by Erik Dalton Ph.D.
founder of Freedom From Pain Institute
Because the symptoms of fibromyalgia wax and wane, treatment (as with that of other chronic diseases) should be considered 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.
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 refrains from “chasing the pain” and instead, seeks to restore whole body function by testing for ART:
restriction of motion
and tissue texture abnormality
Postural evaluations using Vladimir Janda, M.D.’s Upper and Lower Crossed Syndromes (see Figure 1) have proven extremely beneficial in identifying asymmetrical muscle imbalance patterns that exasperate fibromyalgic symptoms.
Specific hands-on techniques that lengthen tight, neurologically facilitated muscles and Tone, inhibited muscles helps restore balance and symmetry while fighting off the compressive forces of gravity.
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 routines such as those demonstrated in Figures 2 and 3 prove very 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.
Figure 1. Tender point therapy must be accompanied by postural corrections using Vladimir Janda’s unique muscle-balancing formula. Following postural evaluation, specific deep tissue, assisted stretching, and myoskeletal routines help restore symmetry, strength, and pain-free range of motion. From the new Poster Myoskeletal Alignment – Postural Patterns and Spring Systems
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 an 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 often debilitating condition.
Fibromyalgia is a disorder with no widely accepted medical proof. It is a chronic condition characterized by symptoms of widespread pain and tender points as well as fatigue, depression, and sleep disorders. While scientists at the present time have found no generally accepted way to medically document the existence of fibromyalgia, it has been proven that there are physiological changes present in many who have the disorder. The debate will continue to rage as to its origin and existence. Some insist that it is a medical condition while others are convinced that it is a mental health issue.
Meantime, as the research rolls in and the truth 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.