By Juan Luis Ordaz Sabag, DVM, CMMP, LMT
For several years, my entire practice is strictly the application of Medical Massage protocols for a variety of chronic somatic abnormalities, as well as post-trauma conditions. After trying various therapy methods, I concluded that integrative approach Medical Massage offers for my patients is the optimal treatment option.
Our clinic in Torreon, Mexico is overwhelmed with patients, but I always wanted to expand the list of pathological conditions I am working with to help more patients. This recent clinical case is one example.
A 69 year-old female came to our clinic with the diagnosis of Parkinson’s Disease established 6 months ago after visiting three neurologists who confirmed the initial diagnosis. The first symptoms appeared 2 years ago on the right side, 6 months ago they really got bad and now the left side is affected even more.
Currently she takes a list of medications to cope with her symptoms but there is no significant progress:
Cloisone: 250 mg of Levodopa and 25mg of Carbidopa;
Inderaloce 40 mg
The patient exhibited very expressive bradykinesia (i.e., slowness of the movements), partial akinesia (i.e., loss of ability to move muscles voluntarily) and poor movement control, she is unable to swing her arms while walking. She had resting tremor in the right arm, hand and leg. Also, very strong spasticity on the left arm, forearm and hand.
The patient exhibited significant postural instability when she tries to turn. She was stuck in our doorway without ability to move when she tried to turn to close the door. She suffered from severe anxiety.
Very strong rigidity in both lower extremities, no knees flexion. Rigidity in forearm muscles especially extensors on the left. Adhesions between skin and superficial fascia on both forearms and above biceps femoris on the left. Soft tissues were very firm, and muscles were tight and spastic.
I made it routine to record all my patients before, during and after application of Medical Massage protocols. Video 1 below shows my patient walking into my clinic for the first time. The intensity of symptoms is obvious. Since Parkinson’s Disease is a pathology of the CNS my intention was to decrease the intensity of her symptoms and support her quality of her life.
I had never worked on a patient with Parkinson’s Disease and I had no clue how to approach her. I told my patient that I could try to help her, but I was not sure if it would work and more likely it would assist her with intensity of her symptoms. Her answer was, “I am ready to start whatever you want me to do. Nobody told me that there was any chance of improvement in the life I am living right now.”
After evaluation I consulted our clinic’s primary source – the Medical Massage textbook written by Dr. Ross Turchaninov and published by the Science Of Massage Institute. In Volume I Medical Massage protocol for Parkinson’s Disease is discussed on pp. 374-376. I used that as a framework of my sessions injecting evaluation results, I obtained during initial examination. The first session was 45 minutes and I performed Steps 1-10 customizing them to my patient’s clinical symptoms.
Step 1. Inhibitory regime of MT on the back according to location of symptoms in upper and lower extremities. Relaxation of paravertebral muscle, intense Dr. Sherback’s Friction especially around C7 to reduce tremor. Stimulation of cutaneous branches of the spinal nerves (circular friction, vibration) responsible for the innervation of affected muscles to decrease excitability of lower motor centers in the spinal segments
Step 2. Elements of Vertebral Artery Syndrome protocol to increase brain perfusion in the pool of vertebra-basilar aretries
Step 3. Same as Step 1 but on L1-S1 levels
Step 4. Later by layer work on the posterior surface of the upper and lower extremities addressing, skin, superficial and deep fascia, muscle bellies
Step 5. Kneading techniques according to the Protocol #1
Step 6. Work at the muscle insertion into the periosteum and engage H-reflex
Step 7. Felp’s technique
Step 8. Kneading techniques according to Protocol #1
Step 9. Passive stretching or very gentle PIR
Step 10. Step 4-9 on the anterior surface of upper and lower extremities
After my patient got up after the first 45 minutes session of Medical Massage, I was stunned with its results. I expected some local improvements since even a mild one is going to be a very big deal for her. What I witnessed well surpassed all my and my patient’s wildest expectations. It one more time proved to me what an incredible clinical tool Medical Massage is and how much we can help patients when things are done right.
Video 2 illustrates my patient walking after her first Medical Massage session. For the first time in almost a year she was walking as a completely healthy person! It was so incredible that I couldn’t believe my eyes!
Also, I want to demonstrate the effect Medical Massage had on the intensity of her resting tremor on the right side. Video 3 and 4 illustrate the intensity of the tremor before and after the first treatment session.
Tremor before the first session
After the first session
In the 4 hours after the session some tremor came back with lesser degree, but spasticity did not! While she continued to take medications, I saw her the next day for the second therapy. This time I added permanent, fixed electric vibration to the previously applied protocol. Results were becoming more stable after every session.
Video 5 illustrates her entering my clinic before the fourth session. As you can see, her walking still dramatically improved and it holds between the sessions! I continued to see her 3 times per week for two weeks and gave her a longer break before re-evaluation.
Now I am planning to extend my practice by including Medical Massage treatment to patients with Parkinson’s Disease in my hometown. Please consider using SOMI’s Medical Massage protocols to help patients. They are irreplaceable clinical tools and this clinical case once more proved it to me.
1. This clinical case is a great illustration of clinical outcomes Medical Massage offers when it is practiced on a scientific basis rather than personal opinions. From SOMI’s perspective, many therapists don’t fully understand what Medical Massage is since partial, personal views and anecdotal experiences are frequently used to define Medical Massage.
2. Working with the soft tissues in the affected extremities Luis used correct activation and alternation of peripheral receptors to change:
a. Plasticity of affected parts of the motor cortex affected by disease.
b. Restore and maintain soft tissue flexibility and elasticity which is dramatically affected in patients with Parkinson’s Disease
3. There is a better chance for Medical Massage protocol to work on patients with Parkinson Disease if it was relatively recently diagnosed
4. Of course Medical Massage is not the only solution for Parkinson’s Disease since patients must take medication and exercise. However, clinical management of Parkinson’s Disease can’t be decisive without Medical Massage as a part of the overall treatment.