relative ease.
Remember to Use Passive Movement
There is a concept in physical education that doing movement passively is not strengthening muscles, and that concept is false. Passive movement with weak muscles strengthens them enough that the client can do the movement themselves. From there, we can continue to use passive movement for circulation, strengthening, and for other parts of the body that still can’t be worked independently. Passive movement is a good way to increase circulation in parts of the body that may otherwise be ignored.
Increase Circulation Through Massage, Movement, and Position
Everyone, mainstream medicine included, realizes that good circulation is integral to every function of the body. In fact, in the Self-Healing Method I teach, I emphasize the importance of circulation all the way to the capillary level, as we aim to bring movement to every little corner of the client’s body. If the client cannot move by themselves, then the therapist must move them through massage and passive movement to bring blood flow to areas that may stagnate. This takes away the sense of fatigue and decreases inflammation caused by muscle wasting.
Remember that weakened areas may not be able to handle more conventional methods of massage; make sure to utilize unorthodox techniques like shaking, tapping, and elevation to get maximum circulation, and don’t forget the power of subtle movements, too. This has direct, positive effects on every single bodily function for your client. Find what movement is possible with your client, no matter how small, and use it.
Utilize Water
Massage therapy and exercise in the water are crucial for clients with limited movement. The benefits of underwater work for the partially paralyzed are much greater than land work, as movement is easier when you’re not fighting gravity. This freedom of movement reduces tension and inflammation, and, more importantly, empowers these clients.
The client can use the water to exercise gently or vigorously, for aerobic exercise, for recovery and relaxation, and to play freely—whether the client is a child or an adult. Water is always indicated, and should be used as much as is reasonably possible, whether in a tub or a pool. The specifics are different for each case, but the principle that water is a healer is the point.
Increase Body Awareness
Body awareness is critical for this client. The client needs to learn what is right for their body at any given time. After each session, whether with or without you, the client should rest, eat, or take a nap. Then, they can take inventory of their body. If they feel more tired than before the session, they did too much. If they feel lighter and more refreshed, things are just right. Be sure to check in with your client with paralysis just as frequently, if not more so, as your other clients.
Deep Breathing and Specific Visualizations
Deep, conscious breathing is integral to improvement, and breathing exercises and practices can help manage the mental battle and improve recovery speeds. Self-affirmations and customized visualizations break the mind’s habit of assuming can’t instead of can, and sometimes that’s half the battle.
In many ways, the mind becomes paralyzed along with the body for these clients. One of our main goals is to help undo this mental paralysis and help the client regain their self-confidence.
For example, one of our clients suffers from muscular dystrophy. Her husband noticed that when she is alone, she stands more easily than when she is around others. Because the muscles do not change from one setting to the next, we know something must be happening mentally. The practitioner working with this client asked her to imagine that when she stands up, she’s doing it on the moon, where no one is watching. The client liked this idea and tried her best to implement it. Since then, her ability to stand, walk, and move has improved tremendously—whether she happens to be on the moon or not. Choose specific visualizations for the client’s personality and needs.
Challenge Your Client’s Limits
Years after I worked with Vered in Israel, she came to the United States to visit me and attended one of my lectures. I realized how I could illustrate the role of the mind and spirit in many cases of paralysis.
At this time, Vered still could not lift her foot higher than an inch from the ground. During the lecture, I put a stool in front of her, about 1 foot tall, and asked her to lift her foot on top of it.
“Are you crazy?” she asked. When she realized I was serious, she was a little angry. I pushed further, and pointed to the massage table, which was 3 feet tall. “Lift it up to the massage table,” I said.
“You’re out of your mind,” she said, but she tried. She didn’t succeed in lifting her foot to the massage table, but she lifted it high enough that she could put her foot on the stool. Everybody opened their mouths in amazement.
Then I pushed again. “Lift your leg all the way up to the massage table,” I said, and she did it. Vered was so shocked that she fell backward onto the mat.
