Multiple Sclerosis

Reflexology and Multiple Sclerosis

Compiled by Amy M Kreydin

May 2004

Reflexology, as an ancient bodywork modality, has become an increasingly popular complement in the treatment of Multiple Sclerosis. It is currently being used to assist in the management of pain, bladder function, insomnia and sleep disorders, numbness and many of the other more common symptoms of this disease. The purpose of this paper is to explore what this disease is, the modern allopathic treatments available, what reflexology is, and conclude with available research to determine whether Reflexology has a place in the treatment of persons with Multiple Sclerosis.

Multiple Sclerosis (MS) is considered to be an autoimmune disease that attacks the Central Nervous System (CNS), consisting of the brain, spinal cord, and the optic nerves. A fatty tissue called myelin surrounds the nerve fibers of the Central Nervous System and protects, which helps these nerve fibers to conduct electrical impulses. In MS, the myelin is lost in multiple areas, leaving scar tissue, which is called sclerosis. The damaged areas are also called plaques or lesions. In some cases the nerve fiber itself has been damaged or broken. This myelin not only protects the nerve fibers, but it also enables them to function. When destroyed or damaged, a disruption of electrical impulses from the nerves to the brain occurs; this is where the symptoms of Multiple Sclerosis are produced.

Some of the more common symptoms would include: bladder & bowel dysfunction, dizziness and vertigo; difficulty with memory, attention and problem solving; fatigue, balance problems and difficulty in walking, numbness or “pins and needles,” pain, and vision problems. Other less common symptoms include: headaches, hearing loss, itching, seizures, spasticity, tremors, and speech and swallowing disorders.

The disease has four courses that it typically runs and they can differ from mild to moderate to severe in each type as follows:

• Relapsing-Remitting is a period of well-defined flare-ups, episodes of acute worsening neurological functions, followed by a partial or complete recovery period without the disease progressing. It is the most common form of Multiple Sclerosis, found in the initial diagnosis, weighing in at approximately 85% of those diagnosed.

• Primary-Progressive patients would find a slow, yet almost continuous, worsening of the disease from the beginning. Remission doesn’t happen with this course but the variations at which it progresses can vary and there are temporary, yet minor, improvements. This course is relatively rare and occurs in about 10% of those diagnosed.

• Secondary-Progressive starts as a Relapsing-Remitting disease but is followed by a steadily worsening course; occasional flare-ups may or may not happen as with remissions or plateaus. Approximately 50% of people with this form of disease developed relapsing-remitting within ten years of their first diagnosis, prior to the introduction of “disease-modifying” drugs. There is no long-term date available to tell whether this delay is caused by treatment.

• Progressive-relapsing is opposite of relapsing-remitting where the individual experiences a steadily worsening condition from the onset but also experiences flare-ups with or without recovery. Compared to relapsing-remitting the periods between relapses for progressive-relapsing disease are identified as the continuance of the disease as it progresses. This type is also relatively rate occurring in about 5%.

Approximately 400,000 people have Multiple Sclerosis in the United States with approximately 200 more being diagnosed each week. It is estimated that 2.5 million individuals may suffer from MS worldwide.

Modern allopathic treatment of Multiple Sclerosis would include one of the following five “Disease-Modifying” drugs: Avonex, Betaseron, Copaxone, Rebif or Novantrone. All are given via injection either subcutaneously or intramuscularly on a daily or weekly basis with the exception of Novantrone, which is injected quarterly at a medical facility and has a lifetime limit of 8-12 doses. Avonex, Betaseron and Rebif are manufactured from one of the naturally occurring interferon amino acid proteins. While Copaxone is a synthetic protein that acts as myelin and therefore confuses the myelin-attacking T Cells and slows the disease down. Novantrone is a form of chemotherapy and is used only on more advanced stages of MS. Exacerbations, or “flare-ups” are treated with a high dose of corticosteroids, such as methylprednisolone, usually intravenously though it is available in oral dosage like Prednisone.

Symptoms of Multiple Sclerosis are treated individually as no two persons have the same course of symptoms and these are frequently changing throughout the course of the disease. Rehabilitation is often necessary to maintain or restore functions essential to daily life. This may consist of: Physical Therapy, Occupational Therapy, Cognitive Therapy, Speech Therapy & Vocational Therapy.

Complementary and Alternative Medicine (CAM) is popular amongst 50-60% of persons with Multiple Sclerosis. Such treatments include Yoga, Vitamin and Herbal Supplements, Meditation, Tai Chi, Diets, Acupuncture, Massage and Reflexology.

Reflexology is a science-art bodywork form nearly 5,000 years old. It’s history first shows up in the tomb of an ancient Egyptian Physician in a wall painting, which depicts two practitioners working on the feet of two men. It is thought to have spread from Egypt through the Roman Empire and is said that Marc Anthony worked on Cleopatra’s feet during dinner parties. Furthermore Reflexology was being practiced in Asia and India for thousands of years, simultaneously, without any known interaction or teachings from the different cultures.

A more modern look at the history of Reflexology finds roots in European & Russian research in the last century. Vladimir Bekterev, a Russian neurologist and psychiatrist, coined the term “Reflexology,” in 1917. While a Dr. William Fitzgerald, an Ear, Nose and Throat doctor who practiced in England and the United States, published his theory on “zone therapy” in the early 1900’s. His colleague, Dr. Joe Shelby Riley, found this work fascinating and passed the enthusiasm to Eunice Ingham, a physiotherapist for Dr. Riley in Florida. Ingham further studied Dr. Fitzgerald’s findings and developed her foot theory in the early 1930’s. She brought popularity to the field in the 1940’s and 1950’s with two publications, “Stories the Feet Can Tell,” and “Stories the Feet Have Told.”

