The study, “Massage therapy and exercise therapy in patients with multiple sclerosis: a randomized controlled pilot study,” involved 48 subjects with multiple sclerosis. Those included in the study had confirmed relapsing- remitting or secondary progressive multiple sclerosis and a score between 2 and 6 on the Expanded Disability Status Scale. Participants also had to be able to stand unassisted, using aids if necessary, for at least 60 seconds, and safely walk 10 meters, with an assistive device if necessary.
The 48 subjects were randomly assigned to four groups: a massage therapy group, an exercise therapy group, a combined massage-exercise therapy group and a control group. Those assigned to the three intervention groups received three 30-minute sessions of the assigned intervention per week for five consecutive weeks, along with standard medical care.
“The focus of both the exercise therapy and massage therapy was on the lower extremities,” state the study’s authors, “because of the more pronounced involvement of the lower limbs as compared to the upper limbs in this specific patient population.”
Subjects in the massage group were given a standard Swedish massage, with a focus on the bilateral quadriceps femoris, hip adductors, peroneal and calf muscles. The massage therapist applied petrissage, effleurage and friction during each 30-minute session.
Participants in the exercise therapy group were guided through a combined set of strength, stretch, endurance and balance training exercises, all focused on the lower limbs. In the massage-exercise therapy group, subjects performed 15 minutes of these exercises and also received 15 minutes of Swedish massage.
Subjects in the control group continued with their standard medical care and were provided with an appropriate intervention immediately after the study was complete. During the five-week study, these control subjects were asked to refrain from any exercise program or any change in their normal activities.
The main outcome measures for this study were pain, fatigue, spasticity, balance, gait and quality of life. Each was assessed right before and after the five-week intervention period. The same physiotherapist, blinded to the subjects’ C group assignments, performed all outcome measurements.
Pain was measured using a visual analog scale, and fatigue was assessed on the Fatigue Severity Scale. Spasticity in the ankle plantar flexors was evaluated via the Modified Ashworth Scale, whereas static and dynamic balance were measured using the Berg Balance Scale and the Timed Up and Go test.
To assess gait, researchers focused on walking speed and endurance, using a 10-meter timed walk and two-minute walking test. Quality of life among the study’s subjects was measured using a questionnaire called the Multiple Sclerosis Quality of Life-54.
Results of the research revealed subjects in the massage group had significantly greater improvements in all outcome measures as compared to the control group. Those in the exercise group also showed significantly greater improvements in all outcome measures, with the exception of pain, as compared to the control group. Subjects in the combined massage-exercise group showed significantly greater improvements on all outcome measures, with the exception of spasticity, as compared to the control group.
When comparing the intervention groups, the massage group showed significantly greater improvements than the exercise group in both pain and gait. The combined massage- exercise group showed a significantly greater improvement than the exercise group in pain. No significant outcome differences were observed when comparing the massage group to the combined massage-exercise group.
Therefore, while all three intervention methods resulted in large improvements as compared to the control group, the data showed massage therapy led to significantly better results than exercise therapy alone.
Authors: Hossein Negahban, Solmaz Rezaie and Shahin Goharpey.
Sources: Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Originally published online in Clinical Rehabilitation in July 2013.
This research report ran in the print edition of MASSAGE Magazine‘s September 2013 issue.