Imagine living with chronic pain. Every day you wake up—after a night where you might not have gotten very much sleep—knowing that your day will involve pain, most often in several areas of your body. Then, add in the depression and anxiety that often accompanies having to deal with chronic pain and what you have is this: a peek at what it's like for someone who suffers from fibromyalgia or chronic myofascial pain syndrome (CMPS).
Though the causes of fibromyalgia and CMPS are unclear, what we are starting to better understand is how massage therapy can help people with these conditions better manage their pain. Read on to learn more.
A Quick Look at the Conditions
Although both fibromyalgia and CMPS present with pain, these are different conditions, and so having an idea of what each diagnosis entails is important.
Some recognizable symptoms of fibromyalgia can include irritable bowel syndrome, headaches, migraines, numbness in the upper and lower body, and joint stiffness that is distributed around several areas of the body. This condition is usually diagnosed when a minimum of 11 out of 18 tender points are active with pain to the touch. The areas where pain is most common amongst patients include the neck and lower back. Additional symptoms include recurrent feelings of exhaustion, musculoskeletal pain and a tingling or prickling feeling known as parathesia, which is similar to that of pins and needles and mainly caused by pressure or damage to the peripheral nerves. Generally speaking, too, fibromyalgia sufferers often have acute, superficial tender points.
According to the National Fibromyalgia Research Association, more than 6 million Americans, 90 percent of whom are women, suffer from fibromyalgia, with symptoms typically showing up between the ages of 20 and 55. Additionally, somewhere between 25 percent and 65 percent of the time, fibromyalgia presents along with other pain syndromes—most commonly rheumatoid arthritis, lupus and spinal arthritis.
With chronic myofascial pain syndrome, symptoms can begin to show up after some type of trauma or injury. This condition often occurs when a muscle has been contracted repetitively, like in jobs that require repetitive motion or when stress-related muscle tension is present.
Some notable symptoms of CMPS include lacrimation, deep aching that affects one group of muscles or several, complications with the vasomotor, cuticle fl ushing, an increase or decrease in body heat, and excessive sweating. Additionally, people with CMPS often have prolonged, deep aching trigger points with desensitized nerve endings, CMPS, unlike fibromyalgia, tends to affect both genders equally, typically appearing in adults who are between the ages of 30 and 60. A diagnosis is usually made when a person has experienced quadrant pain for at least six months or more.
What you Need to Know
Accurate information. Dr. Kimberly Miller, DC, founder of the Georgia Massage Institute in Winder, has some insight into both of these conditions, as she suffers from both fibromyalgia and CMPS. According to Miller, differentiating between these two diseases can be difficult, which can lead to some people being misdiagnosed and a whole host of other issues.
So, massage therapists are going to need to make sure these clients are in regular contact with their health care professional so they know they are getting the most accurate information regarding their diagnosis and disease during intake. Without this information, creating a treatment plan that is beneficial to the client will be difficult. For example, says Miller, clients with fibromyalgia are going to require different pressure than someone with CMPS. “A misdiagnosis leads to an incorrect medication and treatment plan,” Miller explains. “When receiving manual therapy, for example, a patient with CMPS requires the deepest pressure while the true fibromyalgia patient requires only the lightest of touch.”
Understanding the difference and diagnosis. Most, if not all, the clients you see with either of these conditions will have a diagnosis before they make an appointment. With this in mind, massage therapists should have some idea of what these diagnoses involve, as well as what the condition means for the individual client. For example, what are the client’s main symptoms? Where is the pain most intense? What treatments are they currently using to deal with the diagnosis? Before you and the client can decide how massage therapy will best benefit them, you’re going to have to have a good idea of both the condition and how the condition affects their lives.
Doing a thorough intake. Intake is always important, no matter who you are working with. But especially with clients who have a diagnosed medical condition, you’re going to have to be thorough. “During the initial appointment, I do a detailed written health history,” explains Miller. “Then, I sit and go over the written health history with them.” At each subsequent appointment, Miller follows up with questions concerning pain, asking the client where they are on a scale of 0 to 10 at that moment. She also asks about any recent flare-ups since the last visit, and has a conversation about how the massage therapy sessions are working. “I want to know how they’re feeling after the session, as well as how they’re feeling a few days after the session,” Miller says. “I also ask if they’re getting relief so I can make sure we’re on the right track.”
A typical session. For a client with CMPS, a session is typically going to last approximately 30 minutes to an hour and should involve deeper pressure. According to Miller, massage therapists should focus on areas where the pain is most severe. “There are common areas of pain and dysfunction for CMPS patients, which is usually around the joints,” she says.
Applying deep pressure for these clients can take a toll on the massage therapist, so Miller encourages practitioners to find a way to work that takes some of the stress off their own bodies. For example, you might find working with your elbows helps you get the depth you need without straining your own body.
When working with clients who have fibromyalgia, massage therapists are going to need to use a lighter touch. Miller recommends touch that is surfaceoriented and doesn’t apply any pressure to the client’s skin. “Work on the top of the skin to stimulate blood flow,” she encourages. “Then work superfi cially all over the body.”
