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As autoimmune disorders become more prevalent, researchers look at whether massage therapy can help relieve pain.
By Marcella Durand, August 1, 2019
More than 80 autoimmune diseases affect more than 23.5 million Americans, making them among the most prevalent diseases in the country.1 They can affect any part of the body, and disproportionately affect more women than men—in fact, according to the American Autoimmune Related Disease Association, 75 percent of Americans with an autoimmune disease are women.2
In autoimmune diseases, the immune system, which ordinarily defends the body against outside infection, mistakes the body’s own cells, tissues and organs as foreign—and attacks them accordingly. Some diseases involve one part of the body, such as multiple sclerosis, in which the immune system attacks the central nervous system. Others, such as systemic lupus erythematosus, are systemic, affecting the entire body. Commonly known autoimmune diseases include rheumatoid arthritis, celiac disease, Graves’ disease, Hashimoto’s thyroiditis and Type 1 diabetes.
What causes autoimmune diseases is an area of great interest—and great debate—within the scientific community, with experts suggesting a complex interaction of genetic and environmental risk factors. Some recent studies have pointed to Epstein-Barr virus as a possible culprit in the development of lupus and some other autoimmune diseases.3
Because autoimmune diseases can affect different parts of the body, treatment and management may involve specialists from different fields, such as rheumatology, endocrinology, neurology or gastroenterology. But one thing autoimmune diseases share is inflammation. “Essentially they are all inflammatory diseases, regardless of what tissues they are affecting,” says Kait Gardiner, LMT, CNMT, whose practice, Gardiner Wholistic Health, is based in New York City. While there is currently no cure, treatments such as corticosteroids are used to temporarily reduce inflammation, particularly when the symptoms of a disease “flare.”
There is a lack of research on massage therapy and autoimmune diseases overall, although a 2017 review in Complementary Therapies in Clinical Practice4 found benefits to massage, particularly related to pain, when used to treat a range of conditions that included autoimmune diseases such as diabetes, dermatitis and multiple sclerosis.
More often, studies have focused on specific diseases. A 2017 study in Evidence-Based Complementary and Alternative Medicine compared deep tissue massage with therapeutic massage in 27 men diagnosed with ankylosing spondylitis,5 an inflammatory autoimmune condition of the spine and back. While the study did not find significant differences between the two techniques, the results suggested that both may show benefit and warranted further study. Another recent survey6 of individuals living with lupus in the United Kingdom (Lupus, January 2018) revealed that massage and acupuncture are used commonly enough to also warrant further research into their benefits for the disease.
Even within one autoimmune disease, there can be a wide range of experience. “None of these diseases look the same in different people,” says Betsy Blazek-O’Neill, M.D., who practices at the Allegheny Health Network Center for Complementary and Integrative Health. Severity of symptoms can vary by person and can change every day.
“Any time you are doing massage therapy on somebody with a chronic medical condition, you have to get a sense of how it affects them [and] how you want the massage to be beneficial,” says Dr. Blazek-O’Neill. She points out that some types of massage might actually make people experience more severe symptoms, particularly those types that utilize strong pressure. Some medications, such as NSAIDs used to treat pain, may lead to easier bruising or even bleeding. Prednisone, which is used to suppress the immune system, can also lead to bruising and fluid retention.
For that reason, Gardiner, who has worked with clients with diseases such as rheumatoid arthritis, psoriasis, ankylosing spondylitis, Crohn’s and celiac diseases, and thyroid disorders, stresses that it is important to ask about all the medications clients might be taking. “If patients are taking pain relief medications, they might think you can go as deep as you want,” she says. “You have to know as a therapist when to stop and recognize that deeper work isn’t always better.” She stresses researching medications that are not familiar.
“You really need to understand what symptoms your client is dealing with that day and continue to check in as you’re working,” says Gardiner. “No amount of information is too much.”
According to Dr. Blazek-O’Neill, autoimmune diseases like lupus or rheumatoid arthritis can cause muscular/skeletal pain, leading patients to look for relief through massage therapy. “Some people want massage specifically designed to alleviate certain kinds of pain and directed at painful areas such as the lower back, shoulders or neck.” Ankylosing spondylitis in particular affects the spine, causing swelling between the vertebrae and, over time, may even fuse them together.
