Issue link: https://www.massageandbodyworkdigital.com/i/1505456
76 m a s s a g e & b o d y wo r k s e p te m b e r/o c to b e r 2 0 2 3 sessions (i.e., 20 minutes three times a week) than less- frequent, longer sessions; this seemed to be especially helpful for improved sleep. Massage therapy and other non-drug therapies are popular among people with PD, and for good reason: Our work can add substantially to a client's quality of life. Because clients with PD are likely to be challenged in many ways, it is especially important to work in conjunction with their health-care team so our goals are in alignment with theirs and to consult over any questions about physical or mental health. People with PD are at risk for chronic pain, anxiety, depression, injury, falls, and much more. While massage therapy won't solve this problem, our work can certainly help to deal with the consequences of this common and sometimes devastating disease. Notes 1. Parkinson's Foundation, "Statistics," www.parkinson.org/ understanding-parkinsons/statistics. 2. Parkinson's Foundation, "Statistics." 3. Efthalia Angelopoulou et al., "Massage Therapy as a Complementary Treatment for Parkinson's Disease: A Systematic Literature Review," Complementary Therapies in Medicine 49 (March 2020): 102340, https://doi.org/10.1016/j.ctim.2020.102340. 4. Zhiran Kang et al., "Effectiveness of Therapeutic Massage for Improving Motor Symptoms in Parkinson's Disease: A Systematic Review and Meta-Analysis," Frontiers in Neurology 13 (September 2022), https://doi.org/10.3389/fneur.2022.915232. 5. Yolanda Casciaro, "Massage Therapy Treatment and Outcomes for a Patient with Parkinson's Disease: a Case Report," International Journal of Therapeutic Massage & Bodywork 9, no. 1 (March 2016): 11–8, www.ncbi.nlm.nih.gov/pmc/articles/PMC4771486/. 6. Jacques Vaillant et al., "Massage and Mobilization of the Feet and Ankles in Elderly Adults: Effect on Clinical Balance Performance," Manual Therapy 14, no. 6 (December 2009): 661–4, https://doi. org/10.1016/j.math.2009.03.004. Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology (available at booksofdiscovery.com), now in its seventh edition, which is used in massage schools worldwide. Werner is available at ruthwerner.com. One frequently cited case report found that massage therapy treatment had a positive effect on resting and postural tremor, as well as short-term benefits for rigidity. 5 Because balance becomes a challenge, and fear of falling may negatively impact the quality of life of a person with PD, findings like those in the article "Massage and Mobilization of the Feet and Ankles in Elderly Adults: Effect on Clinical Balance Performance" may become relevant. This study found that even a single session of massage and mobilization of the feet and ankles of adults 65–95 years old led to significant improvements in timed up-and-go (how long it takes to come from sitting to standing) and one-leg balance tests. 6 Numerous studies also support massage therapy for improving sleep quality, reducing constipation, improving self-reported quality of life, maintaining f lexibility, and other benefits that speak to the varied experiences of people with Parkinson's disease. That said, this population also presents with some cautions for massage therapy. Diseases rarely occur one at a time, especially in older people. So those with PD may also be living with a variety of comorbidities, including osteoporosis, Alzheimer's disease, complicated surgical histories, and many other factors that must inf luence our choices for massage. The medications that help manage PD also carry significant side effects—like nausea, low blood pressure, lightheadedness, and excessive daytime sleepiness—that might also inf luence decisions. Because PD presents extremely differently from one patient to another, it's impossible to make a comprehensive list of the most appropriate client accommodations. However, we can predict that clients with PD might derive the best benefits from massage when their medication is most active, as opposed to approaching the end of their dose-cycle when their function diminishes and rigidity and tremors worsen. Clients with PD may also have difficulty getting on and off the table, and their tremor or muscular "freezing" may require some in-the-moment adjustments and experimentation to find what techniques they respond to best. Some massage therapists have sent me their best tips for working with clients who have PD. These include working with fully clothed clients using f loor mats—this reduces the risk of falling, but it may add new challenges in helping the client get down and then up. Another therapist found that their clients had better responses to short, frequent PATHOLOGY PERSPECTIVES