Case Report on Exploration of Massage, Bodywork and Mind-Body Interventions for Parkinson’s Disease

Honorable Mention
Rosi Goldsmith from Portland, OR

Background- Parkinson’s Disease (PD) is a disabling, neurodegenerative movement disorder, affecting over 1.5 million Americans. Non-motor symptoms (NMS) and quality of life (QoL) have increasingly become a focus of PD research over the last 10 years.

Objectives- To explore what contributions massage therapy could make to this focus as part of a multi-modal approach to PD treatment.

Methods- A 63 year old male, diagnosed with PD for 5 years, was seen for 56 sessions of 45-90 min. over 36 weeks. Validated, widely accepted Parkinson’s rating scales were administered at study onset, three intermediate points, and conclusion to track motor and NMS and QoL changes, and were supplemented by clinical assessments, narrative reports, medication records, and pain rating scales.

As a proxy measure for parasympathetic response, a fingertip pulse-oximeter monitored heart rate during bodywork interventions of Swedish massage, acupressure, myofascial release and Ortho-Bionomy®. Neurologically targeted exercises and exercises for posture, balance and coordination were developed to complement a home program of yoga routine, mindfulness practice, and meditation.

Results- Posture, gait and balance showed clinical improvements. Overall, graphs of QoL and NMS showed no worsening, or modest gains, but no trend emerged for motor symptoms. Symptoms worsened significantly after adverse life events. A surprising discovery was that sustained massage compressions along paraspinal muscles consistently calmed restless leg syndrome and initiated an overall parasympathetic response. Patient reported sometimes being able to calm tremors and restore normal movement by meditation and mental rehearsal of his yoga routine at home.

Conclusions- These results cannot be attributed to massage alone, considering the multi-modal approach, and medication changes. Although the patient attributes his symptom stabilization to a supportive therapeutic massage relationship, this hypothesis was not investigated. More research may be productive.

AWARD TYPE:  Case Report ContestPractitioner

Massage Therapy for Essential Tremor: Quieting the Mind

Nicole Riou
Grant MacEwan University, Edmonton, AB, Canada

Introduction: Essential tremor (ET) is a neurological disorder resulting in rhythmical shaking of part of the body. The condition is known to have an inheritable tendency and can present in more than one family member, known as familial tremor. Treatment of the disorder is commonly by way of prescription medication. ET is progressive and in its mildest form can be sensed internally and/or observed when performing simple motor skills or activities of daily living.

Objective: To evaluate the effects of massage therapy on the severity of ET using an activity-based rating scale pre and post treatment.

Methods: The study period included five consecutive weekly sessions. The subject, a 63-year old female, indicated her hands and head as the primary areas affected by ET. The treatment aim was to reduce sympathetic nervous system firing; therefore the massage techniques implemented were relaxation-based. Methods included Swedish massage, hydrotherapy, myofascial release, diaphragmatic breathing, remedial exercise education and affirmative symptom management recommendations. Comparison drawings of an Archimedes spiral pre and post treatment provided an objective, visual representation of tremor intensity affecting fine motor control. Goniometric measurements were taken to mark changes in cervical range of motion.

Results: Tremor severity decreased after each session; demonstrated by improved fine motor manipulation skills. The client also reported an increased functionality in cervical range, which was documented during the first and last visits.

Conclusion: The results suggest that tremors, symptomatic to ET, can be eased through initiatives that encourage a parasympathetic response. Massage therapy has shown to be a valuable method of treatment for ET. Tremor severity can present in an irregular pattern due to subjective individual triggers; therefore further controlled research is required to lessen the variability between subjects and to validate these findings.

AWARD TYPE:  Past Poster Presenter

Massage Treatment Improves NTOS Symptoms and Mobility: A Case Study on Neurogenic Thoracic Outlet Syndrome

Robin Sarah Streit, BA, LMT, NCTMB

Introduction: Neurogenic thoracic outlet syndrome (NTOS) is a neuromuscular condition affecting brachial plexus functionality due to compression in the thoracic cavity. NTOS is characterized by paresthesia, pain, muscle fatigue and muscle spasms, restricting mobility in the upper extremity.

Objective: The objective of this study is to quantify the viability of massage therapy as a treatment for NTOS.

Method: A 24-year-old female was diagnosed with NTOS following a motor vehicle accident. Eight 75-minute massage therapy sessions were administered over a 35-day period. Myofascial release addressed fascial restrictions in the upper trapezius and levator scapulae, involving deep stripping from the muscles’ origin to insertion. Sustained compression was applied to release the trigger points found at the insertion of the levator scapulae and origin of subscapularis. Gentle passive stretching addressed hypertonicity of the scalene and sternocleidomastoid muscles. Pre and post treatment assessments measured symptomatic intensity and range of motion.

Results: Massage therapy rendered a 49% decrease in muscle fatigue, 45.7% increase in external shoulder rotation, and a 13.5% improvement in shoulder abduction. Therapy yielded a limited change in muscular spasm severity, frequency, and muscular strength.

