Parkinson’s and Therapy Massage.

by Nicole Cutler, L.Ac.

Parkinson’s disease, also called Parkinsonism, is a fairly common progressive degenerative central nervous system (CNS) disorder. Affecting about one in 1,000 people in the U.S., Parkinson’s disease is a dysfunction in the basal ganglia, an area of the brain that controls voluntary movement. Characteristic symptoms of this chronic, progressive neurodegenerative movement disorder include tremors, rigidity, slow movement (bradykinesia), poor balance and difficulty walking (called parkinsonian gait).

Parkinsonism results from the degeneration of dopamine-producing nerve cells in the brain. Dopamine is a neurotransmitter that stimulates motor neurons, the nerve cells that control muscles. When dopamine production is depleted, the motor system nerves are unable to control movement and coordination. People with Parkinson’s disease have lost 80% or more of their dopamine-producing cells by the time symptoms appear. While symptoms may appear at any age, the average age of onset is 60 years old.

Western Medicine
In addition to not knowing the cause, there is also no cure for Parkinson’s disease. Western medical treatment centers on the administration of medication to relieve symptoms. The Food and Drug Administration (FDA) has also approved a surgically implanted device that lessens tremors. Medication for Parkinson’s disease is a process of experimentation and patience, as its selection and dosage must be individually tailored. As the disease progresses, medications and their dosages will likely require modification.

Medications
Designed to influence dopamine levels, the mainstay medications prescribed for Parkinson’s disease are Levodopa and Carbidopa, or a combination of the two, Sinemet. Of primary concern to bodyworkers, hypotension is a typical side effect of these drugs. Any client at increased risk of hypotension (low blood pressure) requires extra attention during a position change or when rising from a massage table.

Alternative Medicine
Tolerance to these medications builds with time, rendering them less effective and opening up the possibility of new side effects or unpredictable responses. Just like with medications, surgical therapies are not curative and often treat only selected aspects of Parkinson’s disease. It is no wonder that an increasing number of those affected with Parkinsonism are turning to complementary and alternative therapies for help.

Massage Therapy
The benefits of massage therapy have long been recognized by people with Parkinson’s disease. Because Parkinson’s disease typically causes muscle stiffness and rigidity, bodywork’s ability to alleviate joint and muscle stiffness makes it a logical choice. As long as the client has sensation in the area being worked on, it is safe for bodywork. Communicating with a client throughout a bodywork session will ensure a positive experience. However, before working with a Parkinson’s client, bodyworkers must understand the following:

Parkinson’s disease is a CNS dysfunction, and will not be completely resolved with bodywork alone.
Work in cooperation with a client’s primary physician, as massage may impact the need for antidepressants and other medication.
Since uncontrolled movement is characteristic of this disease, getting on and off a massage table may pose safety issues. Bodyworkers must predict this with Parkinson’s clients and either improvise or take extra cautionary measures to ensure the client’s safety.
Research
According to a 2002 study conducted by the Touch Research Institute at the University of Miami, along with staff from the university’s neurology department and Duke University’s pharmacology department, Parkinson’s disease symptoms are reduced by massage therapy. In this study, the group of adults with Parkinson’s disease who received two massages a week for five weeks experienced improved daily functioning, increased quality of sleep and decreased stress-hormone levels. The massage consisted of 15 minutes in the prone position, focusing on the back, buttocks, ribs, thighs, calves and feet; and 15 minutes in the supine position, focusing on the thighs, lower legs, feet, hands, forearms, upper arms, neck, face and head. The study’s authors reported, “These findings suggest that massage therapy enhances functioning in progressive or degenerative central nervous system disorders or conditions.”

While several different massage modalities have been quantifiably researched in the context of Parkinsonism, all modalities report improvement in function, from the reduction of rigidity and improvement of sleep, to the reduction of tremor and increase of daily activity stamina.

Don’t be afraid of working with clients suffering from Parkinson’s disease. The pathology of this condition and the success reported with massage therapy make physical manipulation of the musculoskeletal system an ideal Parkinsonism management component. Being familiar with this disease and welcoming those affected can bring an enormous amount of satisfaction to any compassionate bodyworker.

Recommended Study:
Anatomy and Pathology
Pharmacology for Massage.

More Information:
Parkinson’s Disease: Massage Benefits and Precautions

References:
Massage Reduces Symptoms of Parkinson’s Disease, Massage Magazine, January/February 2003.

Slavin, John, PhD, LMT, Massage and Parkinson’s Disease: A Few Lessons Learned, Massage Today, October 2006.

Werner, Ruth, LMP, NCTMB, Parkinsonism, Massage Today, March 2005.

www.medterms.com, Definition of basal ganglia, MedicineNet, Inc., 2006.

www.neurologychannel.com, Parkinson’s Disease, Healthcommunities.com, Inc., 206.

www.parkinson.org, Complementary Therapies and Parkinson’s disease, Melanie M. Brandabur, MD, Jill Marjama-Lyons, MD, The National Parkinson Foundation, Inc., 1994.