PARKINSON'S SYMPTOMS & 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, including Trager, Alexander
Technique and Swedish massage,
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.
