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Parkinson’s disease is a fairly common progressive degenerative central nervous system (CNS) disorder. Affecting approximately one million 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).
Although Parkinson’s disease symptoms may vary, they are often subtle in the beginning and commonly start on one side of the body. Symptoms may include:
- Tremor – This is shaking that is common in the hand and fingers.
- Bradykinesia – This is slow movement, making simple tasks take longer.
- Muscle rigidity – Stiff muscles can occur anywhere and can cause pain and interfere with range of motion.
- Speech changes – Parkinson’s may cause speech to be softer, faster, monotone, slurred or hesitant.
- Poor balance – Increasing the likelihood of a fall, Parkinson’s is known to cause balance problems.
- Change in writing – The coordination required to write may deteriorate, and those with Parkinson’s typically write very small.
The Physiology of Parkinson’s
Experts believe that in Parkinson’s disease, neurons in the brain gradually break down or die. Many of the symptoms are due to a loss of dopamine-producing neurons. 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 percent 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.
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.
Designed to influence dopamine levels, the mainstay medications prescribed for Parkinson’s disease are Levodopa and carbidopa (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. Additional medications for Parkinson’s may include dopamine agonists, MAO-B inhibitors, Catechol-O-methyltransferase (COMT) inhibitors, anticholinergics and amantadine.
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 Parkinson’s are turning to complementary and alternative therapies for help.
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.
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 Parkinson’s, 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 Parkinson’s management component. Being familiar with this disease and welcoming those affected can bring an enormous amount of satisfaction to any compassionate bodyworker.
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