Parkinson disease is one of the most common neurologic disorders of elderly adults, affecting approximately 1.5 million people in the United States. Common signs & symptoms are tremors, stiffness, impaired balance, & shuffling gait. With life expectancy increasing, we can expect to see a rise in PD in our older clients, especially male clients. Massage can help increase the quality of life in our clients with this disease. Other benefits of massage are featured in this blog.
Parkinson disease (PD) is a progressive neurodegenerative disease that produces a syndrome of abnormal movements called parkinsonism. Neurons deteriorate in a section of the midbrain called the basal ganglia, particularly in the substantia nigra. These neurons produce dopamine, a neurotransmitter that regulates voluntary movements. Dopamine is also involved in emotions, mood, & motivation. In fact, 50% of persons with PD have depression; 20% of persons develop dementia.
The classic triad of symptoms includes resting tremors, rigidity, & a slowness of voluntary movements called bradykinesia. Bradykinesia is characterized by difficulty initiating, continuing, or synchronizing motion. Tremors produce a rhythmic, low-amplitude handshaking motion or a repetitive pill-rolling finger motion. These tremors are present only at rest (hence the term resting tremors), disappearing briefly during voluntary movement & reappearing when the limb is stationary. These tremors are enhanced by emotional stress & cease during sleep. Tremors occur less frequently in the legs than in the arms. These symptoms do not appear until 60% to 80% of pigment is lost in the substantia nigra.
Postural abnormalities, another common symptom, are caused by a loss of normal postural reflexes; the person is unable to maintain an upright position of the trunk while standing or walking. This loss of normal postural reflexes causes a standing posture that is stooped (leaning forward with neck flexed). When walking, a propulsive gait is used, consisting of short, shuffling steps with increasing acceleration. Balance is also frequently lost, which leads to falling. Eventually, the face takes on a masklike appearance, one lacking expression. Speech becomes muffled as the voice becomes low & devoid of inflection or a quiet monotone. Chewing & swallowing become difficult, causing drooling.
PD is incurable. Medications called anticholinergics are used to reduce tremors & rigidity; antidepressants are also frequently prescribed. Speech therapy is needed in cases of swallowing & speech impairments. Physical & occupational therapy often help to maximize mobility within the limitations of the disease. Some patients use an implanted deep brain stimulator (DBS) to reduce tremors & other neurologic signs.
Massage Therapy & Parkinson Disease –
If your client has a deep brain stimulator or DBS, avoid massage over the battery pack, which is usually located in the upper chest wall (like a pacemaker), as well as the posterior neck & skull.
Massage increased activities of daily living including walking and improved self-confidence & well-being. In addition, participants stated they enjoyed the massage experience (1). Physicians rated their patients with PD who received massage as having improved daily living activities (2). In the same study, patients’ indicated they experienced improved activities of daily living & slept better. Furthermore, massage lowered levels of norepinephrine & epinephrine (stress hormones), which implies relaxation (2). One interesting finding in this study was that participants who used progressive muscle relaxation instead of massage experienced increased stress hormones, suggesting that the participants in the study actually found progressive muscle relaxation stressful (2).
Massage is best performed in a position that the client can easily maneuver, which may be a seated position. If the client is a recumbent or lying down during the massage, use only one position such as side-lying. The reason is because activities such as rolling over from the supine position to the lateral or prone position can be quite challenging for persons with PD.
Be sure to take proper precautions to reduce the likelihood of falls which includes removing throw rugs & securing carpet edges; avoiding waxy floors; removing low furniture & objects located on the floor; removing cords & wires on the floor; installing a raised toilet seat if the seat is too low; & checking light sources for adequate illumination.
Articles and Journals Referenced:
- Paterson, C., Allen, J. A., Browning, M., Barlow, G. Ewings. P. (2005). A pilot study of therapeutic massage for people with Parkinson’s disease: The added value of user involvement. Complement Ther Clin Pract. 11(3):161-71.
- Hernandez-Reif, M., Field, T., Largie, S., Cullen, C., Beutler, J., Sanders, C., Weiner, W., Rodriguez-Bateman, D., Zelaya, L., Schanber, S., Kuhn. C. (2002). Parkinson’s disease symptoms are differentially affected by massage therapy vs. progressive muscle relaxation: a pilot study. Journal of Bodywork and Movement Therapies. 6(3):177–82.
Susan Salvo is a board certified massage therapist with 30+ years of experience. Susan is passionate about massage therapy and massage education. You can contact her at firstname.lastname@example.org.