Multiple sclerosis: understanding the science and the supportive role of massage therapy

Multiple sclerosis can be difficult to describe because it does not follow a single, predictable course. Two people may share the same diagnosis yet experience very different symptoms, while one person’s abilities may change from day to day or even hour to hour.

For some, MS first appears as blurred vision, unusual sensations or temporary weakness. For others, fatigue, pain, stiffness or difficulties with balance gradually begin to interfere with everyday life. Symptoms may arrive in episodes, accumulate slowly or remain relatively stable for long periods.

This variability is one of the defining features of MS. It is also why care must be individual. Medical treatment can help control disease activity, while rehabilitation, exercise, psychological support and complementary approaches such as massage may help someone manage its effects on daily life.

What is multiple sclerosis?

Multiple sclerosis is a chronic condition affecting the central nervous system: the brain, spinal cord and optic nerves.

To understand what happens in MS, it can be helpful to imagine the nervous system as an immense communications network. Nerve fibres act rather like electrical cables, carrying instructions between the brain and the rest of the body. Around many of these fibres is a fatty insulating material called myelin, which helps signals travel rapidly and accurately.

In MS, misdirected immune activity damages areas of this insulation. The resulting patches of inflammation and injury are known as lesions. Like a damaged electrical cable, an affected nerve may still carry a message, but the signal can become slower, distorted or blocked altogether.

The comparison is not exact, because nerves are living structures rather than wires. Damage may extend beyond the myelin to the underlying nerve fibre, or axon. This helps explain why MS can affect movement, sensation, vision, balance, bladder function, cognition, mood and energy in so many different combinations.

The nervous system can sometimes repair or work around the damage. New myelin may be formed through a process called remyelination, while the brain can recruit alternative pathways to help maintain function. This is rather like traffic being diverted around a damaged road: the journey may continue, but perhaps more slowly and with greater effort. Over time, repeated inflammation, incomplete repair and damage to the nerve fibres can leave fewer workable routes available.

More than relapses and remission

MS has traditionally been described through several clinical patterns. In relapsing-remitting MS, episodes of new or worsening neurological symptoms are followed by partial or complete recovery. Some people later develop secondary progressive MS, in which disability gradually increases. In primary progressive MS, this gradual progression occurs from the outset, although its pace can vary considerably.

These descriptions remain clinically useful, but research suggests that they do not tell the whole story. Filippi and colleagues argued in 2020 that progression may be occurring even when someone is not experiencing an obvious relapse. A person’s visible symptoms can appear stable while subtler neurological injury continues beneath the surface. It is rather like a building that looks unchanged from the street while wear gradually develops within its structure.

Giovannoni and colleagues used the term smouldering MS to describe this less visible activity. The analogy suggests a fire that is no longer producing dramatic flames but continues to burn slowly underneath. It should not be understood as a separate form of MS; instead, it draws attention to disease processes that may continue independently of recognised relapses.

Kuhlmann and colleagues subsequently proposed a more mechanism-based understanding of progression. Rather than treating inflammation and neurodegeneration as entirely separate phases, they described interacting processes involving immune activity, myelin damage, failed repair and the gradual loss of nerve fibres.

Researchers have also identified a possible “surface-in” pattern in parts of the cerebral cortex. As Pardini and colleagues explained, inflammatory substances within the tissues and fluid covering the brain may contribute to greater injury near its outer surface. This is an important research model, but it does not mean that all MS damage simply spreads from the outside of the brain inwards.

Overall, MS is better understood as a changing balance between injury and repair. On one side are inflammation, demyelination and nerve-fibre damage; on the other are remyelination, neurological adaptation and the brain’s capacity to compensate.

Why does MS develop?

There is no single cause of MS. It appears to arise when genetic susceptibility and environmental influences converge.

One of the strongest environmental associations is infection with Epstein–Barr virus, the common virus that can cause glandular fever. In a major longitudinal study published in 2022, Bjornevik and colleagues found that the risk of developing MS increased markedly following Epstein–Barr virus infection.

