Pain relief, relaxation and comfort can result when you get rubbed the right way
Massage is the manipulation of soft tissue by stroking, kneading and pressure. It's been around for thousands of years, and it's good for babies, kids, adults of all ages, people with almost any medical condition or with none, and even for pets. Its general result is better blood circulation, overall relaxation, stress reduction and relief from muscle pain.
Those effects in turn can — depending on the individual — yield better sleep, more flexibility of joints, improved bowel function, relief of mood symptoms such as depression and anxiety, and in some cases even prolonged muscle function. Though it can't stop or reverse the progress of a neuromuscular disease, massage can temporarily ease some symptoms and make a person feel more comfortable.
Most people who enjoy frequent massage wholeheartedly agree that it feels great, even if they aren't quite sure why. Doctors and physical therapists suggest it can ease neuromuscular pain, with no side effects to be concerned about. There's also a growing field of research aimed at scientifically measuring and explaining why and how massage produces its many benefits.
Bill Altaffer of Tucson, Ariz., has been getting massages twice a month for about 15 years. An attorney who has spinal muscular atrophy, Altaffer says massage has benefits "for circulation, relaxation, contractures, chest loosening up so you can breathe. I can't explain this to you scientifically, but when she works on me, my ribs all crack because things get loosened up, the cartilage sort of gets moved around."
If massage is so great, why isn't everyone doing it every day? One reason may be cost.
Fees can range from $25 to $75 for an hour's treatment. This may be within even a modest budget if you only go once a month or so. If you're a regular customer, you can probably get a cut rate or have shorter sessions.
Williams also suggests negotiating with a therapist for regular sessions. The therapist may offer a sliding scale, or be willing to give a discount if you bring in other referrals or place announcements in a newsletter or bulletin board. Paying for several sessions up front could get you a deal.
It's unusual for health insurance to cover massage therapy, but it may be covered if it's prescribed by your doctor or physical therapist.
An alternative is for family members to learn massage. Schools often give short courses on the basics, and there are instructional books and Web sites.
Massage by a family member can be a bonding or loving experience. Hernandez-Reif points out, "In most of our child studies, we train parents to massage their children because it is cost-effective. There are benefits for the person receiving massage and for the person giving it."
Some people can do self-massage of pressure points on the head, face, torso and feet. You can also use products that apply pressure on trigger points, usually involving hardwood or rubber knobs.
Altaffer points to another significant benefit of massage. "People with disabilities who are skinny and shy about their bodies live in their heads more than they live in their bodies. So it's nice to celebrate your body, give your body a treat every once in a while."
Steve Pinczewski of Erie, Pa., worked as a massage therapist for several years and describes massage as "passive exercise." Pinczewski takes Mestinon for his myasthenia gravis, and finds massage relieves the cramps that sometimes occur with the drug.
Pinczewski can't say enough good about massage. "There's nothing better. It gets rid of all the toxins built up in the muscles. Anybody who can't get rid of their anxiety with a good massage, they've got a serious problem."
Pat Moeschen of Salem, N.H., teaches music in a middle school. He's been getting regular massages for over a year. "It helps relieve stress with the muscles, especially in my legs and my lower back. It has just been fabulous. I feel great every time I have one," he says.
"The next few mornings when I get up after having one I certainly feel better. By better I just mean more refreshed, my muscles are a little bit looser. It makes things easier to stretch."
Moeschen, who has Becker muscular dystrophy, also does regular physical and aquatic therapy. He finds massage a good addition to those treatments. "I push myself to the limits and when I have this treatment I feel that it will make me less prone to injury because things are just looser and easier to be used."
He asks his massage therapist to place particular emphasis on "my calves. It's probably the tightest muscle on my body at all times." Moeschen, who plays the drums, finds massage also helps alleviate fatigue and tightness in his lower back, shoulders, arms and hands.
The professional view
Gregory L. Pittman, MDA clinic director at Baptist Hospital East in Louisville, Ky., considers massage "an untapped resource," especially for dealing with the pain that often accompanies weakening muscles.
"Typically we are always trying to find the least pharmacological means to deal with pain because we know that pain medicines don't generally work very well, at least in the long term. Any time you can come up with something that has nothing to do with medications is always a bonus," he says.
Pittman says massage can provide people with neuromuscular disease with needed physical activity. Family members can stretch the person's limbs and perform basic massage.
|Foot massage can help restore circulation and reduce edema.|
Another benefit is simple physical contact. "I wouldn't underestimate the fact that many of the patients have a serious problem with isolation," says Pittman. "People seem to be afraid to touch the disabled and that may even apply to their own family members. Yet I think that everyone has a certain need to feel physical contact from people."
Robert Lee Archer, MDA clinic director at the University of Arkansas for Medical Sciences in Little Rock, also likes the symptomatic, palliative treatment massage can provide. "I think that in many people, if they're having a lot of problems with muscle spasms, or increased tone [tension] in their muscles, they may well feel better after a massage. Certainly it's not curative.
"I don't think there is any real good hard scientific data to support using it in any certain neuromuscular conditions," Archer adds. "At the same time almost all of us have a subjective impression that massage, when our muscles are tight, tense, seems to help them relax. I will talk to people who chronically have stiffness in their shoulders about having people in their family do massage, or rub their necks on a daily basis."
Wendy M. King, a physical therapist who works with MDA's clinic at Ohio State University Medical Center in Columbus, says, "Massage is one aspect of physical therapy. Personally, it's always been one of my favorites because, aside from all of the anatomical and physiological benefits you might get from massage, it's hands-on. I don't think you can deny the psychological aspect of just having a professional place their hands on you and attempt to help you."