Conclusion: Results suggest massage is a useful treatment for NTOS patients by managing primary symptoms and improving mobility in the affected area.

AWARD TYPE:  Past Poster Presenter

Myofascial Therapy for the Treatment of Fibromyalgia

Renee Stenbjorn, BS, LMT
Director of Education, Albuquerque School of Massage Therapy

Background: Fibromyalgia is a syndrome characterized by pain-producing musculoskeletal changes and Central Nervous System sensitization to pain. Most patients live with chronic pain and additional symptoms such as anxiety, depression, and irritable bowel syndrome. Several studies have revealed the effectiveness of massage therapy for fibromyalgia. Swedish and myofascial massage techniques have found to be mildly successful in reducing symptoms. This pilot study will focus on the use of the Fascial Abrasion Technique tool (FAT-tool), a myofascial massage tool for treatment of fibromyalgia pain. The FAT-tool has been anecdotally reported to decrease fibromyalgia pain. This study will evaluate the effects on pain immediately after a treatment and, as a follow up, three days later.

Methods: Five clients, all diagnosed with fibromyalgia and currently under doctor’s care, were each seen for one half-hour session. Due to the short treatment time, the body region treated was limited to an area between the occiput and the elbow. The client and therapist determined which segment of the region of the body would be treated at the appointment. Using a Visual Analog Scale (0 – 10 scale), each client reported their current pain levels in general and in the specific treatment area before their treatment, immediately after and again three days later. The treatment focus was myofascial therapy. The tissue was warmed with effleurage strokes and myofascial dysfunction of the region was treated with the Fascial Abrasion Therapy Tool (FAT-tool). Each session lasted approximately 20 minutes.

Results: After one short treatment session, 4 out of 5 fibromyalgia patients reported a significant reduction in pain. The average pain level before the treatment was 7, immediately after the session, the average was reduced to 3.6. There was no decrease in the average general pain three days after the treatment session.

Conclusions: This study shows that myofascial therapies may be very effective in the treatment of fibromyalgia pain and should be further investigated. The clients responded favorably to myofascial treatment with the FAT-tool, demonstrating the effectiveness of this method of myofascial work in short-term pain relief. Further studies could investigate the effectiveness of long-term myofascial treatment on overall pain levels of fibromyalgia patients.

AWARD TYPE:  Past Poster Presenter

Relationship Between Non-Specific Muscle Pain and Sleep Practices

Susan Davis RN, BHSc, MClSc, RMT
Southern Cross University Lismore, NSW Australia- Masters Research Project

Introduction: Sleep problems and pain are widely experienced in the general population. Research has shown a relationship between chronic pain and poor sleep and between no pain and sleep. This research aims to investigate the relationship of mild pain and sleep problems.

Methods: Sixty seven (67) patients from an established remedial massage centre completed questionnaires. The majority (79%) of the respondents were female. The questionnaire was a combination of three aspects: general demographics and alcohol consumption; an edited version of the Brief Pain Index; and the 12 question MOS Sleep Scale (revised). Sleep results were produced from the MOS software that compared the participants to the large population (mainly USA) recorded to date. Pain was reported as a 0-10 score (10 being the most pain). Those individuals scoring over 7 were excluded from the survey. The age range was from 20-85 years. Correlational analyses were then made using Microsoft Excel, ANOVA.

Results: The overall results showed a small, but insignificant relationship. Isolating the female results produced a significant relationship, with coincidental movements of pain experience and sleep problems. This outcome is in line with previous studies on chronic pain and serious sleep problems. In the female group (n = 53), 59% fell below the average of 50 set by the MOS Sleep Problem Index (below 50 indicating sleep problems). 41% showed mild pain experience. Correlational analysis showed that increases in pain coincided with decreases in sleep quality. Correlation was r = 0.41 with a p value < 0.05 indicating a statistical significant result.

Conclusions: Although only a small study with limited detail in the questionnaires, it is concluded that the results encourage the need for further research. This research shows that there may be a progressive line of pain before the development of chronic problems that could be detection through the inclusion of sleep assessment in mild pain patients and vice versa. This has important implications for the ongoing treatment of mild pain and the methods of practice for professions that deal with mild pain such as massage therapists.

AWARD TYPE:  Past Poster Presenter

The Effect of Massage Therapy on Cancer Related Fatigue in Breast Cancer Survivors

Paulette Swanson, PT, DPT, MS, cert. MDT
Middlesex Hospital Cancer Center, Middletown, CT
$30,000

Despite being experienced by 80-100% of cancer patients, Cancer Related Fatigue (CRF) is not well managed in traditional care settings. This has led to an increase in use of alternative modalities such as massage to manage and minimize its effects, which is supported by a promising yet limited body of scientific evidence. The Middlesex Hospital Cancer Center’s randomized, controlled pilot study will further examine the efficacy of Swedishstyle therapeutic massage in alleviating CRF in posttreatment breast cancer survivors. Severity of fatigue, the primary response variable, will be measured using the Brief Fatigue Inventory, a validated, tenitem tool from the MD Anderson Cancer Center.