This does not mean that the virus alone causes MS. Epstein–Barr virus is extremely common, while MS remains comparatively uncommon. Infection may therefore be thought of as one key capable of opening a particular lock but only when several other parts of the mechanism are already in place.

Other associations include smoking, low vitamin D exposure and obesity during adolescence. Genetics also influences susceptibility, although MS is not inherited in a simple or inevitable way. Numerous genetic variants appear to alter aspects of immune function, each contributing a small part to the overall risk.

None of this means that someone has caused their MS through lifestyle, stress or personal choices. The condition develops through a complex interaction of influences, many of which are beyond anyone’s control.

What are researchers investigating?

Modern MS research is moving beyond the goal of suppressing acute inflammation. Scientists are also investigating why myelin repair sometimes fails, how damaged nerve cells maintain their energy supplies and why immune activity can persist within the central nervous system.

Oligodendrocytes, the cells responsible for producing myelin are central to this research. Their precursor cells can gather around damaged areas but do not always mature sufficiently to produce an effective new myelin sheath. They are a little like repair crews arriving at a damaged road but being unable to obtain the materials or instructions needed to complete the work. Researchers hope that understanding what interrupts this process may eventually lead to treatments that promote remyelination.

Dolcetti and colleagues have examined another emerging area: extracellular vesicles. These are microscopic packages released by cells, carrying proteins, fats and genetic material to other cells. They can be imagined as biological parcels within the body’s internal communication system. Depending on their contents and destination, they may encourage inflammation, influence immune behaviour or assist repair. Their exact contribution to MS, however, is still being investigated.

Metabolomics examines the small molecules produced through cellular activity. If the body is compared to a busy city, these molecules are rather like the traffic patterns, energy use and waste products that reveal what is happening within different districts. As Zahoor and colleagues explained, studying these patterns may eventually help researchers identify biological signatures associated with inflammation, progression or treatment response. Such tests are promising but are not yet part of routine MS diagnosis.

Human endogenous retroviruses have also attracted attention. These are fragments of ancient viral genetic material that became incorporated into the human genome over evolutionary time. Duarte and colleagues identified an association between the predicted activity of one such sequence and susceptibility to MS. This is an intriguing clue, but it does not establish that ancient viral DNA directly causes the condition. These sequences may affect the biological environment in which MS develops rather than acting as a single trigger.

Treating the disease and supporting the person

Disease-modifying therapies are an essential part of modern MS care. Depending on the type and activity of the condition, they can reduce relapses, limit the formation of new lesions and sometimes slow the accumulation of disability. Steroids may also be used to accelerate recovery from a significant relapse.

Medication is only one part of care, however. Someone may continue to experience fatigue, pain, altered sensation, weakness, stiffness, spasms, disturbed sleep or anxiety even when inflammatory disease activity is relatively well controlled.

Managing MS can therefore be compared to maintaining both a building and the lives taking place inside it. Disease-modifying treatment addresses processes that threaten the structure, while rehabilitation and symptom management help its occupants move around, remain independent and live as comfortably as possible.

Depending on the individual, support may involve an MS nurse, neurologist, physiotherapist, occupational therapist, psychologist, continence specialist, speech and language therapist or pain service. Appropriate exercise can also help preserve strength, mobility, cardiovascular health and confidence.

Massage may sit alongside these approaches as a supportive, complementary therapy. It should not replace neurological assessment, disease-modifying medication, physiotherapy or other prescribed treatment.

What might massage realistically offer?

The most defensible reason for using massage in MS is not to treat the disease itself, but to help the person feel more comfortable.

A systematic review by Heidari, Shahrbanian and Chiu found encouraging evidence that massage may help with symptoms such as fatigue, pain, anxiety, depression and reduced quality of life. The authors also highlighted limitations in the available evidence, including small participant groups and considerable differences between treatment methods.

Schroeder, Doig and Premkumar similarly reported improvements in quality of life and aspects of physical function following massage. More recently, Naderi and colleagues found that six weeks of Swedish massage was associated with improvements in quality of life and several physical and psychological symptoms among people with MS.

