Amyotrophic Lateral Sclerosis (ALS) Massage

An Amyotrophic Lateral Sclerosis (ALS) Massage is a specialized therapeutic approach aimed at improving comfort, mobility, and well-being for individuals living with ALS (Lou Gehrig’s disease). This progressive neurodegenerative condition leads to muscle weakness and physical decline, requiring careful, adaptive bodywork techniques to address evolving needs.​

Signs & Symptoms

• Progressive muscle weakness, often starting in the hands, feet, or limbs

• Muscle atrophy, twitching (fasciculations), and spasms

• Stiffness, cramping, and spasticity

• Impaired coordination and fine motor skills

• Fatigue and reduced mobility

• Difficulty swallowing, speaking, or breathing as disease advances

• Joint stiffness, contractures, and pain due to immobility.​

Contraindications

• Avoid deep tissue or vigorous massage techniques due to fragile, weakened muscles

• No aggressive stretching of spastic or rigid limbs—risk of injury is high​

• Refrain from massage on areas with skin breakdown, pressure sores, active infections, or recent surgical sites

• Extra caution with clients who have compromised respiratory or cardiac status; always monitor tolerance

• Delay treatment during acute illness, fever, or severe changes in neurological status

• Adjust techniques for significant osteoporosis or if DVT/blood clots are suspected.​

Assessment

• Evaluate current muscle strength, mobility, and presence of spasticity or contractures

• Identify common pain or cramp sites (often low back, neck, and shoulders)

• Assess joint range of motion (ROM) and functional limitations

• Monitor for non-verbal cues, especially as speech declines—establish communication signals for feedback

• Review medical history and current medications for contraindications or precautions.​

Treatment

• Gentle Swedish, circulatory, and relaxation massage to improve comfort, circulation, and emotional well-being

• Passive range-of-motion (PROM) and supported stretching to maintain joint mobility and prevent contractures

• Gentle compression, gliding, and vibration to reduce stiffness, cramps, and sensation of cold in extremities​

• Manual lymphatic drainage (MLD) to address edema or swelling when present​

• Positioning support and adaptive techniques, especially for bedridden clients

• Shorter, more frequent sessions may be best in advanced stages; always prioritize client cues and comfort.​

Self Care

• Gentle, daily PROM or passive stretching (with caregiver assistance) to preserve flexibility

• Repositioning and use of support cushions to avoid pressure sores and contractures

• Maintain skin hygiene and monitor for breakdown due to immobility

• Heat packs (with supervision) may reduce localized stiffness and pain

• Accessible communication with care team to adjust self-care/massage as abilities change

• Encourage frequent movement to the client’s tolerance, including sitting up or light supported weight shifts