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influences immune system activity and can reduce inflammation. Vitamin D has been investigated as a protector from several diseases with varying conclusions, but the data on vitamin D and MS is relatively consistent and positive: people diagnosed with MS who have higher levels of serum vitamin D have fewer flares, fewer lesions identified by MRI, and a lower risk of disability than others. Further, people with low levels of vitamin D had a risk of developing MS more than twice as high as people with higher levels.1 (For more information on vitamin D levels, see Vitamin D—How Much is Enough?, page 47.) MS and Massage Massage is a popular intervention for MS patients; about one-third include massage in their treatment strategies.2 The research about the usefulness of massage for MS symptoms is mixed, but mostly positive. One study investigated whether receiving massage would allow MS patients to walk more quickly and report an improved quality of life (QoL). They found that while the walking speed and QoL reports didn't change, patients reported an improved "personal health rating" that fell when massage was withheld. They concluded that massage is a noninvasive, safe, well-received intervention that is effective for controlling pain and managing stress.3 In a study that used craniosacral therapy for MS patients, QoL scores did improve, along with urinary tract symptoms.4 In an MS study comparing several different interventions, 10 patients out of 30 were assigned to a massage clinic while the others received other therapies.5 Patients received massage once a week for 12 weeks. The therapists found that MS patients did not like pressure that was too light or too deep. They also did not like friction or rubbing against the skin layer. Massage use with even rhythms and balancing strokes with no sudden tempo changes was critical. By week four, the patients who used walkers were fully ambulatory. By week 10, the patients who used wheelchairs were fully ambulatory. After the study was concluded, at least two participants who did not continue receiving massage reverted back to wheelchair use. Unfortunately, the study was focused on different outcomes and other interventions, so these remarkable findings have never been reported. Many MS patients experience severe constipation, as nerve signals to the viscera and sphincters can be impeded. Abdominal massage, which can be taught to be self-administered, has been shown to be effective in managing constipation, and this can have a positive impact not only for the patients, but for the patients' caregivers.6 A study comparing traditional foot reflexology to a sham treatment and to a control group to look for ways to manage the pain associated with MS found that both of the foot treatment groups experienced statistically significant improvements in pain as compared to the control group.7 These studies, along with a stack of clinical anecdotes, suggest that massage has more benefits to offer MS patients than risks, though those risks are not negligible. MS patients can experience numbness, which means they are potentially vulnerable to tissue damage. Very advanced cases may interfere with verbal communication, in which Resources Ascherio, A. et al. "Vitamin D and Multiple Sclerosis." The Lancet Neurology 9, no. 6 (2010): 555. National Institutes of Health. "Dietary Supplement Fact Sheet: Vitamin D." Accessed April 2013. http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional. Nusrat, S. et al. "Anorectal Dysfunction in Multiple Sclerosis: A Systematic Review." ISRN Neurology 2012. Accessed April 2013. www.ncbi.nlm.nih.gov/pmc/articles/PMC3414061. Science Daily. "Vitamin D Deficiency Related to Increased Inflammation in Healthy Women." Accessed April 2013. www.sciencedaily.com/releases/2009/04/090408140208.htm. The Wall Street Journal. "Multiple Sclerosis Linked to Vitamin D Levels, Study Says." Accessed April 2013. http://online.wsj.com/article/SB10001424127887323353204578129280745162230.html. 48 massage & bodywork may/june 2013