Body-Based and Manipulative Treatments
Body-based and manipulative therapies include chiropractic medicine, massage, Pilates, reflexology, and unconventional physical therapy approaches, including hippotherapy and therapeutic touch.
Chiropractic medicine is used widely in the US and is one of the most popular complementary and alternative medicine (CAM) approaches used in people with MS. As an intervention, chiropractic is based on the idea that misalignments of vertebrae exert abnormal pressure on nerves in the spinal cord and cause dysfunction in muscles and organs throughout the body. There is sufficient evidence from randomized, controlled studies to support the use of chiropractic treatment to decrease pain in the lower back and improve tension-type headache. There is less evidence to support the use of this approach in other types of pain (neck, shoulder, and thoracic spine), emotional difficulties, or other health conditions (infection, seizure, ulcer). No well-designed studies of chiropractic medicine have shown that these techniques improve common MS symptoms nor provide disease-modifying benefits in people with MS. Although chiropractic treatment is typically well tolerated and safe, rare complications include stroke from vertebral artery dissection and cauda equina syndrome (acute loss of function of nerves in the lower spine).
Massage is an ancient medical treatment technique involving manipulation of soft tissue by means of pressure and traction. There are many different types of massage and the practice is often combined with other approaches in programs of integrative treatment for degenerative diseases, such as fibromyalgia and MS. Massage is a popular therapeutic intervention for a range of health conditions, from pain syndromes to musculoskeletal problems, and is effective at promoting relaxation.
Although massage is widely used, studies evaluating the effectiveness of massage in specific patient groups are limited by problems in design. Therefore, the strongest evidence of benefit is for quality of life improvements in patients with cancer, while convincing evidence is lacking in terms of improvement of mood, decreases in stress and pain (various types), and other symptoms that commonly affect people with MS.
The largest study conducted in people with MS was 5 weeks in duration and tested twice weekly massages administered at home. The study found that massage resulted in improvements in anxiety, depression, self-esteem, social functioning, body image, as well as a parameter described as “image of disease progression.” While these results are compelling, further well-designed studies are needed to get a clearer picture of the potential benefits of massage in MS. Massage is generally well tolerated. However, it can result in lethargy, headache, and muscle ache or pain. Massage should be practiced with caution or avoided in pregnant women and people with heart disease, cancer, and people with burns or open wounds.
Types of Massage and Other Related Bodywork Commonly Used in US
Reflexology is a healing art that has been practiced for thousands of years. Specific traditions can be found in China and throughout the Orient, in Egypt, as well as in other areas. The practice is based on the idea that areas on the feet, as well as the hands and ears, can be stimulated, resulting in effects in other parts of the body. Reflexology shares a similar approach to the practice of acupressure (one example of which is shiatsu), but the two practices are not the same.
Although reflexology has been proposed for a range of health problems, there have been few carefully designed studies evaluating its effectiveness. It may provide benefits including reduction of anxiety, decreased pain (lower back), reduction in side effects of chemotherapy, improvement in depression, and decreased fatigue associated with certain health conditions. When tested in a randomized, controlled study conducted in 71 people with MS, reflexology resulted in significant improvements in pain (paresthesias), bladder problems, and spasticity, with possible improvements in muscle strength. No definitive conclusions can be drawn on the benefit of reflexology based on this single study. Therefore, further studies assessing the effects of reflexology in MS are needed.
Therapeutic touch is a modern approach developed in the 1970s, derived from several different traditions in folk medicine. In therapeutic touch, no physical contact is made with the patient. Rather, the practitioner holds arms and hands a short distance from the subject, with the goal of affecting the energy field to correct imbalances in the field. A number of different types of therapeutic touch have been developed. The claim that the approach works via manipulation of life force or life energy and that this places the understanding of how and why it works is beyond science has made therapeutic touch very difficult to study. The strongest evidence for the effectiveness of therapeutic touch are reports by patients of relief of pain, anxiety, and stress.