As you may recall from our previous articles, research studies have increasingly demonstrated clear benefits of massage therapy for pain. But this study, “Impact of Massage Therapy on Fatigue, Pain, and Spasticity in People with Multiple Sclerosis: a Pilot Study” goes further than supporting previous pain research: it serves as a blueprint for others who are considering developing their own research design or case study.

The authors of this study diligently describe the importance and need to measure the effects of massage in this population; they provide exquisitely detailed methodology; they measure specific and useful outcomes; and they skillfully discuss and interpret the results. If you have never read a research study before, this would be a wonderful place to start. We hope this study review helps you understand that research articles, such as those published in the International Journal of Therapeutic Massage & Bodywork, can be a resource for improving your skills and effectiveness with your clients.

The Importance of Study Purpose

The purpose of this nonrandomized, pre-post pilot study by researchers at the Shepherd Center inAtlanta was to measure symptoms of multiple sclerosis (MS) before and after a six-week massage intervention. The authors highlight the common use of massage in people with MS. “Approximately a third of surveyed individuals with MS report they use massage therapy as an adjunct to their medical treatment, often because conventional treatments are not effective in managing their symptoms.” 

Patients with MS often want options to manage their symptoms, particularly fatigue, pain and spasticity. (Spasticity is defined here as an “increase in response to stretch and movement that is disruptive to everyday function, personal care, and mobility.”) The authors note that “as fatigue, pain and spasticity increase in people with MS, mobility and everyday tasks become more difficult and quality of life (QOL) decreases. Interventions are needed to address these symptoms without side effects, in order to improve QOL in people with MS, especially given that they are expected to live a nearly full lifespan with this chronic condition.” 

The fact that MS affects more than two million people worldwide and massage therapyis commonly used by people with MS is an important consideration for all massage therapists.Even therapists who don’t specifically work with people with MS would benefit from familiarizing themselves with this condition and the beneficial side-effects that that massage therapy has on quality of life for people with this population. The study introduction, the description of the participants, their common health challenges, and how massage intervention demonstrated benefits for people with MS were thorough and especially clear for readers who might be unfamiliar with the condition. 

The Importance of Study Methods

The study methods describe in detail the participants, the outcome measures, the massage therapy intervention and the analysis. The study included 25 individuals who had been medically confirmed to have MS. A pre-post design was used, meaning the same participants were measured before and after the six-week intervention and no “control” group was utilized.

The authors described how they included and excluded participants and gave a description of what types of outcome measures were used. Primary outcome included questionnaires as well as a physical test of spasticity (the Modified Ashworth Scale). Questionnaires used were related to pain (the MOS Pain Effects Scale), fatigue (Modified Fatigue Index Scale). Secondary outcome measures included assessment of perception of health and QOL (Health Status Questionnaire and subscales of the MS Quality of Life Index,). The authors chose meaningful measures that address the symptoms of MS and would provide answers as to whether the massage intervention can meaningfully impact QOL.

As the quality and quantity of research improves, more studies are clearly outlining their protocols, including the modality of massage, a routine that describes the body part being worked on, the type of massage stroke that was used on the specific location, and the details of the stroke. An outstanding part of this article’s Method section is the specificity and transparency of therapy intervention, or routine, which was performed by two licensed massage therapists . Participants received this routine once per week for about an hour for six weeks within an eight-week period. The reporting of this protocol should serve as an example of excellence in research reporting. Moreover, readers hoping to write their own case study could essentially copy this routine (with proper citation to the original article).

The Importance of Study Findings

The authors found significant and large improvements in participants’ pain and QOL measures. However, the authors did not find a reduction of signs of spasticity after MT in the study participants. Importantly, this pilot study “is the first to demonstrate the positive impact of a standardized MT routine on fatigue and pain, as well as perception of health and QOL in individuals with MS.”

These findings are meaningful given the prevalence of fatigue and pain in people with MS, and the extent to which these symptoms impact an individual’s perception of health and QOL. The authors note that the findings are important, not just in the context of MS but for other conditions, noting that massage “has been shown to decrease fatigue and pain in people with chronic fatigue syndrome and fibromyalgia syndrome, both chronic diseases significantly impacting the health and well-being of individuals in a fashion similar to MS.”

The authors address previous research differing from theirs, including other studies that have demonstrated a decrease in spasticity after a massage intervention in individuals with neurological disorders.” One explanation is that earlier studies evaluated spasticity immediately or within 30 minutes following a massage session, while the authors assessed spasticity at the end of the six-week intervention period.

Importantly, the authors conclude by putting their findings into a national context. “Given the state of health care reimbursement, providing evidence to support the use of interventions is critical in order to get paid for those interventions. This issue is even more important for people with MS, who have a chronic disease and resulting long-term health care needs.” The progressive discussion by the authors helps practitioners and/or potential researchers understand how specific studies, even a small case study on one person, can impact people on a greater scale. It’s also important for all massage therapists, with many different styles and specialties, to understand that a wide variety of clients may seek massage therapy and that we can safely and effectively treat them with proper education and training. Should a person with MS show up on your table you could use this research study as an introduction to the benefits of massage therapy for the patients’ doctor, thus providing you with a potential referral source.

You can read this study in the 2016 issue of the International Journal of Therapeutic Massage & Bodywork, a peer-reviewed journal (Vol. 9, No. 4). Or,  learn more at the 2019 International Massage Therapy Research Conference (IMTRC) http://massagetherapyfoundation.org/imtrc-2019/.