There’s been renewed interest and discussion about fibromyalgia with Lady Gaga’s recent announcement that she suffers from this often debilitating condition. Fibromyalgia is a chronic pain condition that includes musculoskeletal pain, fatigue, and sleep problems – and affects over 10 million Americans, which is approximately 2% – 4% of the adult population. About 80% of fibromyalgia patients are women.
3 Main Symptoms of Fibromyalgia
Fibromyalgia results in widespread pain in all four quadrants of your body, for more than three consecutive weeks. Traditionally, there were 18 specific tender points that needed to be tender for a fibromyalgia diagnosis, but this is no longer a requirement. Now, diagnosis is done through the elimination of other conditions that can cause the same symptoms combined with ongoing, widespread pain for over three weeks. Getting a diagnosis of fibromyalgia can be an extremely difficult and complex endeavor, as symptoms mimic other conditions and come and go without clear reason or triggers.
- Sleep disturbances are significant in fibromyalgia, including insomnia and frequent waking during the night due to pain.
- Chronic fatigue is also very common, as often those with fibromyalgia wake feeling tired even when they have slept through the night. Studies have shown that patients experiencing pain after surgery show disturbed sleep, specifically rapid eye movement (REM) sleep. Fibromyalgia patients also experience these disturbances during the deepest stages of sleep, when recovery and repair to the body take place. This results in waking to feel tired and fatigued, as well as with a lack of recovery in muscle tissue, which results in more pain . . . then more sleep disturbances . . . then more pain. This pain/sleep disturbance cycle is ongoing in fibromyalgia patients, and is the underlying cause of the chronic fatigue that they experience.
- Cognitive difficulties, or fibro fog, also occur in most fibromyalgia sufferers at least on occasion. This fibro fog is often a result of the constant pain and disturbances to restorative sleep that occurs. Anyone who has suffered from pain, even a garden variety pulled muscle or a headache, knows that it leaves you feeling exhausted and makes mental concentration difficult. Being in constant, daily pain, with ongoing sleep disturbances, makes it an everyday challenge for fibromyalgia sufferers to concentrate.
Other conditions often accompany fibromyalgia, including migraines and headaches, irritable bowel syndrome (IBS), and other autoimmune diseases including lupus or rheumatoid arthritis. Inflammation is a major component of fibromyalgia, which increases the incidence of many autoimmune diseases as well as the symptoms of any preexisting autoimmune or inflammation-based conditions. This contributes significantly to the difficulties of diagnosing fibromyalgia.
Treatments for Fibromyalgia
Treatment for fibromyalgia usually involves over-the-counter pain relievers and can require prescription pain medications when the condition flares up. Antidepressants often help to reduce the pain and fatigue that accompanies fibromyalgia, and can help improve sleep. Anti-seizure drugs are often used to reduce pain and fibromyalgia symptoms.
Studies have shown that, while exercise is a major contributing factor in reducing symptoms of fibromyalgia, heavy weight lifting or strenuous exercise may trigger flare-ups of symptoms. Low impact cardiovascular exercise, like walking, biking or rowing, has been shown to help manage symptoms long term. The increase in circulation improves oxygenation throughout your body and helps to reduce inflammation and pain. Yoga, tai chi, and qigong have been shown to reduce pain by improving flexibility and can also improve sleep, a key component in reducing fibromyalgia symptoms.
How Massage Therapy Can Improve Symptoms of Fibromyalgia
Alternative treatments such as massage therapy have also been shown to greatly improve symptoms of this chronic condition.
Massage therapy has been shown to:
- reduce headaches and migraines
- reduce anxiety and depression
- improve mental clarity
- improve restorative and restful sleep
- reduce muscle tension
All of these outcomes greatly improve the symptoms of fibromyalgia, making massage a fantastic therapy option for these patients.
Caution with Deep Tissue Massage
Because fibromyalgia is a constant, chronic, low-level pain condition, it presents some specific challenges when working with these patients. The constant inflammation of fibromyalgia affects the soft tissues, including muscle tissue and fascia. The muscle tissue becomes hypertonic throughout the body, creating conditions of reduced blood supply that brings about reduced oxygenation and increased trigger point, and tender point, activity.
While the traditional approach to hypertonic muscle tissue and trigger point activity is deep tissue massage with neuromuscular techniques in addressing the trigger points, this approach is often counterproductive in fibromyalgia patients. Because of the constant inflammation and pain that underlies this condition, deep tissue massage techniques can often bring on a flare up of pain symptoms in fibromyalgia patients.
Working with this population requires an ongoing evaluation process to assess their present state, as well as their reaction to massage therapy work. Fibromyalgia symptoms can come and go with little or no warning, and they can be triggered by something as simple as sitting in an uncomfortable chair for a few minutes. Because of the underlying nature of fibromyalgia, it is important to have constant feedback from these patients.
When working with a fibromyalgia patient for the first time, light to moderate effleurage is appropriate to gauge your client’s body reaction to massage. If there is no flare up from a light to moderate massage, the next session may involve deeper pressure and/or more specific work, such as trigger point work. It is critical that the therapist does not “dive in” to deep work on fibromyalgia patients but, rather, increases pressure and adds techniques slowly, allowing for feedback to determine the level of physical responses.
Many fibromyalgia patients do actually see improvement in symptoms from deep tissue massage and techniques for releasing trigger points, but it remains important to progress slowly, allowing time to see how your client’s body responds. Another factor to consider is that fibromyalgia patients will go through cycles when they are relatively symptom-free and can tolerate deeper massage work and other cycles where they experience every symptom fully and even the lightest touch can be painful. It is necessary to do an intake before each appointment to determine where your client is – that day – in the lifecycle of this complex and ever-changing condition. It is also vital to establish constant, open communication with your client in which they feel comfortable giving feedback about pressure and technique.
While there is much to consider when providing massage to fibromyalgia sufferers, massage therapy can be an excellent treatment option that can aid with improved sleep, reduced pain, muscle tension and anxiety, and improved cognitive function.