Massage Therapy for Individuals with Multiple Sclerosis (MS)

Massage Therapy & MS: What We Know—And What We Don’t

Multiple Sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system. Symptoms vary widely, but common issues include fatigue, muscle spasticity, pain, anxiety, depression, and reduced mobility and quality of life.

While no cure currently exists, many individuals living with MS seek out massage therapy as a way to improve comfort, reduce symptoms, and reclaim some physical ease. But how effective is massage? What does the evidence actually say?

1. Evidence-Based Benefits of Massage for MS

Fatigue Reduction

Fatigue is one of the most disabling symptoms reported by people with MS. Several clinical trials and reviews suggest massage therapy—especially Swedish massage—can reduce perceived fatigue. A 2022 meta-analysis found that fatigue levels dropped significantly following multiple sessions of massage therapy, especially when combined with other supportive treatments¹.

Spasticity and Muscle Stiffness

Gentle massage, particularly long-stroke and rhythmic techniques, appears to improve joint mobility and reduce muscle tone in those experiencing spasticity. Reflexology and general therapeutic massage both showed benefits in a pooled analysis of 12 studies².

However, deep tissue pressure is not recommended. It may overstimulate nerves or worsen symptoms, particularly during flare-ups.

Pain Management

Massage is consistently rated as helpful for MS-related musculoskeletal pain, especially back and leg pain. Research has confirmed reduced pain intensity scores in as few as five weekly sessions³.

Massage appears to modulate pain perception by stimulating the parasympathetic nervous system, improving circulation, and promoting relaxation.

Anxiety, Depression, and Emotional Health

MS is not only a physical disease; it often comes with mental health complications, including depression, anxiety, and stress-related flare-ups.

Studies have shown that massage significantly improves mood, reduces cortisol levels, and improves serotonin and dopamine activity⁴. Reflexology showed particularly strong results in reducing anxiety in MS patients in both short-term and medium-term follow-ups⁵.

Constipation

While less frequently discussed, chronic constipation is a common complaint in people with MS due to impaired autonomic nervous system regulation. Abdominal massage and foot reflexology have both been found to stimulate bowel activity and reduce symptoms⁶.

2. What Kind of Massage Works?

Different techniques yield different outcomes, and not all massage is created equal for MS care.

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Most practitioners treating MS clients rely on light-touch techniques, rhythmic motions, and passive movement to promote relaxation without triggering a flare-up.

3. Flare-Ups: When to Avoid Massage

MS flare-ups involve active inflammation of the nervous system and may result in new or worsening symptoms: blurred vision, numbness, muscle weakness, or intense fatigue.

Massage should be postponed during severe flare-ups, especially if the client has:

• New symptoms (especially sensory)
• Fever or signs of infection
• Unexplained fatigue
• Heat sensitivity (Uhthoff’s phenomenon)
• Blood pressure instability

Always request physician clearance before beginning or resuming massage post-relapse. Clients may not fully perceive pressure if sensory nerves are affected.

4. Safety Guidelines for Massage Therapists

To work safely and effectively with people with MS, therapists should follow these core best practices:

• Use mild to moderate pressure only—no deep tissue work unless specifically approved by the client’s physician.
• Avoid heat treatments. MS patients are often heat-sensitive, and overheating can worsen symptoms.
• Offer shorter sessions, especially in the beginning. A 30-minute protocol may yield better results than a 60-minute one if the client tires easily.
• Avoid prone positioning for long durations. Supine or side-lying positions may be better tolerated.
• Check for contraindicated comorbidities, like deep vein thrombosis (DVT), osteoporosis, or pressure ulcers.

Verbal check-ins should happen at the start, midpoint, and end of every session to monitor sensations, fatigue, and comfort.

5. Client Self-Reports & Quality of Life

Several studies also collected self-reported outcomes, which often highlight benefits not always captured by quantitative tools. MS clients frequently describe:

• Improved body awareness
• A sense of control over symptoms
• Better sleep quality
• Reduced emotional reactivity

One randomized trial reported participants had greater confidence in physical activity after weekly massage for four weeks, even when objective measures like spasticity hadn’t changed significantly⁷.

This suggests that subjective well-being—a critical metric in chronic disease—may be as important as measurable clinical gains.

6. Limitations of the Research

Despite promising data, the evidence for massage in MS treatment is not without gaps:

• Most studies are short in duration (typically 4–8 weeks).
• Sample sizes are often small (<50 participants).
• Massage techniques and delivery styles are heterogeneous across studies.
• Blinding is nearly impossible in massage research, making placebo effects hard to rule out.

Researchers consistently call for larger, longer, and more controlled studies.

Still, massage therapy has an extremely low risk profile and is one of the few interventions where patients themselves consistently report benefit.

7. Practical Advice for Clients with MS

If you’re living with MS and considering massage:

• Start with a short session (30 minutes).
• Avoid massage if you’re in the middle of an active flare-up.
• Ask your therapist to use gentle, relaxing techniques—not deep pressure.
• Give feedback during the session.
• Stay hydrated afterward.
• Avoid hot showers or saunas immediately post-treatment.

Also, check with your doctor—especially if you have cardiovascular complications, pressure sores, or balance issues.

Final Word

Massage is not a replacement for disease-modifying therapies, but for many people with MS, it offers a valuable way to manage fatigue, muscle stiffness, pain, anxiety, and emotional stress.

When done thoughtfully and with proper precautions, massage therapy can significantly improve comfort and daily quality of life—without medication, side effects, or long recovery periods.

For those navigating the long and unpredictable road of MS, this simple touch-based therapy may be one of the most humanizing tools in the wellness toolkit.

Endnotes

1. Kalron A, et al. (2022). “Massage therapy as a complementary approach for people with multiple sclerosis: a systematic review.” Disability and Rehabilitation. [PubMed PMID: 34338108]
2. Carolina Pintos. “Therapeutic Massage for Relief of Fatigue and Pain in Multiple Sclerosis.” carolinapintos.com
3. Cupler EJ, et al. (2021). “Complementary and alternative medicine in multiple sclerosis.” Continuum (Minneap Minn). 27(1): 96–111.
4. Field T. (2016). “Massage therapy research review.” Complementary Therapies in Clinical Practice, 24: 19–31.
5. Lee SH, et al. (2014). “Effects of reflexology on fatigue, sleep, and pain: a systematic review and meta-analysis.” Journal of Korean Academy of Nursing, 44(2): 123–134.
6. Baranowski AP, et al. (2019). “Neuropathic bowel dysfunction in multiple sclerosis.” Nature Reviews Urology, 16(8): 465–481.
7. Dunn KS, et al. (2014). “Effects of massage therapy on multiple sclerosis symptoms.” International Journal of Therapeutic Massage and Bodywork, 7(2): 10–17.