The Effectiveness of Personalized Manual Therapy and Rehabilitation Program in Multiple Sclerosis: A Case Report

Year 2025, Volume: 3 Issue: 2, 92 - 99, 30.04.2025

Özge Gümüş , Vesile Yıldız Kabak

Abstract

ABSTRACT
Purpose: This case report aims to investigate the effects of personalized manual therapy and rehabilitation programs on pain management, physical functions, quality of life, and overall well-being in patients with multiple sclerosis (MS).
Methods: A 39-year-old male patient with MS participated in a 12-week treatment program, conducted twice a week for 80 minutes per session. The therapy included manual therapy, balance-coordination exercises, stretching, and strengthening exercises. Pre- and post-treatment evaluations were conducted using comprehensive measurement tools, including quality-of-life surveys, pain and fatigue assessments, and posture analyses.
Results: After the 12-week program, significant improvements were observed in the patient’s muscle strength, joint range of motion, and balance-coordination abilities. Pain and fatigue levels decreased, and quality-of-life scores showed a marked increase.
Discussion: This case report demonstrates the efficacy of manual therapy and individualized rehabilitation approaches in improving physical functions, reducing pain, managing fatigue, and enhancing the quality of life in MS patients. Consistent with existing literature, the applied treatment protocol contributed positively to the overall well-being of the patient.
Keywords: Multiple Sclerosis, Manual Therapy, Rehabilitation, Physical Function, Pain

