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A Message From Your Massage Therapist

An estimated six million Americans suffer from fibromyalgia (FM), a syndrome that produces chronic pain. Though it continues to mystify the medical community, it is becoming more recognized. In this month’s article, “The Untouchables: Light Touch Massage Therapy Offers Hope, Relief For Those With Chronic Pain,” writer Amanda Kipp explains what the syndrome is, and offers some tips for those who suffer from it.

Currently, there aren’t any medications designed specifically for FM, so those with the syndrome must turn to therapies like massage to ease their pain—and it seems to work!

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By Amanda Kipp

It took Lynne Matallana visits to 37 doctors in the course of a year until she was finally diagnosed with fibromyalgia (FM) in 1993. It was at a time when Matallana says physicians claimed that patients were simply overstressed or oversensitive.

Matallana, who lives in Orange County, California, is now the founder and director of National Fibromyalgia Association (NFA) While recognition of the disease is getting better, Matallana claims that people with FM often ignore the symptoms. “They think that they will go away, but eventually the symptoms only get worse,” she says.

What Is FM?

The term fibromyalgia first appeared in 1990, when the American College of Rheumatology created it.

“The cause of the condition, simply described as chronic pain, continues to baffle the medical community today,” says Laurel Freeman, American Massage Therapy Association (AMTA) president. Freeman specializes in massage for chronic pain says she has had wonderful results decreasing FM discomfort and pain of her clients.

However, FM is anything but simple.

“FM is not a disease, it’s a syndrome,” explains Denise Borrelli, Ph.D., a massage therapist who wrote her doctoral dissertation on FM. “It’s not just one thing, it is a variety of things—scleroderma, arthritis, Reynaud's disease, etc.—pulled together, which is what makes it so hard to diagnose; it mirrors so many diseases.”

As a result of the abnormal sensory processing found in those with FM, the list of associated syndromes include: chronic fatigue, restless leg syndrome (numbness, tingling, itching and muscle crawling in the lower limbs, which may extend to the arms and scalp), irritable bowel syndrome, irritable bladder syndrome, cognitive dysfunction, cold intolerance, multiple sensitivities (amplified sensations that lower the tolerance of adverse weather, loud noises, bright lights, and other sensory overloads), dizziness, and neurally mediated hypotension accompanied by low blood pressure that does not go up normally on standing or on exercise, according to the NFA.

Who Is At Risk?

An estimated four to six million Americans have FM, with women seven times more likely than men to develop it, according to Robert M. Bennett, M.D., professor of medicine, and head of the division of arthritis and rheumatic diseases at Oregon Health Sciences University’s Department of Medicine in Portland. And while FM is seen in all ethnic and age groups, from young children through the older population, most patients are in their 20s or 30s.

Getty Images More women than men suffer from fibromyalgia, and it is often difficult for physicians to diagnose, since it mirrors many diseases.

Bennett advocates that there are 18 focal areas of tenderness in the muscles, called “myofascial trigger points” or “hot spots,” including the neck, shoulders, elbows, thighs and knees. To be diagnosed, pain must be felt in at least 11 of those areas for no less than three months.

To date, no drugs have been developed for the treatment of this mystifying disease, but a handful of well-known pharmaceutical makers have begun clinical trials. For now, those diagnosed with FM must rely on therapies like massage to cope with their chronic pain.

It wasn’t until two years ago, when Daniel Clauw, M.D., executive director of the Chronic Pain and Fatigue Research Center and Professor of Medicine in the division of rheumatology at the University of Michigan in Ann Arbor, was able to use functional MRI scans to supply the first objective proof that FM pain, in fact, really exists.

Researchers have since been able to pinpoint FM as a disease of the central nervous system, in which the pain-processing system between the brain and spinal cord is somehow off-kilter.

Yet not all physicians are convinced FM is real, often dismissing patients as hypochondriacs, which only further exacerbates the frustration of both patients and their physicians in the management of this disease.

“The pain is very real. All one has to do is palpate in the proper places, and one would be assured that there is definitely pain and discomfort; you can see it on the looks on [the client’s] face,” says Borrelli, who currently sees 10 to 12 FM clients on a weekly basis. Having had more than 15 years of experience working with FM clients, she says she finds it absolutely appalling that one would not to 1recognize the syndrome.

