Reprinted from The Fibromyalgia Network Newsletter 10/31/11
Myofascial Release Therapy Eases Tension
Are you looking for ways to relieve the tension, stiffness, and knots in your muscles that lead to so much aching? With the probability that 90 percent of your tender points are actually myofascial trigger points, more studies are being done on therapies to ease this type of pain. Recently a team in Spain led by
Adelaida Maria Castro-Sanchez, Ph.D.,
wanted to determine if myofascial release therapy would reduce tender points and pain, and improve physical function and balance for fibromyalgia (FM) patients.* Of the 94 patients studied, 47 were given a one-hour therapy session twice a week for 20 weeks. The team focused the hands-on massage technique to work on muscles related to tender areas surrounding the temples, lower back of the skull, jaw, neck, chest, upper back, and low back regions. A control group of 47 FM patients received a “sham” or disconnected short-wave and ultrasound treatments on the neck and back areas twice a week for 20 weeks. Both groups were tested for tender points, pain, balance, and physical function before the study, after completion, six months, and one year after the last therapy session. Following the 20-week treatment, the study group showed significant benefits in 10 painful tender points, physical function and ability, and overall pain. This included improvements in fatigue, tiredness upon waking, stiffness, and overall number of days they felt good. The positive effects of the myofascial release therapy carried over six months after the treatment stopped. After one year, the only measures that sustained improvement was the number of days feeling good and the overall severity of their FM. In comparison, the control group showed no improvement throughout the study. Neither group reported any improvement in balance or stability. “This study has demonstrated that fibromyalgia patients can benefit from myofascial techniques. In these patients, the decrease in muscular tension secondary to the release of myofascial restriction improves physical function,” said Castro-Sanchez. For the average FM patient, a twice weekly one-hour therapy session for 20 weeks seems rather intense and impractical in terms of expense. However, patients might consider starting with a weekly myofascial release therapy session until their most troublesome knotted trigger points become deactivated. Then build on this therapy with gentle stretching and application of moist heat to sustain the effects for longer periods between massages. This type of therapy should be considered a compliment to a broad treatment plan that works for you. Practitioners who may be knowledgeable about myofascial release include physical and massage therapists.
* Castro-Sánchez AM,
This article was originally written in 1995 and might be a helpful tool to use to share how you are feeling with others who might not understand: by Ricky Buchanan
These are the things that I would like you to understand about me before you judge me... Please understand that being sick doesn't mean I'm not still a human being. I have to spend most of my day flat on my back in bed and I might not seem like great company, but I'm still me stuck inside this body. I still worry about school and work and my family and friends, and most of the time I'd still like to hear you talk about yours too. Please understand the difference between "happy" and "healthy". When you've got the flu you probably feel miserable with it, but I've been sick for years. I can't be miserable all the time, in fact I work hard at not being miserable. So if you're talking to me and I sound happy, it means I'm happy. That's all. I may be tired. I may be in pain. I may be sicker than ever. Please, don't say, "Oh, you're sounding better!" I am not sounding better, I am sounding happy. If you want to comment on that, you're welcome. Please understand that being able to stand up for five minutes, doesn't necessarily mean that I can stand up for ten minutes, or an hour. It's quite likely that doing that five minutes has exhausted my resources and I'll need to recover - imagine an athlete after a race. They couldn't repeat that feat right away either. With a lot of diseases you're either paralyzed or you can move. With this one it gets more confusing. Please repeat the above paragraph substituting, "sitting up", "walking", "thinking", "being sociable" and so on .... it applies to everything. That's what a fatigue-based illness does to you. Please understand that chronic illnesses are variable. It's quite possible (for me, it's common) that one day I am able to walk to the park and back, while the next day I'll have trouble getting to the kitchen. Please don't attack me when I'm ill by saying, "But you did it before!" If you want me to do something, ask if I can and I'll tell you. In a similar vein, I may need to cancel an invitation at the last minute, if this happens please don't take it personally. Please understand that "getting out and doing things" does not make me feel better, and can often make me seriously worse. Fibromyalgia may cause secondary depression (wouldn't you get depressed if you were stuck in bed for years on end!?) but it is not caused by depression. Telling me that I need some fresh air and exercise is not appreciated and not correct - if I could do it, I would. Please understand that if I say I have to sit down / lie down / take these pills now, that I do have to do it right now - it can't be put off or forgotten just because I'm doing something. Fibromyalgia does not forgive. Please understand that I can't spend all of my energy trying to get well. With a short-term illness like the flu, you can afford to put life on hold for a week or two while you get well. But part of having a chronic illness is coming to the realization that you have to spend some energy on having a life now. This doesn't mean I'm not trying to get better. It doesn't mean I've given up. It's just how life is when you're dealing with a chronic illness. If you want to suggest a cure to me, please don't. It's not because I don't appreciate the thought, and it's not because I don't want to get well. It's because I have had almost every single one of my friends suggest one at one point or another. At first I tried them all, but then I realized that I was using up so much energy trying things that I was making myself sicker, not better. If there was something that cured, or even helped, all people with Fibro then we'd know about it. This is not a drug-company conspiracy, there is worldwide networking (both on and off the Internet) between people with Fibro, if something worked we would KNOW. If after reading that, you still want to suggest a cure, then do it, preferably in writing, but don't expect me to rush out and try it. If I haven't had it suggested before, I'll take what you said and discuss it with my doctor. Please understand that getting better from an illness like this can be very slow. People with Fibro have so many systems in their bodies out of equilibrium, and functioning wrongly, that it may take a long time to sort everything out. I depend on you - people who are not sick - for many things. But most importantly, I need you to understand me.