These findings are encouraging, but they should be interpreted carefully. Many massage studies have been small and short-term, and they often rely on participants describing how they feel. Treatments also differ in pressure, duration, style and frequency, making direct comparisons difficult.

The evidence therefore suggests that massage may provide symptom relief. It does not demonstrate that massage repairs myelin, suppresses the immune activity responsible for MS, prevents relapses or slows neurological progression.

That distinction does not make massage unimportant. It simply locates its value honestly. Massage may help to turn down the “volume” of discomfort, muscular tension or anxiety, even though it does not remove the neurological condition producing the wider pattern of symptoms.

For someone whose body often feels unpredictable, a period of reduced pain, improved rest or safe and reassuring touch may carry considerable value.

Adapting massage to the individual

Making massage work for you

Living with MS often means that your body does not feel the same every day. A massage that feels restorative one week might be too tiring or intense the next. There is therefore no standard routine that suits everyone or even one person all of the time. A good session begins with how you are feeling that day.

Before the massage, you can expect a brief conversation about anything that might affect your comfort, such as fatigue, pain, mobility, altered sensation, spasms, heat sensitivity, medication or a recent change in your health. This is not an examination, and you do not need to describe every aspect of your MS. It simply helps the session respond to your needs rather than following a fixed formula.

You might also want to mention if you need help getting on or off the couch, cannot remain in one position for long or find lying face down uncomfortable. Massage does not have to take place in a conventional position. Cushions, side-lying or semi-reclined treatment, shorter periods in each position and regular pauses can all make the experience more comfortable.

Fatigue deserves particular consideration. Energy with MS can sometimes feel like a limited daily allowance: if too much is spent during the massage, there may be too little left for travelling home or managing the rest of the day. A shorter or gentler session may therefore be more beneficial than a long, physically demanding one.

Some people with MS are also sensitive to heat and notice a temporary increase in their existing neurological symptoms when they become too warm. If this affects you, it is worth mentioning before the session so that heated equipment, heavy coverings and room temperature can be adjusted.

Numbness or reduced awareness of pressure and temperature can make it harder to recognise when something is too strong or too hot. Massage is not a test of how much pressure you can tolerate. Where sensation is altered, lighter pressure and regular communication may help to keep the experience comfortable and reassuring.

Spasticity is also more complex than an ordinary “tight muscle”. It arises from changes in communication between the brain, spinal cord and muscles, rather than simply from a muscle needing to be loosened. Forceful pressure, discomfort or sudden movement can sometimes aggravate spasms, whereas slower and more predictable touch may feel easier for the nervous system to accept.

It can also help to distinguish between different kinds of pain. Musculoskeletal pain may arise from muscles, joints, posture or the additional effort involved in moving differently. Neuropathic pain comes from changes within the nervous system and may feel burning, electric, stabbing or unusually painful in response to light touch. Because these experiences have different origins, they may not respond to massage in the same way.

Medication or other health conditions do not necessarily prevent someone from having a massage, but they may influence how it is approached. Blood-thinning medication, long-term corticosteroid use, osteoporosis, fragile skin or a tendency to bruise are all worth mentioning beforehand.

Massage is usually best postponed if you have a fever, an acute infection or feel generally unwell. New neurological symptoms, a marked unexplained deterioration or concerns about a possible relapse should first be discussed with your MS nurse, neurologist or GP rather than treated as muscular tension.

Most importantly, you remain in control throughout the session. Consent is not a single “yes” given at the beginning. You can ask for less pressure, more support, a different position, a pause or an end to the treatment at any time. An appropriately adapted massage should work with your body as it is that day, not ask you to endure discomfort in pursuit of a supposed benefit.

Stress, symptoms and the nervous system

Stress does not cause MS, and it would be misleading to claim that massage controls the condition simply by “reducing inflammation”. The relationship between stress, symptoms and neurological disease is far more complex.

Living with an unpredictable condition can itself place the nervous system under considerable strain. Poor sleep, worry and muscular guarding may increase pain, fatigue and the sense of being physically overwhelmed. Existing symptoms may feel more prominent during stressful periods without this necessarily indicating a new inflammatory lesion.