King explains that in neuromuscular diseases, various muscles degenerate at different rates, leading to an imbalance between muscle groups. This can lead to development of nodules or trigger points, places in the muscles where tension builds up. Massage can relieve those trigger points.
Marla Kaplan, a licensed massage therapist in Commack, N.Y., works with many clients who have chronic diseases or disabilities. For those with neuromuscular disorders, she says, "We can increase circulation to the area, which has to improve the health of the tissue. We can keep the tissue to a certain degree from the natural atrophy that is going to happen, and that is going to aid in movement."
In addition, Kaplan says, "A massage will bring about an awareness to a muscular dystrophy patient on just how tight they are, just exactly what is happening from their body. So that when they are getting sore, when their legs are getting tired, they can do something about it whether it's moving, or calling an aide."
Maria Hernandez-Reif, director of research at the Touch Research Institute at the University of Miami School of Medicine, finds that massage before a physical or occupational therapy session can warm up and relax the muscles, thereby making the therapy session more comfortable and effective.
What science says
Shiatsu — This form of massage is based on stimulating the so-called energy meridians or channels of the body. A gentle touch is involved, and the client can be dressed in loose clothing (many other forms require near nudity).
Trigger point — This deeper type of massage focuses on knots or nodules of muscle fibers, cramps and spasms. These tight spots build up in people with neuromuscular disease because muscles are too weak to flush out toxins and may remain contracted.
King says massage can help break down these knots. "We are talking microscopic here, but it doesn't matter because you as a person can tell the results. Now it's true that it may not always be a permanent effect but if it could be done on a somewhat regular basis the results can carry over."
Trigger points are sensitive and feel painful when the therapist presses on them with fingers or elbow. But the brief pressure soon leads to relief.
Myofascial release — This form of massage focuses on muscles (myo) and connective tissue (fascia). The fascia are believed to retain tension from physical and emotional trauma, and to become shortened in dysfunction. Myofascial release helps restore correct shape and equilibrium.
If you decide you'd like to try massage, first ask your neuromuscular doctor if there's any reason you shouldn't have a massage. Usually there isn't.
Physician Greg Pittman says, "I don't think there would be much likelihood of actually damaging anybody with massages. I can't imagine you could do anything by massaging a muscle that would make a difference in that person's neuromuscular disease."
However, massage isn't advisable for anyone with a skin condition, blood clots or circulatory problems, active infections or inflammation, malignancies, congestive heart disease or dermatomyositis.
It should also be avoided in the abdomen in the early months of pregnancy and in areas with unhealed wounds such as pressure sores.
Once you have your doctor's go-ahead it's time to find a massage therapist. You can start with recommendations from friends, your doctor, physical therapist or independent living center. You can also check with the American Massage Therapy Association (see Resources) for names of practitioners near you.
Most massage therapists probably are not familiar with disability or neuromuscular disease, but you may be able to find one who is. Ask about experience and don't hesitate to ask for references.
Tracy Williams, a rehabilitation counselor who founded Touch/Ability in Tucson, Ariz., trains massage therapists and other practitioners in disability awareness.
"The effective practitioner is one that is hard to determine. You have to go to them, you have to talk to them, you have to ask them questions and then you have to feel if your personality melds with theirs," she says.
"If the therapist kind of has a hesitancy to take you on as a client then you probably want to find another referral," Williams advises.
About half the states regulate massage therapists and require a license, which is earned by completion of at least 500 hours of classroom instruction. The Commission on Massage Therapy Accreditation/Approval accredits training programs according to federal guidelines. Be sure to find out whether your state or city requires a license, certificate or registration, and whether the therapist you're considering qualifies.
Accessibility of the therapist's facility — the building, the massage rooms, the restroom — is another consideration. (Some massage therapists are willing to come to your home.)
It's possible to do some upper body massage on a person sitting in a wheelchair, but best benefits result when the recipient is lying on a massage table. Is there a lift or an adjustable table that lowers so you can transfer onto it? Will the personnel help you transfer, and do you want them to, or will you need to bring someone with you?
Be sure the therapist will work with your preferences and restrictions on body positions. For example, if you have breathing limitations, you probably don't want to lie on your stomach. Massage facilities usually have a variety of pillows and wedges to give you support and make you comfortable.
It's important that your therapist be willing to learn everything that will help her treat you. Urge her to phone your doctor with any questions and to read MDA literature.
Be sure she's open to feedback about comfort and areas where you'd like special attention. She should be asking whether various movements are comfortable, painful or too intrusive, and heeding your answers.
Marla Kaplan asks clients to rate pain and sensation of various touches, especially when they have limits on sensation. "You have to be very careful to make sure that they completely understand that when it comes to massage therapy, unless it's trigger point, that it should feel comfortable at all times and that feedback is extremely important. No therapist is going to know better than them what they are feeling," she says.
Massage enthusiasts will cite many cases of remarkable results in which some symptoms were noticeably changed. However, any massage program that claims to cure or reverse the effects of a neuromuscular disease should be avoided. Though a legitimate therapist may have seen people achieve great symptom relief, anyone claiming to do more than that is a charlatan.
American Massage Therapy Association (AMTA)
American Organization for Bodywork Therapies of Asia (AOBTA)
Hands on Healthcare
Peaceful Spirit Therapeutic Massage Center
Pressure Positive Co.
Thera Cane and other massagers
Touch Research Institute
"Massage Therapy for People With Injuries or Disabilities," videotape, Massage Tapes Inc., (541) 488-4686, firstname.lastname@example.org
"Massage Techniques in Rehabilitation Medicine," by Debra L. Braverman, M.D., and Robert A. Schulman, M.D. Physical Medicine and Rehabilitation Clinics of North America, Vol. 10, no. 3, August 1999.