The point is that Vered had convinced herself that she was much more limited than she actually was. When we managed to break that idea and confuse the mind out of its paralysis, the body responded unexpectedly. Every individual can’t have this level of sudden improvement, but we must always remember that quite often there is room for great recovery. These moments of clarity provide great motivation to continue our work.
how the mind affects our condition
In understanding the connection between our feelings, behaviors, and physical conditions, let’s look at my client Kathy to further illustrate the point.
Kathy came to me in the late ’70s with multiple sclerosis (MS). She was still pretty mobile, but she was quite prone to bladder infections because of weakness in that area. As we worked together, her situation became stable, and she began to recover from numbness and limited mobility. She understood my exercises very well and eventually took my training courses to understand them even better.
Her situation remained good until the early ’90s. While her gait had improved considerably over the years, somebody chose to complain about Kathy and called her a drunk because of her limited gait. A police officer arrived on the scene, evaluated the situation, and to confirm the complaint was wrong, gave Kathy a breathalyzer test before going on his way.
To many of us, that episode may not have been a huge deal, but Kathy was traumatized. She is a shy person and felt so embarrassed that she stopped going out in public after the incident. As a result, she became weaker, and eventually developed osteoporosis. She suffered broken bones and further deterioration.
After some work together, I was able to get her to walk again. After going through some sorrow in her life, including a broken relationship, she finally went to a wheelchair. We had been able to avoid it for 30 years. I didn’t see her again for a few years because Kathy got along very well in her wheelchair, but one day she fell and couldn’t get up. She called for emergency help, and the idea of putting her in a nursing home was posed.
Obviously, she didn’t want that, and she sought me out again to help. I met with her for several sessions in a row and mobilized her. She again became stable in her wheelchair.
That all happened in 2011. Kathy is still in her home, but it’s a work in progress. As part of her therapy, we get her into a cold pool and have her climb the stairs on her own. The cold pool makes a huge difference for her, and climbing stairs makes her stronger. In cases of MS, cold helps to shrink scar tissue in areas where the myelin sheath is damaged, enhancing the chances for movement.
In the winter, we get her to the floor and have her roll from side to side. I also always do a massage designed for multiple sclerosis, during which I shake each muscle with my fingertips to create a new message to the brain that more mobility is available.
Kathy is still in a compromised position, but having avoided a nursing home seven years ago, she remains committed to maintaining her mobility, limited as it is.
From Kathy’s story, we can clearly see that her fear of being judged changed her behavior, which in turn resulted in rapid degeneration. When she realized her situation after her fall, she faithfully undertook a specialized regimen to restore and maintain her mobility—and it’s working. Had she been resigned to a nursing home, who knows what condition she might be in—physically and emotionally—today.
I’ve worked with people and gotten them out of the wheelchair, and I’ve worked with people whom I couldn’t prevent from getting into the wheelchair. But in all cases, these clients felt they became stronger as a result of the effort. Bodywork, in combination with massage and a deep understanding of the client, can make all the difference in the world.
Lasting Improvement
In addition to the physical causes of paralysis (injuries, accidents, and genetics), I believe some incidences of paralysis may have spiritual and mental triggers as well. Vered’s conditions growing up and Kathy’s fear of judgment are perfect examples.
These cases serve as a great inspiration for myself, our practitioners, and our clients. Even when the results are not so immediately clear, there is always benefit. Do not give up—all is possible with patience. The person in the wheelchair needs and deserves your touch.
Meir Schneider, PhD, LMT, is founder of the School for Self-Healing in San Francisco. He healed himself of congenital blindness and developed an original holistic approach to health through a unique combination of therapeutic massage, movement, and natural vision-improvement exercises for prevention and rehabilitation of degenerative conditions. A globally respected therapist, educator, and bestselling author, Schneider’s upcoming book, Awakening the Power of Self-Healing, will be published by Self-Healing Press. To learn more, call 415-665-9574, email info@self-healing.org, or visit www.self-healing.org.