Fibromyalgia and Massage

I’ve heard a little bit about fibromyalgia, especially in recent years. Occasionally I’ll have a client come in with the disorder, and although we never learned specific techniques for fibromyalgia in massage school, I’ve been able to work effectively with these clients. It is, after all, a pain condition, and managing these conditions happens to be my specialty.

But you might not know anything about the disorder, besides the name. So let’s start from the beginning. What is fibromyalgia?

Fibromyalgia is a widespread, chronic pain disorder. It has an unknown cause, and there are no objective tests to diagnose it. Rather, a patient is diagnosed with fibromyalgia if they have pain in 11 out of the 18 predetermined sites (see diagram below). These areas need to be in all 4 quadrants – left and right side, above and below the waist.

Oh dear, that’s a lot of pain.

But take a look at the diagram again. Don’t those areas look… familiar? No? Well they do to me, anyway. I regularly find trigger points at all of those sites.

The painful areas in fibromyalgia patients are known as “tender points”. How similar are these to trigger points? According to one study, there’s a huge overlap in the two points’ pain patterns, and the researchers conclude that “most of the tender point sites in FMS (fibromyalgia syndrome) are trigger points.”

That’s certainly good news, in my opinion. This conclusion points to the theory that it isn’t the pain itself that’s unique to fibromyalgia. Indeed, plenty of people have trigger points without having fibromyalgia. Rather, it’s how the brain translates and experiences this pain that defines the disorder. This hypothesis is known as “central sensitization”, which refers to a hypersensitivity to pain, light, temperature, and other stimuli in the central nervous system (brain and spinal cord).

Fibromyalgia isn’t the only disorder with its roots in central sensitization – researchers and doctors believe that migraines, chronic fatigue syndrome, and irritable bowel syndrome (among other disorders) may stem from this as well. And conveniently enough, fibromyalgia has a high comorbidity rate with these disorders. Depression and anxiety are also common in FMS patients.

But back to the tender points. If these really are trigger points, then there’s an easy fix for them, right? Well, ideally. But as I’ve written about before, trigger point massages are not always the most pleasant to endure. And if the patient is already hypersensitive to pain and pressure, a trigger point massage certainly won’t be like an afternoon at the spa.

But the answer, as usual, is communication. The massage therapist needs to work very closely with her fibromyalgia clients in order to stay within an acceptable range of pressure. Communication will also help to keep the client focused on the goals of treatment and the positive, though gradual, progress. Overtime, the frequent massages will release the trigger points, thereby making the tender points disappear.

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