by Erik Dalton Ph.D.
As with many chronic diseases, the symptoms of fibromyalgia often wax and wane. Therefore, pain management therapy should be considered as an ongoing process, rather than management of a single episode. Flare-ups often exacerbate the client’s underlying stress. Furthermore, stress can also precipitate flare-ups of fibromyalgia. In my opinion, the first line of defense for relieving basic fibromyalgic symptoms should be body therapy and exercise. Although pain from this condition primarily manifests in specifically designated areas the trained manual therapist must refrain from chasing the pain and instead, seek to restore whole body function by testing for ART: asymmetry; restriction of motion; and tissue texture abnormality.
Tissue texture abnormalities must be closely evaluated in clients presenting with fibromyalgic symptoms. Boggy, leathery, fibrotic, contractured, and spasmodic tissues are potential pain generators, with each requiring a uniquely different hands-on approach. Post isometric relaxation cervical routines such as those demonstrated in the above video seem to be beneficial in recovering lost range of motion to fibrotic spine related tissues such as joint capsules, ligaments, and paravertebral myofascia. Any deep tissue technique that calms central nervous system hyperactivity and lowers sympathetic tone will greatly benefit those with fibromyalgia.
While it is tempting for the client to relax and not move joints and muscles that are hurting, moving them is one of the best preventive and curative measures found so far to alleviate the painful symptoms. Traditional massage techniques are helpful in desensitizing hyperexcited cutaneous (skin and fascial) neuroreceptors. However, deep-tissue techniques that incorporate active client movements (enhancers) during the hands-on work add additional therapeutic power by calming pain generating articular (joint) receptors. Intrinsic muscles and joints are inseparable; what affects one always affects the other. Therefore, a more holistic approach to treating fibromyalgia and myofascial pain syndromes should include soft-tissue techniques that create extensibility in contractured tissues; tonify weak muscles; and decompress impacted, motion-restricted joints and their supporting ligaments.
Exercise … gooood!
Incrementally, the more exercise clients are able to do, the better they will feel. It doesn’t matter what kind of aerobic exercise — swimming, biking, jogging, walking, dancing — as long as they hit their target heart rate for at least 30 minutes a day. Some clients report feeling better as they gradually increase their exercise programs to 30 minutes twice a day.
Why do clients suffering fibromyalgia improve with vigorous exercise? One notion suggested is that aerobic exercise beefs up the body’s supply of endorphins, a natural pain dampening and sleep-deepening substance. Exercise increases levels of serotonin and growth hormones, the exact pain reducing, muscle-repair hormones that people with fibromyalgia may lack. Exercise also increases blood flow to the muscles. It is well documented that people with fibromyalgia do have slightly less blood flow to their muscles, which might also contribute to pain. Exercise and bodywork together are often just the answer for helping reverse this oft-debilitating condition.
As the research rolls in and causality is eventually decided, it is in the client’s best interest to immediately begin routinely scheduled bodywork sessions in conjunction with a specialized exercise regime… regardless of origin. Well structured manual therapy sessions and individualized rehabilitation programs appear to be the treatment of choice for this chronic and sometimes disabling condition that affects an estimated 2 million Americans each year.