And don’t be afraid to change things up if what you’re doing isn’t working. Miller gives any one treatment plan between four to six massage sessions before she reevaluates and then, if the client isn’t seeing any relief, they begin to look at making some changes. “Maybe the pressure or the length of massage is a little off,” says Miller. “Or perhaps we need to vary the technique we’re using.”
Miller says that most often it’s the clients with fibromyalgia that need to more frequently reassess and change direction, as the clients with CMPS typically benefit from sessions that incorporate deep tissue massage. “Clients with CMPS are pretty much going to be deep tissue every single time,” she explains. “There are usually more variables involved with the clients who have fibromyalgia.”
Make adjustments. If you work with other consumer demographics that are dealing with a particular health condition, knowing that you’re going to have to make some adjustments to each session, for each client, isn’t going to come as a surprise. As Miller notes, clients with CMPS may like and need deep pressure, whereas clients with fibromyalgia might only be able to withstand the lightest of touch. Additionally, there may be some appointments where clients come for pain relief and others where stress relief is what is going to be more beneficial.
Think, too, of your physical space. These clients may very well have some sensitivities that are going to need to be accounted for prior to each appointment. For example, you might fi nd that strong scents are disagreeable to some of these clients, or that they need the lights to be dimmed. Music, too, could be a trigger, so be sure to talk to your client about music, oil and lighting preferences before each massage session.
With these clients, checking in during the session is going to be imperative. Massage therapists are going to need to verify that pressure is appropriate and the client is comfortable. You may find some people only want you to work where they are experiencing the most pain. Or, perhaps they want you to deal with their trigger points. Regardless, let them guide the session and set the pace, and understand if they need to take a break.
Medication and massage. As with many people who deal with chronic health conditions, most of these clients are probably going to be on at least one—and potentially multiple—medications. So, massage therapists are going to need to be aware of the medications being used and fully understand how these medications might impact a massage therapy session.
When working with clients who have CMPS, fibromyalgia or other chronic pain conditions, the goal is helping them better manage the pain that is, for many, a part of their everyday lives. Learning how massage therapy can benefit people suffering from a variety of health conditions provides massage therapists with a real opportunity to reach out to new clients with the message of how massage can help.
From the Client's Perspective
Holly Ingraham, who was diagnosed with fibromyalgia in February of 2013, had visited a chiropractor and an orthopedic doctor prior to becoming a patient of Dr. Kimberly Miller DC, founder of the Georgia Massage Institute in Winder. “She started me on a regimen of having two massages a week and then an adjustment right after the massages,” explains Ingraham, describing the treatment plan she and Miller devised together.
Ingraham, a 39-year-old wife and mother, was experiencing some pain due to both a herniated disc and bulging disc after an injury at work. At first, she attributed the lower back pain she felt to over-compensation due to the injury. But that turned out not to be the case, and soon she realized she was dealing with what would become a life-changing diagnosis: fibromyalgia.
For Ingraham, nothing’s been the same since she learned she had fibromyalgia. “It’s changed everything. It’s changed the way I’m able to be a mother. It’s changed the way I’m able to be a wife, and it’s aff ected my sleep,” she explains. “It affects my ability to work, my mood, and my ability to do things for myself. It’s horrible.”
Although the pain is always present, Ingraham has noticed the massage therapy she receives from Miller helps make the pain bearable. Before massage, her pain was at a nine (with 10 being the worst). After massage, she says, her pain is at a manageable five or six. In addition to the weekly massages, Miller showed her some neck and back stretches she can do between sessions to help keep the pain at bay.
Judy Carlisle, a client with chronic myofascial pain syndrome (CMPS) has been seeing Miller for the past nine years and says that when she couldn’t get to her session for three weeks, she could defi nitely feel the diff erence. “I was a mess when I got to her,” says the 70-year-old retired registered nurse whose condition has affected her ability to get around. “Everything was so tight and stiff .”
Ingraham had a similar experience after missing just one week of massages with Miller. “That’s when I could really feel the difference because I’m always in pain and I always feel tired, even when I get B-12 shots and take supplements,” she says. “But when I didn’t go for the massage and the adjustment, I was miserable.”
For Carlisle, a session with Miller includes a deep tissue massage for 30 minutes to an hour. She believes the weekly massages have helped improve her mobility, circulation, muscle soreness, as well as decreasing the pain she feels in her upper body. “I’ve been going to Dr. Kim for a long time, and she’s really done a lot to help,” says Carlisle. “If I had any idea that massage would do for you what it’s done for me, I would’ve started a long, long time ago.”
Consistency is key. For these clients, regular massage therapy is going to be key, as pain and other issues tend to reappear if time between appointments is too great.
Looking for more in-depth information on working with clients with fibromyalgia? Consider this continuing education course—An Evidence Based Guide to Treatment of Fibromyalgia for Massage Therapists.