Pain Relief, Relaxation and Comfort Can Result When You Get Rubbed the Right Way
by Carol Sowell
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Concordia uses an elbow to work on a trigger point in Lorenzini's upper back.
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The popular idea that massage releases toxins is fact-based. According to an article by two physicians in Physical Medicine and Rehabilitation Clinics of North America, tense or contracted muscles can release substances, such as potassium, that cause pain, leading to more tension, more toxins, and more pain, and so on. Relaxation of these muscles can "flush out the algesic [painful] substance as new circulation is brought to the area." Massage may also prompt production of endorphins, substances that can reduce pain perception.
The relaxation of tense, tight or contracted muscles is what leads to that "looser all over" feeling, along with increased flow of blood. The better flow of blood and lymph (a fluid collected from tissues and carried by the bloodstream) into tissues and organs throughout the body makes these areas healthier and better functioning.
The Touch Research Institute is studying the effects of touch therapies on people with a variety of health conditions. They're attempting to measure and understand scientifically what happens when people are touched therapeutically. Hernandez-Reif, a research psychologist, says there are two theories about how massage reduces pain.
The gate theory suggests that pressure and cold nerve fibers are larger and more myelinated (insulated) than other nerves. "If you apply pressure and cold to a painful area, typically those signals reach the brain quicker than the pain signal because the connection is larger and more myelinated, which means it slides quicker," she says. The signal then "shuts the gate, so that the pain signals are blocked."
The second theory is that the neurotransmitter serotonin is involved in pain (as well as depression). "Individuals who experience a lot of pain have depleted serotonin. We find that massage naturally increases or replenishes serotonin levels. By replenishing these levels, it helps the body perceive less pain as well." This idea is backed by studies measuring serotonin levels in painful conditions, Hernandez-Reif says.
The institute's research is based on a view that applying pressure to the skin through massage stimulates the touch receptors, which in turn stimulate the vagus nerve, a primary nerve that branches to organs of digestion, the heart, lungs and larynx, Hernandez-Reif explains. This stimulation "tends to generate a parasympathetic state, which is sort of a calming relaxing state."
The institute's research has found beneficial effects of massage for everyone from premature babies to people with cerebral palsy, multiple sclerosis, juvenile rheumatoid arthritis, depression, Down's syndrome, social isolation, history of sexual abuse, migraine, fibromyalgia and more. Measured results include decreases in spasticity and hypotonia, improved range of motion, and increased self-esteem and optimism.
The group hasn't yet studied muscular dystrophy but plans to do so.
There are dozens of types of massage, many developed with a spiritual component. Most well-trained therapists apply a combination of techniques suited to the individual client. Following are some of the most commonly used and most applicable types of massage for people with neuromuscular disease.
Swedish massage -- This is perhaps the most familiar type. Through basic stroking on superficial layers of muscle with pressure to relax muscles and stimulate blood flow, it can help restore temporary length and comfort, if not function, to muscles that have atrophied. The strokes in Swedish massage include moderate rolling, shaking, squeezing and tapping.
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.
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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.
 | Mara Concordia of Peaceful Spirit Therapeutic Massage Center in Tucson, Ariz., helps Michelle Lorenzini transfer to the massage table and asks her for feedback on position and strokes. Lorenzini has Friedreich's ataxia. |
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.
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American Massage Therapy Association (AMTA)
(847) 864-0123
www.amtamassage.org
American Organization for Bodywork Therapies of Asia (AOBTA)
(856) 782-1616
AOBTA@prodigy.net
www.healthy.net/aobta
Associated Bodywork and Massage Professionals (ABMP)
(800) 458-2267
expectmore@abmp.com
www.abmp.com
Hands on Healthcare
Marla Kaplan, Director
(631) 462-HAND
HOHCMK@aol.com
www.hohc.com
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Peaceful Spirit Therapeutic Massage Center
(520) 320-1953
www.bestmassageintucson.com
Pressure Positive Co.
(800) 603-5107
www.pressurepositive.com
Thera Cane and other massagers
(800) 587-1203
tcanedist@aol.com
www.theracane.net
Touch/Ability
(520) 743-7566
dh25734@goodnet.com
Touch Research Institute
Department of Pediatrics
University of Miami School of Medicine
(305) 243-6790
www.miami.edu/touch-research
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"Massage Therapy for People With Injuries or Disabilities," videotape, Massage Tapes Inc., (541) 488-4686, jcarolan@jeffnet.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.
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