This is a newly-released article from the Fibromyalgia Network about new diagnostic criteria and the impact.
It’s been 20 years since the American College of Rheumatology (ACR) published the criteria for the classification of fibromyalgia (FM). This criteria requires pain in all four quadrants of the body for at least three months AND moderate pain sensitivity at a minimum of 11 of the 18 predetermined tender points. As with any diagnostic criteria, especially those that cannot be based on a blood marker or similar test, there were problems with implementing the 1990 criteria. The authors of the new preliminary criteria, headed up by Frederick Wolfe, M.D., of Wichita, KS, contend:1
Tender point counts are rarely performed in primary care where most FM diagnoses occur. Even when the count was performed, it was usually done incorrectly.
Many physicians do not know how to examine for tender points and some simply refuse to do so.
Outside of research, practitioners in the clinical setting often diagnose FM based on symptoms rather than tender point counts.
According to Wolfe and the other nine authors of the newly proposed criteria for FM, the prior focus on tender point counts obscured the importance of other common symptoms, such as fatigue and cognitive difficulties. The authors also contend that the tender points “erroneously linked the disorder to peripheral muscle abnormality.” How ironic it is that this latter statement is made at the same time that Hong-You Ge, M.D., Ph.D., of Aalborg University in Denmark, demonstrated that more than 90 percent of the predetermined 18 tender points were actually myofascial trigger points (MTPs). Indeed, MTPs do have an underlying muscle abnormality that can be imaged by a vibration-assisted ultrasound technique. MTPs (felt as hard nodules in the muscles) can be treated by various hands-on therapies but do not respond well to pharmacological approaches. Twenty years experience with any set of diagnostic criteria is bound to illuminate its shortcomings. As you may have read in the March eNews Alert, there is a serious gender bias in how the 1990 criteria are used, making it much harder for men to receive this diagnosis and the available treatments.2 The tender point criteria also did a poor job of measuring symptom severity or charting the effectiveness of new treatments. Although the new diagnostic criteria do away with the tender point concept and take into consideration the more common symptoms of fibromyalgia, it remains unknown whether primary care physicians will find them any easier to implement. The new ACR diagnostic criteria for fibromyalgia should still be viewed as preliminary. However, patients should be aware of what Wolfe and the ACR committee are proposing. For starters, Wolfe’s editorial published online along with the new criteria in Arthritis Care and Research, makes two unflattering statements about fibromyalgia:
“The ACR diagnostic criteria should not be seen as an endorsement of the legitimacy and existence of fibromyalgia—the criteria are neutral on that point.”3 He goes on to indicate that the “fibromyalgia wars” over whether FM is a real condition, or just the end of the spectrum showing how some people poorly respond to distress (it’s what Wolfe refers to as “fibromyalgianess”), remain unresolved.4
“... one can now study fibromyalgia and fibromyalgianess without the requirement for belief in its existence.” Does this mean that Wolfe and other non-believers will enter the research field of FM? Time will tell. With the new criteria that is virtually a symptom checklist, Wolfe adds, “... it is now possible to study widespread pain, fibromyalgia, fibromyalgianess—indeed the whole spectrum of illness related symptoms, simply and inexpensively in survey research.” But this form of “study” is not likely to lead to biomarkers or effective new therapies, which is what FM patients need the most.
The study paper for developing the new ACR diagnostic criteria for fibromyalgia was only based on 829 FM patients (75 percent meeting the tender point criteria) and 829 control subjects with other non-inflammatory rheumatic disorders (e.g., osteoarthritis, degenerative neck and back conditions, regional pain syndromes, etc.). For the purposes of developing new criteria, this is a relatively small group of study subjects and could be why the authors refer to them as “preliminary.” The new criteria appear in a one-page symptom checklist format that will hopefully be more suitable for use in the primary-care setting. A tender point evaluation is no longer required although a full physical exam is still recommended along with other diagnostic tests to identify causes for the patients’ symptoms besides FM. In place of the tender point count, patients (or their physician) may endorse 19 body regions in which pain has been experienced during the past week. This number is referred to as the Widespread Pain Index (WPI) and it is one of the two required scores needed for a doctor to make a diagnosis of FM. The second part of the score required to assess the diagnosis of FM involves the evaluation of a person’s symptoms. The end result is a Symptom Severity score or SS score. The diagnosis is based on evaluating both the WPI score and the SS score. Overall, it takes into consideration the widespread nature of your pain and your other bothersome symptoms. The greatest problem with the new criteria is that the authors do not state how severe the pain must be in order to check “yes” for that area. What if the pain is just a dull ache or intermittent? The criteria do not specify the intensity or quantity of pain that one must have in a given area over the past week to merit a “yes” answer. Quantifying the symptoms for the SS score is even more vague. In fact, the carefully selected non-FM control patients scored an average of 3 on a scale of 0 to 12, which is not far from the SS score requirements for FM. On the downside, is it possible these new criteria may greatly increase the number of patients diagnosed with FM by diluting what is called “fibromyalgia.” Quite possibly, people with chronic, painful illnesses that do not involve widespread pain will meet the new diagnostic criteria. So you may want to ask: “Who might benefit from a larger, diluted pool of FM patients?” Perhaps all one has to do is look at who sponsored this study: Lilly Research Laboratories. Eli Lilly is the manufacturer of Cymbalta (duloxetine). If more patients are diagnosed with FM, then the pharmaceutical industry will definitely benefit.
