Research Paper:

Effects of Osteopathic manipulative treatment

with Multiple Sclerosis patients

Helen Cheung
BSc Category 2

Jan 10, 2015

According to numerous studies, Osteopathic manipulative treatments have positive effects on

Multiple Sclerosis (MS) patients. Currently, MS is a disease that has no cure based on western
medicine.
What is Multiple sclerosis?
MS is a degenerative inflammatory disease of the central nervous system which may affect the
brain, spinal cord and optic nerve. For example, the inflammation of the optic nerve can cause
vision problems and eye pain. Inflammation of the sensory or motor nerves can produce sensory
symptoms, such as tingling or numbness, or muscle weakness or spasms. About 50,000 people
living with MS in Canada. The general rates range from one MS case per 500 people to one in
1,000 (1).
The first symptoms often start between from ages 17 to 35 with 3:1 ratio of female to male (2).
Most people with MS have attacks, also called relapses, when the condition gets noticeably
worse. They are usually followed by times of recovery when symptoms improve. For other
people, the disease continues to get worse over time.
MS occurs when the immune system attacks a fatty material called myelin sheath, which wraps
around the nerve fibers to protect them. Without this outer shell, the nerves become damaged.
Scar tissue may form. The nerve messages are not transmitted properly.
Nerves damage may result the following symptoms:

Weakness in an arm or leg

Fatigue
Muscle weakness or spasms
Blurred or double vision
Numbness and tingling
Sexual problems
Poor bladder or bowel control
Pain
Depression
Problems focusing or remembering
Belt like sensation around waist
Dysarthria, dysphagia
Spasticity
Worse with hot showers or hot climate
These symptoms may lead to frequent tripping or difficulty walking. More than half of people
with MS experience a vision problem called optic neuritis. This inflammation of the optic nerve
may cause blurred vision, loss of color vision, eye pain, or blindness, usually in one eye. The
problem is usually temporary and tends to improve within a few weeks. In many cases, vision
problems are the first sign of MS.
Some people with MS develop slurred speech. This happens when MS damages the nerves that
carry speech signals from the brain. Some people also have trouble swallowing. Other MS
symptoms are that some people may find it takes longer to solve problems. Others may have
mild memory loss or trouble concentrating. Most people with MS also experience some loss of

bladder control, because signals between the brain and bladder are interrupted. Finally, fatigue is
a common problem. People may feel tired even after a good night's sleep (3).
What Causes MS?
While the etiology of MS remains mysterious, scientists believe that the interaction of several
different factors may be involved. It is most common in regions far from the equator, including
Scandinavia and other parts of Northern Europe. These areas get less sunlight, so some
researchers believe that vitamin D (the "sunshine vitamin") may be involved. Research suggests
a possible link between vitamin D deficiency and autoimmune disorders, but studies are ongoing.
Genetics appear to play a role, as well. (4)
Diagnosing MS
Tests are often used, along with a medical history and neurological exam, to diagnose MS and
rule out other causes of symptoms. More than 90% of people with MS have scar tissue that
shows up on an MRI scan. A spinal tap can check for abnormalities in the fluid that bathes the
brain and spinal cord. Tests to look at electrical activity of nerves can also help with diagnosis.
Doctors usually see four forms:
1. Relapsing-remitting: Symptoms flare during acute attacks, then improve nearly
completely or "remit." This is the most common form of MS.
2. Primary-progressive: MS slowly but steadily worsens.
3. Secondary-progressive: Begins as relapsing-remitting type, and then becomes
progressive.
4. Progressive-relapsing: The underlying disease steadily worsens. The patient has acute
relapses, which may or may not remit. This is the least common form of MS.
Research suggests that the disease may be more active during the summer months. Heat and high
humidity may also temporarily worsen symptoms. Very cold temperatures and sudden changes
in temperature may aggravate symptoms, as well (3).
Medications
While there is no cure for MS, there are disease-modifying therapy (DMT) that can reduce the
frequency and severity of MS attacks. Use can result in less damage to the brain and spinal cord
over time, slowing the progression of disability. When an attack does occur, high-dose
corticosteroids can help cut it short. Many drugs are also available to manage troubling MS
symptoms, such as muscle spasms, incontinence, and pain (2).
Pain Management
About half of people with MS develop some form of pain, either as a result of a short circuit in
the nervous system or because of muscle spasms or strain. Doctors may prescribe antidepressants
and anticonvulsant medications to ease nerve pain. Pain medicines and anti-spasm drugs may
also be used. Muscle pain often responds well to massage and physical therapy.
Various treatment modalities
Physical therapy can help strengthen muscles, combat stiffness, and get around more easily.
Occupational therapy can help retain coordination in hands for dressing and writing. A speech

