The Complex world of FIBROMYALGIA and how CLINICAL MASSAGE can support those living with it?

“It is as if all of my joints were locked and I am caught inside, as though imprisoned in a kind of body or an envelope that has padlocks inside, like doors that I cannot open.” Fibromyalgia patient interview (Valenzuela-Moguillansky, 2012)

Fibromyalgia is, in essence, a "syndrome"—a term used to describe a collection of symptoms. The list of symptoms is virtually limitless, but is mainly characterised by pain, exhaustion, and disturbed sleep. It can also co-exist with mental health and emotional problems such as panic disorder, anxiety, PTSD and depression. It affects women more (3.45 of women and 0.5% of men) and is in approximately 1-2% of the general population.

Many people with Fibromyalgia will have a combination of different symptoms.

· Muscles, soft tissue and joint pain

· Pin and needles

· Tender skin and points in the body

· Muscle weakness

· Stiffness

· Trigger points (like knots) in soft tissues which cause referred pain

· Unpredictable pain which moves around the body

· Nausea

· Restless Legs

· Brain Fog, memory loss

· Loss of balance

· Visual Disturbances

· IBS, constipation and diarrhoea

· Anxiety, Depression, PTSD, Panic Disorders, mood swings

· Allergies

· Sensitivity to light, smell, sound and touch

· Flu like symptoms

· Lack of energy

Any many many more.

Fibromyalgia is a complex condition, which may be why some people wait years for a diagnosis. It can be an incredibly frustrating process, and many may have been told that that symptoms are psychological or exaggerated, often leading to an intense feeling of not being believed.

Rachel Fairweather from Jing Massage states that “A key factor in FMS (and other chronic pain conditions) is a phenomenon known as central sensitization. In central sensitisation, the sympathetic nervous system is in a persistent state of high sensitivity (known as “wind up”). This results in the spinal cord and brain acting like a faulty amplifier that literally turns up the volume of any pain signals -the client is in (real) pain even though there is no injury or damage to the tissues or organs of the body. Central sensitization is somewhat like the over-sensitive car alarm that keeps getting triggered even though there is no danger or damage to the car.1” Central Sensitisation can also heighten all senses and is associated with the cognitive deficits common to FMS, such as poor concentration and short-term memory.

Doctors have found that when people with FM are experiencing pain, there is no evidence of any actual damage to tissues or organs of the body. According to (Liptan 2010) 'no definite evidence of muscle pathology in fibromyalgia has been found.2' However, there is some evidence which points to the dysfunction of 'the intramuscular connective tissue, or fascia, in fibromyalgia,3' proposing that inflammation of the fascia is the source of peripheral nociceptive input that leads to central sensitization in FM.

What Is Fascia?

When I ask my clients if they know what fascia is, their faces mostly always draw a blank. So what is fascia? Fascia is a thin film of connective tissue which surrounds and runs through all the structures in our body; holding every organ, blood vessel, nerve, muscle and bone in their place. Have you ever noticed the white film on the outside of a chicken breast? Well, that is fascia. Fascia can become injured, restricted, inflamed and be painful. It can cause adhesions, which can get tight and stuck causing stiffness, soreness, pain and impair function. So when someone with Fibromyalgia says their 'muscles hurt' it could in fact be their fascia which causing pain.

Clinical Massage and Fibromyalgia

Research is starting to show that massage therapy can provide real benefits to anyone dealing with chronic pain and health conditions, such as fibromyalgia. Whilst there is still more research to do, what does exist is very promising. A 2011 study found that massage therapy reduced sensitivity to pain at tender points in FM patients while also lowering anxiety and improving sleep quality 4. Another 2014 study, which systematically reviewed nine other studies on massage therapy and FM, discovered that massage therapy had immediate beneficial effects on pain, anxiety, and depression in FM patients 5.

Research in Spain evidenced that 20 weeks of myofascial release therapy improved sleep, pain, anxiety and quality of life 6. The study found that immediately after treatment and at 1 month, anxiety levels, quality of sleep, pain and quality of life improved. It also showed that Myofascial release techniques improved pain after 6 months of treatments.

Another small study conducted in 2017 looked at self-myofascial release 7. This involved teaching people with FM to treat themselves using myofascial techniques. When practiced consistently and regularly, it resulted in significant improvements.

CLINICAL MASSAGE uses a multi modal approach using techniques such as Myofascial release, Trigger Point therapy, Accupressure and Stretching. As evidence is starting to suggest fascia is key to understanding FM, techniques such as myofascial release therapy can play a key role in helping those living with FM. Myofascial release is usually performed directly on skin without oils or lotions, allowing the therapist to accurately detect fascial restrictions and apply the appropriate amount of sustained pressure to facilitate release of the fascia. The movements are slow, deliberate and gentle, making it more tolerable than other forms of bodywork.

If you have Fibromyalgia, it is important to find a therapist who is qualified to treat FM.

As an Advanced Clinical Massage however, I have received extra training to treat fibromyalgia and have worked with a number of clients with FM with great success.

Schedule a FREE consultation to find out how Clinical Massage can help you.

References

1. Fairweather, R. Understanding and treating fibromyalgia through advanced massage techniques

2. Liptan GL. Fascia: A missing link in our understanding of the pathology of fibromyalgia. J Bodyw Mov Ther. 2010 Jan;14(1):3-12. doi:10.1016/j.jbmt.2009.08.003

3. Liptan GL. Fascia: A missing link in our understanding of the pathology of fibromyalgia. J Bodyw Mov Ther. 2010 Jan;14(1):3-12. doi:10.1016/j.jbmt.2009.08.003

4. Castro-Sánchez, A.M., Matarán-Peñarrocha, G.A., Granero-Molina, J., Aguilera-Manrique, G., Quesada-Rubio, J.M., Moreno-Lorenzo, C. (2011). Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Evid Based Complement Alternat Med. 2011:561753.

5. Li Y.H., Wang F.Y., Feng C.Q., Yang X.F., Sun Y.H. (2014) Massage therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials. 2014 Feb 20;9(2):e89304. doi: 10.1371/journal.pone.0089304. eCollection 2014.

6. Castro-Sánchez AM, Matarán-Peñarrocha GA, Granero-Molina J, Aguilera-Manrique G, Quesada-Rubio JM, Moreno-Lorenzo C. Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Evid Based Complement Alternat Med. 2011;2011:561753. doi:10.1155/2011/561753

7. Ceca D, Elvira L, Guzmán JF, Pablos A. Benefits of a self-myofascial release program on health-related quality of life in people with fibromyalgia: a randomized controlled trial. J Sports Med Phys Fitness. 2017 Jul-Aug;57(7-8):993-1002. doi:10.23736/S0022-4707.17.07025-6