Based on criteria prior to 2010:What is Fibromyalgia?*
Although often mistaken for a muscle disorder, fibromyalgia, (also known as fibromyalgia syndrome or simply FMS) can be defined as a dysfunction in the way the central nervous system processes pain. FMS is associated with widespread sensitivity in the body and an amplification of pain sensations. Responses to various stimuli such as sound, scent, light, or touch can be exaggerated or misinterpreted by the brain as pain.
Symptoms: Each person suffering from FMS may present with a slightly different series of symptoms. However, the most common symptoms include the following: deep muscle aching or burning, muscle stiffness or twitching, fatigue and complaints of limbs feeling like "dead weight," difficulty concentrating or "brain fog," sleep disorders, irritable bowel syndrome, chronic headaches, temporomandibular joint dysfunction (TMJ), and multiple chemical sensitivities. Individuals with fibromyalgia may report increased symptoms from changes in the weather or barometric pressure or with increased personal stress.
Causes: There are various theories regarding the cause or onset of FMS. One event or a series of traumatic events to the body can trigger the dysfunction, but it can also be caused by long-term stress. Examples include auto accidents, severe infections, or the onset of another disease affecting the connective tissues. The body is made up of connective tissue called fascia that winds its way like a silken web through the body, around muscles, bones, nerves, and even organs. With FMS, there are often unrecognized restrictions in the fascial system contributing to the pain syndrome.
**Diagnosis: In order to meet the diagnosis criteria for FMS, a physical examination (often performed by a rheumatologist) will reveal that a person has at least 11 out of a possible 18 tender points for a minimum duration of 3 months. It is important to be aware that FMS may be diagnosed along with co-existing conditions.
**See new diagnosis criteria at top of the page.
Treatment: There are various treatments aimed at assisting sleep, reducing pain, and curtailing the co-existing symptoms of fibromyalgia. A gentle hands-on approach with a combination of manual therapy and craniosacral therapy techniques address a number of the FMS symptoms. The goal is to assist the client back into healthy, everyday living.
Traditional vs. Complementary Techniques
Traditional therapies may focus on using modalities (such as electrical stimulation and ultrasound) to reduce localized symptoms and exercise to strengthen de-conditioned tissues.
However, the source of the symptoms is not always the site of the discomfort. Muscles cannot be strengthened to a functional state and tissues cannot relax until restrictions are released.
Treating clients with fibromyalgia requires an understanding of your special needs. By following a phased treatment regimen and customizing care to each individual, Sari Lewis, OTR/L, RCST® can help you relieve your symptoms of fibromyalgia and let you regain control of your life. Calming your tissues and nervous system with gentle hands-on therapy techniques is a primary goal in treating the varied symptoms of fibromyalgia.
"Sari~Thanks for all the tools you teach me to help me get through life...for the sensitive way you explain and give reason for my concerns and questions, for your intuitive way of knowing what I need before I even say it, for the feeling of complete trust, relaxation and relief in my physical and mental being." D.C.
At the Fibromyalgia Network website you can find information on fibromyalgia and chronic fatigue syndrome. Read about support groups, research information, advocacy, past newsletters, and more. I encourage you to contact the FM Network to learn more. http://www.fmnetnews.com
The Oregon Chapter of the Fibromyalgia Foundation has a website at http://www.myalgia.com/. Check out the information on FMS and Sjogrens, Lupus, and other related diagnoses.
The Fibromyalgia Network April 2005 edition summarized a study related to capillary blood flow and patients with FMS. Here is an excerpt from the review: ‘The authors hypothesize that the sympathetic branch of the peripheral nervous system is overly active, causing the blood vessels to constrict…In addition, non-drug therapies that enhance circulation tend to reduce FMS pain.’ http://www.arthritis-research.com/content/7/2/R209
Craniosacral therapy helps to calm the nervous system, improve fluid nutrition to the brain, spinal cord and tissues and increase blood flow and circulation.
*The 18 Tender Point Locations for FMS on "The Three Graces" Masterpiece.