Treatment group members will receive four, one hour massages over consecutive weeks; fatigue will be measured one week before the initial massage, immediately before and 24 hours after each massage, and four weeks after the final therapy session. Control group participants will not undergo massage while enrolled in the study but will complete BFIs on the same schedule as the treatment group. The delivery schedule of the BFI will allow for analysis of both short and longer term severity of fatigue.

Click here to view Paulette Swanson’s research study featured on CBS-WFSB in Connecticut.

AWARD TYPE:  Research Grants

The Effect of Massage Therapy on Cancer Related Fatigue in Breast Cancer Survivors

Paulette Swanson, PT, DPT, MS, cert. MDT
Middlesex Hospital Cancer Center, Middletown, CT
$30,000

Despite being experienced by 80-100% of cancer patients, Cancer Related Fatigue (CRF) is not well managed in traditional care settings. This has led to an increase in use of alternative modalities such as massage to manage and minimize its effects, which is supported by a promising yet limited body of scientific evidence. The Middlesex Hospital Cancer Center’s randomized, controlled pilot study will further examine the efficacy of Swedishstyle therapeutic massage in alleviating CRF in posttreatment breast cancer survivors. Severity of fatigue, the primary response variable, will be measured using the Brief Fatigue Inventory, a validated, tenitem tool from the MD Anderson Cancer Center.

Treatment group members will receive four, one hour massages over consecutive weeks; fatigue will be measured one week before the initial massage, immediately before and 24 hours after each massage, and four weeks after the final therapy session. Control group participants will not undergo massage while enrolled in the study but will complete BFIs on the same schedule as the treatment group. The delivery schedule of the BFI will allow for analysis of both short and longer term severity of fatigue.

Click here to view Paulette Swanson’s research study featured on CBS-WFSB in Connecticut.

AWARD TYPE:  Research Grants

The Use of Massage Therapy to Relieve Chronic Low Back Pain

Silver Award Winner
Laura Allen from Rutherfordton, NC

Backround and Objective- To enable the subject to cut down on pain medication, currently prescribed at 7.5 mg of Percocet (acetaminophen and oxycodone) 4 times per day, through the help of massage therapy. The subject states he does not like to take it that frequently because it makes him feel lethargic and disoriented. A 53-year old male, formerly employed as a construction worker, was referred for massage therapy for treatment of debilitating low back pain. He has pain in all areas of the back; although he sometimes experiences cervical pain and/or thoracic pain, he reports the majority of his pain is in the lumbar area. He has multiple diagnoses of osteoarthritis, scoliosis, spinal stenosis, and degenerative disc disease.

Methods- The massage used was a combination of Swedish strokes (effleurage, petrissage, and friction), muscle stripping, and myofascial release, techniques chosen based on the practitioner’s 14 years of experience in working with clients who are in pain. A treatment plan of 6 weekly visits was agreed upon with re-evaluation after the sixth visit.

Results- Progress was measured using the Oswestry Low Back Pain Scale and by subjective statements on his decreased pain level and decreased need for medication, and positive effects on his activities of daily living. The massage therapy intervention was so successful that the subject switched to monthly maintenance care after four sessions instead of six as originally planned. Conclusion: The success of this intervention for this subject suggests that massage therapy can be an effective intervention for chronic low back pain.

AWARD TYPE:  Case Report ContestPractitioner

Zen Shiatsu: A Viable Intervention for Stress Reduction in Children with Autism Spectrum Disorder

Gold Award Winner
Angela Burke from Boulder, CO

Objective- Autism Spectrum Disorder (ASD) is a developmental disability that manifests as impairments in social interaction, communication and behavior.  The objective of this study is to determine if Zen Shiatsu can reduce short and long-term stress levels in a child with ASD.

Methods- A seven-year-old male with a diagnosis of Autism was given twenty-minute Zen Shiatsu sessions weekly for six consecutive weeks.  Using a 5-point stress scale designed for children with Autism, the client indicated his stress level before each session, as well as afterward.  In addition, the parent was given the PEDS QL 4.0 Young Child Questionnaire to determine the child’s HRQoL (Health Related Quality of Life) prior to the six-week Zen Shiatsu treatment to establish a baseline.  The parent completed the same questionnaire after the six weeks of sessions to compare results.

Results-  Based on the 5-point pictorial stress scale, the client indicated that stress levels decreased after receiving Zen Shiatsu after all six sessions. The PEDS QL 4.0 showed higher HRQoL scores in all domains, indicating that the child’s overall quality of life improved within the six weeks of receiving Zen Shiatsu.

Conclusion-  Zen Shiatsu, a form of Traditional Chinese Medicine, has the potential to be a viable treatment for stress reduction in children with Autism Spectrum Disorder, therefore improving overall quality of life.

AWARD TYPE:  Case Report ContestPractitioner