The Role Of Massage In FM Relief

When massage therapy is first suggested to those with FM, Matallana says that some immediately think "heavy-duty" Swedish massage. “But not all massage is [that way]—oils and aromatherapy can be quite pleasant,” says Matallana, adding that the heightened sensitivity to touch associated with FM waxes and wanes. Matallana has found that massage helps people with FM relax as well as “move through the pain process.”

Matallana admits that her first experience with massage was not a good one, but she, like many others living with FM, have gone on to have a very positive reaction to massage therapy. “Once you find a therapist who is good—who knows to avoid the tender points, and not apply direct pressure, that person becomes really, really popular [among the FM community].” In fact, Matallana, who prefers light touch massage to aid in the stretching and moving of her muscles, says that massage is one of her favorite methods of pain relief.

“What many doctors are realizing is that massage over the long term may help decrease the symptoms a patient is having with FM, since much of the pain begins in the muscle,” Freeman adds. “Massage therapy on a regular basis can remind the muscle fibers to lengthen, relieving muscle tension, and allowing the client to function.”

“The benefits of massage are phenomenal,” Borrelli agrees, adding that through massage therapy she has even been able to keep clients out of wheelchairs.

Research indicates relaxed muscles naturally result in a reduction of pain, stress, and anxiety. In addition, massage therapy has been shown to stimulate the production of endorphins, the body’s natural painkillers—another beneficial side effect for FM sufferers.

Massage Modalities And Styles

While some massage therapists may choose to use stones, wooden knobs, hydrotherapy or a number of other devices, it’s the trust and synergy between the therapist and client that will ultimately enhance wellness, Freeman says.

Borrelli cautions against the use of devices. “They can go too deep, too fast and you can’t gauge them [as well as working with your hands].”

Getty Images Research has shown massage therapy produces endorphins, the body's natural painkillers, which may be another reason FM sufferers benefit from massage.

A trained massage therapist can feel the fascia releasing under his or her hands and can therefore go with the flow, says Borrelli. By moving the fascia layer by layer, as done with light Swedish massage, the tight fascia can be released, therefore decreasing pain in the long and short run for the FM client. Massage therapists should treat FM clients with caution, and very lightly use their hands as the vehicles that release the tissue, says Borrelli. “Fascia should be released like pealing an onion—layer-after-layer, and slow and easy allowing the fascia to release at an even pace.”

Other types of massage that work well with FM patients include myofascial release, which specifically functions to relieve tightness and restricted movement of the body’s connective tissue, Borrelli says. When done correctly, myofascial release can help lengthen connective tissue and reduce its pull on the skeletal system.

In addition to very light Swedish massage craniosacral therapy is another popular FM treatment, which releases the tissue in a slow, steady, fashion that also helps to decrease pain and discomfort, Borrelli says.

Hot-and-cold sensitivity runs hand-in-hand with FM, Borrelli explains, which is why she says the use of hot stones is an absolute “no-no.” Heating up the fascia with hot rocks in order to better manipulate the tissue is contraindicated, Borrelli says. “The therapist could end up going too deep, much too fast, resulting in more pain later, even if it feels good to the client at the time.”

In Borrelli’s experience, she says the FM client may not always know what is best because “all they know is pain.” An FM client may come in for a massage, she says, and ask for deep tissue work, and it may actually feel good to them, “but two days later they will be in excruciating pain.”

Massage therapists will know what they feel under the skin, says Freeman, and clients with FM have muscle fibers that need to be reminded to loosen up, which is what therapists do best. “A client will benefit from massage done on a regular basis; however, if the client can afford to come at least once per week for a massage, it will dramatically enhance their lifestyle.”

Approaching The FM Client

Borrelli says she treats all her clients the same way, with respect and caution. “One never knows what lies beneath the muscle tissue and fascia. Some clients have some emotions that are suppressed within the fascia of the connective tissue. I have found that the onset of FM can come from a trauma—either physical, mental, or both, says Borrelli.

For Matallana, what’s most important is that massage therapists “understand and believe that our pain is very real” and that through touch, massage therapists “can do something that is really helpful.”

~ Amanda Kipp is a freelance writer based in Chicago, who has written for both Massage Therapy Journal and e-touch. She can be reached at amandamkipp@earthlink.net.

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