Exploring the science and complimentary therapies of Multiple Sclerosis

What is Multiple Sclerosis?

Multiple Sclerosis (MS) is a long-term disease that affects the brain and spinal cord, causing problems with muscle control, balance, and other basic body functions. In MS, the immune system, which normally protects us from germs, mistakenly attacks the protective covering of nerves, called myelin. This damage makes it difficult for messages to travel between the brain and the rest of the body (Zahoor et al., 2021).

MS can develop in several ways. Some people experience sudden episodes of symptoms that come and go, while others have a steady worsening of their condition without breaks. Researchers are finding that MS is not simply a disease of sudden flare-ups but can also involve ongoing nerve damage beneath the surface, even when symptoms seem stable (Giovannoni et al., 2022).

The disease progresses differently in each person. Factors like genetics, environment, and the immune system’s behaviour all play a role in how MS develops and gets worse over time (Filippi et al., 2020; Zahoor et al., 2021). Over time, persistent inflammation, stress, and damage to the brain and spinal cord lead to worsening symptoms, such as muscle stiffness, difficulty walking, and fatigue (Filippi et al., 2020).

How MS Progresses in the Body

MS progresses when the immune system continues attacking the myelin, leading to damage that spreads from the outer layers of the brain inward. Researchers have observed that this “surface-in” pattern of damage seems to be linked to chemicals in the fluid that surrounds the brain, which cause inflammation (Pardini et al., 2021).

As MS advances, it becomes more about constant nerve damage rather than just immune system attacks. As a result, treatments aimed at reducing inflammation aren’t always effective in stopping the overall decline (Filippi et al., 2020; Kuhlmann et al., 2023). Instead, researchers believe MS is better understood as a combination of ongoing inflammation, nerve cell breakdown, and the body’s failed attempts to repair itself (Kuhlmann et al., 2023).

The Role of Extracellular Vesicles, Metabolism, and Viral DNA in MS

A new area of research in MS looks at tiny particles released by cells called extracellular vesicles (EVs). These EVs carry messages between cells and can either worsen inflammation or help repair damage. EVs have been found to come from both immune cells and brain cells, which makes them important in both MS’s development and potential recovery processes (Dolcetti et al., 2020). Targeting these EVs might offer new ways to treat MS in the future.

Another exciting area of study is how metabolism, or the body’s chemical processes, changes in people with MS. Changes in certain metabolic pathways, like those involving fats and proteins, have been found in MS patients. These changes might be used to find new markers that help diagnose MS earlier and tailor treatments more effectively (Zahoor et al., 2021).

Recent research has also highlighted the role of ancient viral DNA, known as human endogenous retroviruses (HERVs), in MS. HERVs are remnants of viruses that infected our ancestors millions of years ago and now make up about 8% of our genome. Scientists have discovered that certain HERVs are associated with MS susceptibility and may play a role in the disease by affecting how cells stick together and communicate (Duarte et al., 2024). The study identified HERV expression changes linked specifically to MS, suggesting that these viral remnants could contribute to the disease by affecting immune system behaviour and brain cell stability (Duarte et al., 2024).

The Benefits of Massage Therapy for MS Patients

Massage therapy is a valuable complementary treatment for people with MS, especially for managing symptoms that are difficult to treat with medication alone, such as muscle tightness, pain, fatigue, stress, and sleep disturbances. Recent studies have provided more detailed evidence about these benefits.

For example, a study on Swedish massage, where participants received massage twice a week for six weeks, showed that MS patients experienced significant improvements in mood and quality of life. Stress, anxiety, depression, and fatigue levels were all reduced, while sleep quality and relaxation increased. Anxiety levels in the massage group dropped by nearly 15%, and depression symptoms decreased by 28.2%, indicating that massage therapy can have a strong positive effect on mental well-being (Naderi et al., 2024).

Effleurage massage, which involves gently rubbing the skin, was also found to be effective. A study showed that after two weeks of effleurage massage, MS patients experienced significant reductions in pain, anxiety, fatigue, and sleep disturbances compared to those who received only standard care. This suggests that effleurage massage can be a simple yet effective way to improve comfort and well-being (Gaballah et al., 2023).

Another study compared the effects of massage therapy with mindfulness training for women with MS. The results showed that while both approaches helped reduce anxiety and depression, massage therapy was particularly effective in easing these mental health symptoms. This is crucial because mental health issues, such as anxiety and depression, can worsen MS symptoms and negatively impact overall quality of life (Tavakoli Kohpaei and Rezaei Dehnavi, 2020).