Reflexology is the theory that the feet, hands, and ears are microcosms of the body, reflecting each organ, gland and body part in “reflex points.” It is believed that by stimulating these “points” with a thumb and finger pressure, the body is encouraged, through the Central Nervous System, to bring relaxation and balance to those corresponding organs, glands and parts that are worked. Oxygen and blood circulation are improved, and by working through the 7,000+ nerve endings on the feet, relaxation is a result. With this relaxation comes stress reduction and causes these physiological changes in the body. The primary benefit of Reflexology is relaxation. Therefore it is thought that through this relaxation the body can balance any kind of stress it may be experiencing.

Would Reflexology then be beneficial for a person with Multiple Sclerosis? Can it help alleviate symptoms? If so, which symptoms would be improved?

A study by the Grampian branch of the Charity Action & Research for Multiple Sclerosis (GARMS) teamed with the Scottish Institute of Reflexology to work on fourteen volunteers, persons with MS, to receive reflexology weekly for eighteen weeks. Assessments from the volunteers were taken at the beginning of the study, and each six weeks thereafter. They were to judge nineteen of the most common symptoms as either major or minor, and then follow-up with whether these same symptoms were improved, worsened or changed with each six week assessment. Participants showed an improvement in 45% of their symptoms by week eighteen compared to 13% in the control group (twelve volunteers). They determined that reflexology did offer some therapeutic benefit to the volunteers, especially in the first six weeks of treatment, but that the sessions needed to be regular and the benefits tapered off after twelve weeks.

The Complementary Medicine Clinic at the Sheba Medical Center in Tel-Hashomer, Israel conducted a study with seventy-one persons diagnosed with Multiple Sclerosis for an eleven-week treatment period. The fifty-three reflexology volunteers received manual pressure on specific points in the feet and massage of the calf area. Their control group received a nonspecific massage on the calf area. Symptoms were assessed in a masked study in the beginning, a follow-up after six weeks, at the end of the treatment phase and again at three months. The study concluded that those receiving specific reflexology treatment benefited in alleviating motor, sensory and urinary symptoms. Parasthesias, abnormal sensations (e.g. burning, tingling, feeling numb), were significantly improved at the end of the treatment period and remained so at the three-month follow-up test.

A current clinical study being conducted by Andrea Lowe-Strong, PhD at the University of Ulster in Belfast is trying to determine if Reflexology can relieve pain in people with Multiple Sclerosis. The study started in February of 2004 and is expected run into January 2005. Dr. Lowe-Strong plans to recruit 100 people for the study across Northern Ireland. The study is hoped to be useful evidence on an international level of Reflexology’s usefulness in the disease. “Reflexology has been shown to be effective in reducing a number of different symptoms including chronic pain and headache and improving general well-being. However, previous studies were quite small, and so no definite conclusions can be drawn.  By undertaking a large-scale trial, we will be able to determine whether reflexology is indeed effective for the symptoms associated with MS. This in turn will add to the body of knowledge about the question and will help people with MS to decide whether to use the therapy,” Dr Lowe-Strong said. Treatments will take place for one hour a week and last ten weeks. Pain will be measured at the beginning and end of the study and again at weeks 16 and 22 to determine any lasting effects of the treatment. The Multiple Sclerosis Society of Northern Ireland’s Community Support Officer, Robert McConnell, welcomes the advancement of knowledge in this field, “It is considered that approximately 3,500 people in Northern Ireland have MS. Some of our members already attend reflexology sessions and consider it to be extremely beneficial for their general well being. The Society welcomes the introduction of this research and following a previous announcement regarding the study, we have already been contacted by people with MS who wish to have further information”.

Dr. Lowe-Strong is correct about the previous small studies. The 1993 & 1994 China Reflexology Symposium Reports from Beijing published two studies on Reflexology and Multiple Sclerosis. The first study was with a 26 year old man who was experiencing quadriplegic numbness and weakness. His Prednisone dosages were reduced after his Reflexology treatments and they concluded that Reflexology was in fact effective for the symptoms. The second study was with a 27 year old woman who was experiencing pain with movement and was on muscle relaxants and anti-depressants. It was thought that her disorder was linked with Myasthenia Gravis and normal nerve transmission couldn’t take place. They noted that her health was improved but she “was not completely cured.”

With continuing research in this field many remain hopeful that new studies will advance our knowledge on Reflexology and Multiple Sclerosis. In the meantime the National Multiple Sclerosis Society acknowledges the popularity of Reflexology amongst its members and local chapters have published articles in their quarterly newsletters about Reflexology and the need for human touch, especially with MS. They remain guarded however, to admitting any benefits and caution users to consult with their physician before undergoing any treatment not currently prescribed to them. As they should, most Reflexologists have a disclaimer in their intake forms about the modality not being a substitute for medical care and to consult with their medical doctor if they are experiencing any specific medical conditions.

Reflexology and Multiple Sclerosis research is off to a good start and, if used in conjuncture with allopathic medicine, may very well be a beneficial modality to those with MS. We have seen positive data suggesting this so far. Not a cure by any means, but a means to live a little better, through touch, with the debilitating disease. And that in itself can go a long way toward bridging the gap between allopathic medicine and complementary and alternative medicine.