Keywords

Multiple Sclerosis, Manual Therapy, Rehabilitation, Physical Function, Pain

References

• 1. Doğan Mert CE, Ateş Y, Güngör M. Measurement and evaluation in Parkinson's disease. In: Kılınç Muhammed AYS, ed. Measurement and evaluation in neurological physiotherapy and rehabilitation. Ankara: Vize Publishing; 2019. p. 45–75.
• 2. Mitchell AJ, Benito-León J, González JM, Rivera-Navarro J. Quality of life and its assessment in multiple sclerosis: Integrating physical and psychological components of wellbeing. Lancet Neurol. 2005;14(9):556–566.
• 3. Dalgas U, Stenager E, Jakobsen J, et al. Resistance training improves muscle strength and functional capacity in multiple sclerosis. Neurology. 2009;73:1478–1484.
• 4. Hoang PD, Gandevia SC, Herbert RD. Prevalence of joint contractures and muscle weakness in people with multiple sclerosis. Disabil Rehabil. 2014;36:1588– 1593.
• 5. White L, McCoy S, Castellano V, Gutierrez G, Stevens J, Walter G, et al. Resistance training improves strength and functional capacity in persons with multiple sclerosis. Mult Scler. 2004;10(6):668–674.
• 6. Sandoval AE. Exercise in multiple sclerosis. Phys Med Rehabil Clin N Am. 2013;24(4):605–618.
• 7. Cameron, M. H., Horak, F. B., Herndon, R. R., & Bourdette, D. (2008). Imbalance in multiple sclerosis: A result of slowed spinal somatosensory conduction. Somatosensory & Motor Research, 25(2), 113–122.
• 8. Novotna K, Sobisek L, Horakova D, Havrdova E, Lizrova Preiningerova J. Quantification of Gait Abnormalities in Healthy- Looking Multiple Sclerosis Patients (with Expanded Disability Status Scale 0-1.5). Eur Neurol. 2016;76(3-4):99-104.
• 9. Rasova, K., Feys, P., Henze, T. etal. Emerging evidence-based physical rehabilitation for Multiple Sclerosis - Towards an inventory of current content across Europe. Health Qual Life Outcomes 8, 76 (2010).
• 10. Bowling AC, Stewart TM. Current Complementary and Alternative Therapies for Multiple Sclerosis. Curr Treat Options Neurol. 2003 Jan;5(1):55-68. doi: 10.1007/s11940-003-0022-z. PMID:12521563.
• 11. Zhang T, Yan HX, An Y, Yin L, Sun PP, Zhao JN, et al. The efficacy and safety of manual therapy for symptoms associated with multiple sclerosis: A systematic review and meta-analysis. J Integr Complement Med. 2022;28(10):780–790.
• 12. Stathopoulos N, Dimitriadis Z, Koumantakis GA. Effectiveness of Mulligan's mobilization with movement techniques on pain and disability of peripheral joints: a systematic review with meta- analysis between 2008-2017. Physiotherapy. 2019 Mar;105(1):1-9.
• 13. Hing, W., Bigelow, R., & Bremner, T. (2009). Mulligan’s Mobilization with Movement: A Systematic Review. Journal of Manual & Manipulative Therapy, 17(2), 39E-66E.
• 14. Halabchi, F., Alizadeh, Z., Sahraian, M. A., & Abolhasani, M. (2017). Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations. BMC neurology, 17(1), 185.
• 15. Başarır M, Özek MM. Spasticity and its treatment. Turkish Neurosurgery Journal. 2013;23(2):158-73
• 16. Otman SA. Muscle strength and evaluation methods. In: Otman AS, ed. Basic evaluation principles in therapeutic movements. Ankara: Pelikan Publishing; 2014. p. 120–195.
• 17. Vickrey B, Hays RD, Harooni R, Myers LW, Ellison GW. A health-related quality of life measure for multiple sclerosis. Qual Life Res. 1995;4:187–206.
• 18. Sampath KK, Mani R, Miyamori T, Tumilty S. The effects of manual therapy or exercise therapy or both in people with hip osteoarthritis: A systematic review and meta-analysis. Clin Rehabil. 2016;30(12):1141–1155.
• 19. Şen S. (2018). Neurostatus and EDSS Calculation with Cases. Noro psikiyatri arsivi, 55(Suppl 1), S80–S83. https://doi.org/10.29399/npa.23412
• 20. Sampath KK, Mani R, Miyamori T, Tumilty S. The effects of manual therapy or exercise therapy or both in people with hip osteoarthritis: A systematic review and meta-analysis. Clin Rehabil. 2016;30(12):1141–1155.
• 21. Beselga C, Neto F, Alburquerque-Sendín F, Hall T, Oliveira- Campelo N. Immediate effects of hip mobilization with movement in patients with hip osteoarthritis: A randomised controlled trial. Man Ther. 2016 Apr;22:80-5.
• 22. Brun A, Sandrey MA. The Effect of Hip Joint Mobilizations Using a Mobilization Belt on Hip Range of Motion and Functional Outcomes. J Sport Rehabil. 2020 Dec 8;30(4):559-567.
• 23. Cattaneo D, Jonsdottir J, Zocchi M, Regola A. Effects of balance exercises on people with multiple sclerosis: A pilot study. Clin Rehabil. 2007;21(9):771–781.
• 24. Schlagheck ML, Hübner ST, Joisten N, Walzik D, Rademacher A, Wolf F, et al. Physical activity is related to disease severity and fatigue, but not to relapse rate in persons with relapsing remitting multiple sclerosis - a self-reported questionnaire based study. Front Neurol. 2023;14:1217000.
• 25. Pilutti LA, Greenlee TA, Motl RW, Nickrent MS, Petruzzello SJ. Effects of exercise training on fatigue in multiple sclerosis: A meta- analysis. Psychosom Med. 2013;75(6):575–580.
• 26. Frost-Hunt A. Effects of massage therapy on multiple sclerosis: A case report. Int J Ther Massage Bodywork. 2020;13(4):35–41.
• 27. Grubić Kezele T, Babić M, Kauzlarić-Živković T, et al. Combined upper limb and breathing exercise programme for pain management in ambulatory and non-ambulatory multiple sclerosis individuals: part II analyses from feasibility study. Neurol Sci. 2020;41:65–74.
• 28. Kannan P, Bello UM, Winser SJ. Physiotherapy interventions may relieve pain in individuals with central neuropathic pain: A systematic review and meta-analysis of randomised controlled trials. Ther Adv Chronic Dis. 2022;13:20406223221078672.
• 29. Zhang T, Yan HX, An Y, Yin L, Sun PP, Zhao JN, et al. The efficacy and safety of manual therapy for symptoms associated with multiple sclerosis: A systematic review and meta-analysis. J Integr Complement Med. 2022;28(10):780–790.
• 30. Huynh TLT, Barstow EA, Motl RW. Feasibility of a theory-based physical activity intervention for persons newly diagnosed with multiple sclerosis. Mult Scler Relat Disord. 2024;83:105446.