Massage works by helping muscles relax, which eases pain and stiffness. It also encourages the body's relaxation response, lowering stress hormones and promoting a sense of well-being. Stress is known to make MS symptoms worse by increasing inflammation, so the relaxation benefits of massage can help counteract these effects (Schroeder et al., 2014).

How Massage Therapy Fits with MS Treatment

The treatment of MS can be complex, and no single approach works for everyone. Medicines, especially those that modify the disease, are effective at reducing attacks but often do not help as much with long-term nerve damage or with improving quality of life (Filippi et al., 2020). Physical therapy, including massage, is one way to help people with MS stay more comfortable and mobile in their daily lives (Santos-Filho, 2019).

Massage is helpful because it targets problems like muscle stiffness, pain, and stress symptoms that medicines often don’t fully relieve. By reducing stress and relaxing muscles, massage can make it easier for people with MS to maintain their physical abilities and feel better overall. Massage also helps balance out the effects of chronic stress, which plays a big role in making MS worse over time (Schroeder et al., 2014).

Combining New Insights with Traditional Care

New research into MS is helping us understand the condition better and develop new treatments. For instance, the role of cells called oligodendrocytes, which help form new myelin, is crucial. Understanding how these cells respond to inflammation could lead to new treatments aimed at repairing the damage caused by MS (Zahoor et al., 2021).

Also, researchers are finding that immune cells, nerve cells, small particles like EVs, and ancient viral DNA (HERVs) all interact in complex ways that influence how MS progresses. Massage therapy may not change the disease at the cellular level, but it can help by reducing symptoms and improving quality of life (Dolcetti et al., 2020; Giovannoni et al., 2022; Duarte et al., 2024).

Conclusion

Managing MS is most effective when different approaches are used together. Medicine can help reduce relapses and inflammation, while therapies like massage can improve day-to-day quality of life, reduce stress, and alleviate symptoms like pain and muscle tightness. Massage therapy complements traditional treatments by focusing on symptoms and overall well-being that medication alone might not address. Looking ahead, more research is needed to explore how massage therapy, along with other complementary treatments, can be best used to support people living with MS (Schroeder et al., 2014; Dolcetti et al., 2020; Giovannoni et al., 2022; Duarte et al., 2024).

References

• Dolcetti, E., Bruno, A., Guadalupi, L., et al. (2020) 'Emerging Role of Extracellular Vesicles in the Pathophysiology of Multiple Sclerosis', International Journal of Molecular Sciences, 21(19), p. 7336.

• Duarte, R.R.R., Nixon, D.F., & Powell, T.R. (2024) 'Ancient Viral DNA in the Human Genome Linked to Neurodegenerative Diseases', Brain, Behavior, and Immunity, 123, pp. 765–770.

• Filippi, M., Preziosa, P., Langdon, D., et al. (2020) 'Identifying Progression in Multiple Sclerosis: New Perspectives', Annals of Neurology, 88, pp. 438–452.

• Gaballah, S., El-Deen, D. S., & Hebeshy, M. I. (2023) 'Effect of Effleurage Massage Therapy on Sleep Disturbance, Fatigue, Pain, and Anxiety in Patients with Multiple Sclerosis: A Quasi-experimental Study', Applied Nursing Research, 73, p. 151719.

• Giovannoni, G., Popescu, V., Wuerfel, J., et al. (2022) 'Smouldering Multiple Sclerosis: the “Real MS”', Therapeutic Advances in Neurological Disorders, 15, pp. 1–18.

• Kuhlmann, T., Moccia, M., Coetzee, 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., & 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, p. 103032.

• Pardini, M., Brown, J. W. L., Magliozzi, R., et al. (2021) 'Surface-in Pathology in Multiple Sclerosis: A New View on Pathogenesis?', Brain, 144(6), pp. 1646–1654.

• Santos-Filho, S. D. (2019) 'Physical Therapy in Multiple Sclerosis: A New Strategy of Treatment', ResearchGate, January 2019.

• Schroeder, B., Doig, J., 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, Article ID 640916.

• Tavakoli Kohpaei, S. & Rezaei Dehnavi, S. (2020) 'The Effectiveness of Massage Therapy and Mindfulness Training on the Symptoms of Depression, Anxiety, and Disability Level in Women with Multiple Sclerosis', International Journal of Medical Investigation, 9(2), pp. 109-129.

• Zahoor, I., Rui, B., Khan, J., et al. (2021) 'An Emerging Potential of Metabolomics in Multiple Sclerosis: A Comprehensive Overview', Cellular and Molecular Life Sciences, 78, pp. 3181–3203.