The nervous system has sometimes been compared to a smoke alarm. When it has been repeatedly challenged, it may become more vigilant and react strongly to relatively minor signals. This analogy does not mean that symptoms are imagined. Rather, it illustrates how pain, fatigue, anxiety, sleep and sensory processing can amplify one another.

Massage may help by creating a period of safety, rest and reduced sensory demand. Slow, comfortable touch can encourage relaxation and ease some of the muscular tension associated with anxiety or compensatory movement. This may improve someone’s immediate experience of their symptoms, but it should not be confused with altering the underlying course of MS.

A complementary—not alternative—approach

The word complementary is important. Massage is best understood as one possible element within a much broader plan of care.

For someone living with MS, a successful treatment may not involve a dramatic physical transformation. It may mean lying comfortably without bracing against pain, sleeping better that evening, feeling less guarded through the shoulders or simply having an hour in which the body receives calm attention rather than being examined for another problem.

These outcomes may appear modest when compared with repairing myelin or preventing disability, but they are not trivial. Quality of life is built from everyday experiences of comfort, autonomy, movement and rest.

MS remains a complex condition, and research continues to reveal how much more there is to learn. Disease-modifying medicine targets inflammatory activity; rehabilitation helps protect function and independence; and carefully adapted massage may offer supportive relief from some of the physical and emotional burdens accompanying the condition.

The aim is not to promise that touch can cure MS. It is to work safely, honestly and collaboratively with the person in front of us.

This post

provides general information and does not replace advice from a neurologist, MS nurse, GP or another suitably qualified healthcare professional.

References

Bjornevik, K. et al. (2022) ‘Longitudinal analysis reveals high prevalence of Epstein–Barr virus associated with multiple sclerosis’, Science, 375, pp. 296–301.

Dolcetti, E. et al. (2020) ‘Emerging role of extracellular vesicles in the pathophysiology of multiple sclerosis’, International Journal of Molecular Sciences, 21(19), 7336.

Duarte, R.R.R., Nixon, D.F. and Powell, T.R. (2025) ‘Ancient viral DNA in the human genome linked to neurodegenerative diseases’, Brain, Behavior, and Immunity, 123, pp. 765–770. Published online in 2024.

Filippi, M. et al. (2020) ‘Identifying progression in multiple sclerosis: new perspectives’, Annals of Neurology, 88, pp. 438–452.

Giovannoni, G. et al. (2022) ‘Smouldering multiple sclerosis: the “real MS”’, Therapeutic Advances in Neurological Disorders, 15.

Heidari, Z., Shahrbanian, S. and Chiu, C. (2022) ‘Massage therapy as a complementary and alternative approach for people with multiple sclerosis: a systematic review’, Disability and Rehabilitation, 44(20), pp. 5758–5769.

Kuhlmann, T. et al. (2023) ‘Multiple sclerosis progression: time for a new mechanism-driven framework’, The Lancet Neurology, 22, pp. 78–88.

Naderi, A., Rezvani, M.H. and Aminian-Far, A. (2024) ‘Can a six-week Swedish massage reduce mood disorders and enhance the quality of life in individuals with multiple sclerosis?’, Explore, 20, 103032.

Pardini, M. et al. (2021) ‘Surface-in pathology in multiple sclerosis: a new view on pathogenesis?’, Brain, 144(6), pp. 1646–1654.

Schroeder, B., Doig, J. and Premkumar, K. (2014) ‘The effects of massage therapy on multiple sclerosis patients’ quality of life and leg function’, Evidence-Based Complementary and Alternative Medicine, 2014, 640916.

Zahoor, I. et al. (2021) ‘An emerging potential of metabolomics in multiple sclerosis: a comprehensive overview’, Cellular and Molecular Life Sciences, 78, pp. 3181–3203.

National Institute for Health and Care Excellence (2022) Multiple sclerosis in adults: management (NG220). Available at: https://www.nice.org.uk/guidance/ng220.