Ashley Stafford, LMT, who runs Tranquil Therapy in Philadelphia, is particularly careful when applying pressure if a client is experiencing pain or tenderness. “I find a tender point and stretch the skin around it. If it’s very painful, I avoid the area and tell them to go to a doctor.” She likes a technique called DermoNeuroModulation7, which she has found helpful with clients who are sore to the touch. “I also recommend yoga or tai chi—gentle practices—to get the body used to doing new movements.” She says she works very slowly, especially as she gets to know a client, and keeps detailed notes that she goes over and adds to often.
When Gardiner works with a client who is recovering from a flare, or exacerbation, of symptoms, she likes to use myofascial release and passive range of motion techniques, as well as neuromuscular therapy “just to open up and alleviate some of the restrictions in the tissues.” Effleurage can also help increase circulation. “Basic circulation is important, especially if you’re doing deep work,” she says.
For clients experiencing pain or achiness, Gardiner may use bolstering to support knees and head, or conduct a session in a side-lying or supine position, or even do chair work. “Especially with arthritic conditions where there may be a lot of pain involved, there may be positions they can’t get into,” she says. She recommends that therapists stay flexible depending on how their client is feeling. “It can change at a moment’s notice, so be open to changing your format."
Gardiner also notes that, when dealing with chronic pain, clients tend to close in on themselves. “They get very protective of their bodies,” she says. “They contract in on themselves and become locked into their own bodies. This affects their posture and range of motion.” To counteract this tendency, she uses postural alignments and other techniques “to make space in the joints and allow connective tissue to work through its full range of motion.” She stresses that it’s important to use techniques that allow clients to be more active and in less pain.“It’s a vicious cycle—contract, pain spasm, contract. It’s a very valuable role we have as massage therapists to help break that cycle.”
Other symptoms can affect the overall body, as well. For instance, Gardiner points out, gastrointestinal symptoms like cramping can lead to postural misalignment, while the fluctuating hormone levels of autoimmune thyroid diseases can cause energy and weight issues. She has noticed that fascia may be particularly “rigid” in clients with thyroid issues, so she finds myofascial release particularly helpful.
Chronic diseases also bring emotional issues. More “visible” autoimmune diseases such as psoriasis can cause people to feel embarrassed. And even just the nature of an autoimmune disease can make people feel disconnected from their own bodies. “It can be as simple as the stress of knowing that your body is attacking itself,” says Gardiner.
The often-difficult process of diagnosis can add to that stress. According to an AARDA study, it took an average of 4.6 years for people with a serious autoimmune disease to get a diagnosis—and 46 percent had been told they were “chronic complainers” or too concerned with their health.8
For people with autoimmune diseases, Dr. Blazek-O’Neill says the most common outcomes of massage therapy is decreased stress, improved sleep and decreased pain symptoms. “I think people with autoimmune diseases feel like their body has betrayed them in some way,” she says. “Their body is doing something it is not supposed to do and it alienates them from their body. Massage therapy can help them get in touch with their body in a positive way.”
The official number of Americans affected by autoimmune diseases is 23.5 million and rising, according to the National Institutes of Health (NIH). However, the American Autoimmune Related Diseases Association (AARDA) states that number is even higher and estimates that 50 million Americans are affected. That’s because, according to AARDA, the NIH only included 24 diseases for which epidemiology studies were available. Either way, both sources agree that prevalence is rising.
Because autoimmune diseases are complex and variable, with a range of symptoms that may require a spectrum of care, massage therapists point out that it’s important to know the limits. “Know your scope of practice,” Kait Gardiner says. “If someone comes in dealing with something you don’t know how to work with, refer them to the right person.”
Ashley Stafford has a network of health care experts at a local hospital that she relies on. “If I have a question, I’ll email or call if it’s immediate—whenever there’s something I’m not sure about.” She wants to make sure that everyone working with a client is “on the same page.” And if a client won’t see a doctor, she will refuse to continue treating them.