therapist can help for trouble speaking or swallowing. Acupuncture relieves symptoms such as
muscle spasms and pain, but research to confirm its value.
It is safe for women with MS to get pregnant. Research suggests no increased risk of
complications during pregnancy. In fact, many women have fewer MS symptoms during
pregnancy. High levels of hormones and proteins may suppress the immune system, reducing the
odds of a new attack.
Osteopathic Treatment
According to Yates findings, osteopathic manipulative treatment combined with eccentric
maximal-effort exercise (MEE) significantly increases strength and ambulatory levels while not
increasing fatigue in female patients with MS who have low to medium impairment. Qualitative
data show that this intervention also produces beneficial effects in activities of daily living.
Clinical research on the effects of osteopathic manipulative treatment (OMT) on viscerosomatic
and somatic dysfunctions adds to a growing body of knowledge. The components of disease may
be direct, obvious, and somatic as in musculoskeletal diseaseor these components may be less
obvious, viscerosomatic disorders. The results of studies of OMT on the trophic and
neurotrophic function indicate that, theoretically, OMT could beneficially affect patients with
MS through viscerosomatic, endocrine, and psychoimmunologic pathways (6-12). Osteopathic
manipulative treatment can provide benefits for patients with MS who suffer from somatic
(musculoskeletal) dysfunctions and the ongoing compensatory problems that result from MSrelated disabilities (7).
Specific OMT techniques used included myofascial techniques to reduce muscle spasm and
inflammation, articulatory techniques to increase restricted range of motion, and multiple
types of both direct and indirect spinal and rib techniques to lessen somatic and somatic visceral
dysfunctions by enhancing beneficial trophic and neurotrophic effects on associated connective
tissues.
The MEE used in this study included three repetitions per session of each phase: concentric and
isometric vertical leg forces (concentric leg press), eccentric and isotonic vertical leg forces
(eccentric leg press), and concentric and isometric semi-erect, whole-body exercise (e.g. Lunge).
Three MEE repetitions were completed for each phase with a 30 to 300 second subjectdetermined rest period between repetitions (5).
Another study from Whites reported that there were positive effect on an eight-week progressive
resistance training programme on lower extremity strength, ambulatory function, fatigue and
self-reported disability in MS patients. Subjects completed one set of maximal voluntary
contraction (MVC) of knee flexion, knee extension and plantar flexion exercises. Isometric
strength of the quadriceps, hamstring, and plantar flexor and dorsiflexor muscle groups was
assessed before and after the training programme using an isokinetic dynamometer. Magnetic
resonance images of the thigh were acquired before and after the exercise programme as were
walking speed, number of steps in 3 min, and self-reported fatigue and disability. Self-reported
fatigue decreased and disability tended to decrease following the training programme. MS

patients are capable of making positive adaptations to resistance training that are associated with
improved ambulation and decreased fatigue (13).
In addition, Dr. Vardy stated that MS patients can enhance homeostasis by doing some special
techniques: deep tissue work to feet, upper thigh, tendon and outer rim of calf, hamstrings and
quadriceps. The frog of the foot is a peculiarity of Chronic Fatigue and MS patients - deep
rotatory stimulation to centre of plantar surface of foot. Deep tissue massage and drainage to
inner rim of pelvis and axilla area blood and nerve supply to lower and upper extremities (14).
Staying Mobile
The vast majority of people with MS are able to continue walking, though many benefit from
some type of assistive device. Orthotic shoe inserts or leg braces can help increase stability.
When one leg is stronger than the other, a cane can help. People with significant problems with
their legs may need to use a walker. And a wheelchair or scooter may be best for those who are
very unsteady or tire easily.
Adapting the home environment
Making a few changes around the home can help manage daily activities. Install grab bars inside
and outside the shower or tub. Use a non-slip mat. Add an elevated seat and safety rails to the
toilet. Lower the kitchen counters to reach it from a sitting position and get rid of any throw
rugs, which are a tripping hazard.
Exercise
Exercise can ease stiffness, fatigue, and other symptoms of MS. But overdoing it could make
things worse. It is best to start slowly. Try exercising for 10 minutes at a time, then gradually
working the way up to a longer session. A few possibilities include water aerobics, swimming,
tai chi, and yoga.
Food and Diet
MS patients are always recommended to follow well balanced diet, high fiber and low in fat.
Maintaining a nutritious diet, 6 to 8 glasses of water is need daily. There are some foods that
help increase alertness and energy. Here is a short list:

Blueberries a great source of antioxidants that help fight off urinary tract infections and
are filled with cancer-fighting properties
Oranges an energy food with a valuable source of Vitamin C, increases iron absorption
Salmon a great source of protein containing omega-3 essential fatty acids, that can help
lower heart disease risks and cancer, and according to preliminary evidence, can help
boost fat loss
Raw Almonds a healthy fat and a rich source of protein
Green tea a great source of antioxidants and energy booster
Vitamin D 4000IU/day and Omega 3 are recommended supplements.

Outlook for MS
Most people with MS live a normal or near-normal lifespan. While the condition may make it
more difficult to get around or complete certain tasks, it does not always lead to severe disability.
Finally, effective medications and osteopathic treatments help many people with MS remain
active, stay in their jobs, and continue to enjoy their families and favorite activities.

Reference:

1. The Demographics of MS. http://www.mswatch.ca/en/learn-about-MS/what-isMS/demographics-of-MS.aspx (accessed 9 Jan, 2015)

2. Miliana Vojvodic & Ann Young. Toronto notes, 30th ed. Toronto: Toronto Notes for
Medical Students, Inc; 2014
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(accessed 9 Jan, 2015)
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