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This article fully details the three conditions, and considers whether massage might be helpful. by Ben E. Benjamin and Ruth Werner The poliovirus is almost extinct, but post-polio syndrome, a condition affecting polio survivors, is on the rise. These individuals have seriously reduced nerve supply to skeletal muscles, resulting in pain and weakness. We include information on the polio infection itself in order to help readers understand how post-polio syndrome works. People with post-polio syndrome often find that massage can ease their pain while helping to keep the functioning muscle fibers as healthy as possible. Another nervous system disorder addressed in this issue is multiple sclerosis, a common and serious condition that affects both motor and sensory functioning. Individuals with multiple sclerosis respond differently to varying treatment options, including medication, bee venom therapy, hyperbaric oxygen chambers, vitamin therapy and many others. Massage therapy can be useful for people with multiple sclerosis so long as sensation is present, and care is taken not to overstimulate the nervous system.
Polio Definition. Poliomyelitis or infantile paralysis, as it used to be known, is a viral disease. Most viruses have a target tissue, or a "favorite food," so to speak. Herpes zoster targets sensory neuron dendrites; most cold viruses attack mucous membranes; and HIV goes after helper T cells. The poliovirus targets intestinal mucosa first, and anterior horn nerve cells later. Etiology. The poliovirus usually enters the body through the mouth; contaminated water is the usual medium. The virus-carrying medium travels through the acidic environment of the stomach, and sets up an infection in the intestine. New virus is released in fecal matter, possibly to contaminate water elsewhere. For 99 percent of people exposed to the poliovirus, this is the end of the story. There will be symptoms that look like severe flu-headache, deep muscular ache and high fever. These are followed by an intestinal infection, a bout with diarrhea, and then the infection is over. But in about 1 percent of people who are infected, the virus will travel into the central nervous system, where it targets and destroys nerve cells in the anterior horns of the spinal cord. This impedes motor messages leaving the spinal cord, which, in turn, leads to rapid deterioration and atrophy of muscles and motor paralysis. A couple of interesting facets to polio are worth mentioning. First, when people are exposed to this virus in infancy, they seldom get seriously ill. The later the exposure, the more dangerous the virus can be. So although this disease has been identified from as far back as 3,000-year-old Egyptian carvings, it didn't really become a public menace until sanitation services were set up in heavily populated areas. Although these measures reduced the rates of cholera, typhoid and a host of other infectious diseases, they also prevented middle- and upper-class infants from exposure to the poliovirus. Then, when they were exposed at later ages, the disease took a heavier toll. For many years, polio was considered a disease of the upper classes. Second, as stated above, a polio infection usually resolves itself in a short bout of flu-like symptoms with diarrhea. It only infects the spinal cords of approximately 1 percent of the people who are exposed to it. That doesn't sound like a lot, but it means that if 10,000 children go swimming in a contaminated lake, 100 of them will experience some level of paralysis. The paralysis caused by polio is motor only; sensation is still present. And because the motor nerves tend to overlap each other in the extremities, there still may be functioning muscle fibers left, even though a whole level of motor neurons may have been damaged. In other words, look at the dermatomes for the quadriceps. Even if all the impulses to the motor neurons in L2 have been eliminated, there are other motor neurons to the same muscle group provided by L3 (see Figure 1). Furthermore, anterior horn cells that survive the initial attack can create new nerve connections to help reestablish motor control during recovery. Unfortunately, these cells can become overtaxed later in life, giving rise to post-polio syndrome. The most serious form of this disease, bulbar polio, attacks not only the anterior horn cells, but the nuclei of some cranial nerves as well. Patients with this kind of damage risk death due to respiratory or heart failure. It was these patients, mostly children, who were confined to the "iron lungs" that were a big part of the American medical landscape in the 1930s and 1940s. Treatment. Moist heat applications and massages have been used to treat polio survivors once the initial infection has subsided. Together, hydrotherapy and massage can help to limit contractures and to keep functioning muscle fibers healthy and well-nourished. Prevention. Polio is stunningly easy to prevent. There are two inexpensive, stable and easy-to-administer vaccines that are effective against this disease. The Salk vaccine injects inactivated poliovirus into the bloodstream, causing the recipient to create a set of antibodies against it. This vaccine, although it protects the patient, does not eliminate the possibility of that person's transmitting the disease to someone else. The Sabin vaccine, an oral medication, introduces weakened viruses into the digestive system, where they attract antibodies exactly where the virus first tends to reside. The advantages of the Sabin vaccine are that this approach prevents the patient from being a carrier of the disease, as well as creates an internal immune response, and because it is given orally rather than hypodermically, it can be administered by anyone. People who handle the diapers of infants who have received the oral vaccine need to be aware that there may be live virus in the fecal matter. Immune-suppressed persons should avoid contact with infants who are undergoing this treatment. State health departments vary in how they recommend polio vaccines to be administered. Many of them now give both the oral and injected vaccines, giving the best of both worlds to their patients. Massage? Massage therapists in the United States are extremely unlikely to encounter an acute case of polio in their practice. Polio survivors will experience only a motor paralysis; sensation is still intact. So massage can be performed for these clients with good possibility of benefit, and little risk of danger.
Post-Polio Syndrome Definition. Now that polio is little more than a memory for most people (the last reported case in the Western Hemisphere was in 1979), an unexpected phenomenon is being found among its survivors. Some who had polio as children, especially those people who experienced significant loss of function, have found as they reach middle age that they have a sudden, and sometimes extreme, onset of fatigue, achiness and weakness, not always in just the muscles originally affected. There also may be breathing difficulties, sleep disturbances and trouble swallowing. These symptoms usually begin about 25 to 40 years after the original infection. This condition is called post-polio syndrome, or PPS. Demographics. There are 300,000 polio survivors in the United States. Of them, approximately 25 percent have some symptoms of PPS; although polio survivors are more than usually prone to arthritis, tendinitis and other orthopedic problems that mimic PPS. Etiology. PPS is not a resurgence of the original polio infection. Instead, it seems to be the result of normal aging combined with the loss of some percentage of anterior horn cells from the initial polio attack. The surviving cells, in spite ofÑor because ofÑwhatever new synapses they were able to make in the recovery process, may be severely overtaxed. PPS may be the result of overstressed motor neurons. Post-polio may be the result of overstressed motor neurons. Treatment. There is no new infection with PPS. It is treated as a problem that may be ameliorated by reduced muscular and neurological stress-adjusted braces, a change in activity levels, exercise programs that encourage the use of muscles not supplied by the damaged nerves. People with PPS need to avoid excessive use of their affected muscles, since exercise to these damaged tissues can cause permanent damage to the working fibers. Massage? Massage for persons with PPS is indicated. It will relax muscles, improve local nutrition and generally decrease strain on the nervous system. |