Some diseases sometimes thought of as autoimmune are actually not, while others may instead be designated “immunemediated” or as possibly having an autoimmune component.
For instance, in multiple sclerosis, the body’s immune system attacks the central nervous system, so that would seem to qualify as “autoimmune.” However, some scientists point out that they have not identified the specific antigen—the protein that stimulates the immune system response—in MS, so that it’s more correct to call it an immune-mediated disease.9
Fibromyalgia is sometimes thought of as an autoimmune disease because it often overlaps with other autoimmune diseases like rheumatoid arthritis and lupus.10 However, it does not actually cause inflammation or damage tissues the way autoimmune diseases do.11 Instead, studies show that the areas of the brain that process pain may be different in people with fibromyalgia, but for now, its cause remains unknown.
Amyotrophic lateral sclerosis, or ALS, is considered part of a group of motor neuron diseases, but not as an autoimmune disease.12 The cause of ALS remains unknown, but a 2013 study found that significantly more cases of ALS than expected were associated with a prior diagnosis of autoimmune diseases, including celiac disease, lupus, multiple sclerosis and Sjögren syndrome.13 According to the researchers, these associations raise the possibility of shared environmental or genetic risk factors, or modifiable triggers.
Massage Therapy as an Alternative to Opioids
The American Massage Therapy Association (AMTA) continues to be actively engaged with several organizations, as well as federal and state governmental agencies regarding massage therapy for pain and specifically as an alternative to opioids.
Research: Cumulative Effects of Regular Massage
What effect does massage have on immune function?
1. “Autoimmune diseases,” National Institutes of Environmental Health Sciences https:// www.niehs.nih.gov/health/materials/autoimmune_diseases_508.pdf.
2. “Women & autoimmunity,” American Autoimmune Related Diseases Association, https://www.aarda.org/who-we-help/patients/women-and-autoimmunity.
3. “Epstein Barr virus protein can ‘switch on’ risk genes for autoimmune diseases,” National Institute of Allergy and Infectious Diseases, News Releases, April 16, 2018. https://www.niaid.nih.gov/news-events/epstein-barr-virus-protein-can-“switch-”-risk-genes-autoimmune-diseases.
4. Field T. “Massage therapy research review,” Complementary Therapies in Clinical Practice, August 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5564319.
5. Wojciech Romanowski M, Spiritovic M, Rutkowski R, Dudek A, Samborski W, Straburzynska Lupa A. Comparison of deep tissue massage and therapeutic massage for lower back pain, disease activity, and functional capacity of ankylosing spondylitis patients: a randomized clinical pilot study, Evidence- Based Complementary and Alternative Medicine, 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563410.
6. Morgan C, Bland AR, Maker C, Dunnage J, Bruce IN. Lupus, April 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5888773.
7. http://www.dermoneuromodulation.com.
8. “Do you know your family AQ?” American Autoimmune Related Diseases Association, https://aarda.org/wp-content/uploads/2016/12/AARDA-Do_you_know_your_family_AQ-DoubleSided.pdf.
9. “What is an immune-mediated disease?” National Multiple Sclerosis Society. https://www.nationalmssociety.org/What-is-MS/Definition-of-MS/Immune-mediated-disease.
10. “What is fibromyalgia syndrome?” Society for Women’s Health Research. https://swhr.org/associated-disorders-what-is-fibromyalgia-syndrome.
11. Anthony K, reviewed by Nancy Carteron, MD, FACR. “Fibromyalgia: is it an autoimmune disease?” Healthline, December 14, 2017. https://www.healthline.com/health/is-fibromyalgia-an-autoimmune-disease.
12. “Amyotrophic Lateral Sclerosis (ALS) Fact Sheet.” National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Amyotrophic-Lateral-Sclerosis-ALS-Fact-Sheet
13. Turner MR, Goldacre R, Ramagopalan S, Talbot K, Goldacre MJ. Autoimmune disease preceding amyotrophic lateral sclerosis: An epidemiologic study. Neurology, October 1, 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3795611.