Archive for the 'fibromyalgia' Category

Nov 18 2011

Fibromyalgia Relief with Massage

Published by under fibromyalgia,Massage Therapy

Help your clients with fibromyalgia relieve their pain. Learn about this debilitating syndrome — and how massage therapists can make a tremendous impact on their clients with fibromyalgia.

Fibromyalgia, a syndrome with widespread chronic pain as its hallmark, is an enigmatic ailment with no known cause, no simple diagnostic test and no cure. While not a “cure”, massage therapy is an effective means for helping people manage their fibromyalgia. Most clients with fibromyalgia syndrome (FMS) say that they ache all over. They describe their pain in a variety of ways, such as burning, stabbing, gnawing, aching, stiffness or soreness. The American College of Rheumatology (ACR) estimates there are between three and six million people in the U.S. with fibromyalgia syndrome.

While the cause of FMS remains elusive, many believe that certain events may trigger this syndrome’s onset. Some of the trigger suspects include viral or bacterial infections, automobile accidents, rheumatoid arthritis and tragic events (physical and psychological). Many experts believe that an abnormally functioning central nervous system is at the root of FMS. Hormone and neurochemical imbalances are common findings during the medical evaluation of someone with fibromyalgia. The complexity of FMS may call for an entire medical team in the person’s care, including a rheumatologist, an endocrinologist and a neurologist.

Physicians often have difficulty diagnosing FMS because its symptoms have a high degree of variability and they overlap with a long list of other conditions. In 1990, the ACR listed two primary criteria for the classification of fibromyalgia. The first is a history of widespread pain involving all four quadrants of the body (right side, left side, above waist, below waist) for a minimum of 3 months. The second criterion which points to FMS is the presence of pain in at least 11 of 18 tender points when touched or pressed. It is suggested that a massage therapist confirm that his/her client received a diagnosis of fibromyalgia from a physician, to insure that something else isn’t the cause of the client’s maladies.

Clients with FMS not only report pain associated with specific “tender points” used for diagnosis, but also describe pain that is associated with myofascial trigger points. Pain originating from either source can fluctuate and is further aggravated by various physical, environmental and emotional factors. Fatigue, stiffness, poor sleep, and a host of other related symptoms often send fibromyalgia sufferers to seek relief from this disabling pain from a massage therapist. An ABC News/USA Today/Stanford University Medical Center April 2005 poll on chronic pain reported that more than half of Americans live with chronic or recurrent pain. According to this poll, 28 percent of Americans had tried massage therapy for relief of their chronic pain. Many fibromyalgia sufferers report massage as bringing them more relief than any other treatment prescribed by their physicians.

Massage is an excellent way to decrease pain, relax muscles, improve circulation, passively stretch muscles and create an overall feeling of well-being. In 1994, research at the Touch Research Insititute, Miami School of Medicine demonstrated that fibromyalgia responds well to massage. Rheumatologists evaluating the participants in this study found that only those receiving massage reported decreases in pain, fatigue, stiffness and improvements in their quality of sleep.

With such a high degree of variability of FMS symptoms and a client’s preferences, communication during the massage process is essential. Encourage feedback from your client, and adjust your administration to maximize his/her comfort. Starting out slowly with some moist heat application or initially warming the muscles with light strokes can allow for the client to relax into your care and guide you toward his/her needs. When the practitioner begins slowly, it is easier to assess the client’s needs, sensitivity and tolerance levels.

Many forms of massage can ease fibromyalgia pain. While gentle techniques may be favored by some FMS clients, others may benefit greatly from deep work, such as penetrating ischemic work on trigger points. For some with FMS pain, low-force or non-force techniques help them the most — without overstimulating their already overburdened nervous system. Strenuous massage that uses deep tissue and/or neuromuscular techniques may possibly trigger flare-ups of muscular pain and make some FMS sufferers feel worse, which can exacerbate other symptoms associated with fibromyalgia like sleep problems, depression, lack of concentration and fatigue.

Following treatment, FMS clients should be instructed to take it easy for awhile. Soreness may be present the day after treatment, especially if trigger points were treated. After the massage, drinking plenty of water and soaking in a warm (not hot) Epsom salts bath, with a few drops of a muscle relaxing essential oil (such as lavender, bay laurel or white birch), can provide relief from soreness and promote restful sleep. If deep work was included in the session, it is especially important for your client to consume extra water, and having water on hand for the client at the close of the treatment, or sending your client home with a bottle of water can be a nurturing physical enforcement of your instructions to him or her. You might mention to your client that the enzyme bromelain, harvested from the pineapple stem, has been shown to reduce muscle and tissue inflammation. [Note: Use caution when combining bromelain with anticoagulants (blood thinners), such as enoxaparin or warfarin. This enzyme is a natural blood thinner and may increase the medication’s effect.]

Elusive and debilitating, chronic pain associated with FMS affects all aspects of one’s life. Individuals with FMS and experts in the field agree that those who are most successful in controlling their symptoms utilize a comprehensive approach to their healing that integrates multiple modalities. Long term massage therapy has been shown to offer the most benefits for FMS and can enable you to successfully help your clients manage their pain and get control of their fibromyalgia.

Editor’s Note: See the related article, “Fibromyalgia Part 2: Nine Massage Techniques”.

Recommended Study
Fibromyalgia and Massage

Posted by Nicole at 09:50 AM
© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute.

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May 30 2009

Enhance Your Clients’ Circulation with Topicals

Published by under fibromyalgia,Massage Therapy

The guiding principle of all bodywork types is increasing circulation throughout the body’s tissues. For massage therapists, a prime illustration of integrative medicine is purposefully choosing an herbal topical application to use for a massage session. Discover what topicals best match and enhance the principles directing your own work.

By Nicole Cutler, L.Ac.

The last ten years has brought great advancements to the healthcare industry. Due to medical research’s undeniable and reproducible results, many allopathic physicians now study and recommend various complementary therapies to patients. The increased acceptance of integrated medicine will lead patients to receive a single, customized treatment employing more than one modality. Massage therapists and other health practitioners who wish to learn and practice multiple modalities will lead this evolution of healing.

Guiding Principles
The primary principles directing massage therapists is analogous to many other healthcare professions. Differing only in the tools used and the tissues affected, bodyworkers of all kinds – including chiropractors, acupuncturists, osteopaths and physical therapists – generally practice according to the following guiding principles:

• Enhance circulation
• Foster relaxation
• Increase flexibility and range of motion
• Decrease inflammation

Once these healthcare professionals all recognize these shared principles, then medical breakthroughs will follow.

When cleaning a dirty floor, the best results occur from a combined approach, consisting of dusting, mopping and maybe even waxing. In this example, simply vacuuming up any loose debris could be considered the bare minimum when it comes to actual cleanliness. Similar to solving any challenge, people suffering from a certain malady typically experience a quicker resolution when the challenge is approached from more than one perspective. It is this premise that the value of integrative medicine rests.

Techniques such as effleurage, percussion, acupressure and neuromuscular therapy all increase circulation. Combining this style of work with an herbal topical preparation whose purpose is also to enhance circulation instantly magnifies the therapeutic aim of the treatment.

Many natural herbs contain circulation-enhancing properties. Aromatherapists and herbalists are just two of the professions familiar with the substances that can be used topically to create this effect. In addition to matching the client’s needs, there are several factors to consider when choosing the ideal topical preparation:

1. Skin sensitivity: Be aware of any skin sensitivity for your chosen product. Some ingredients may irritate the skin, while others may render it photosensitive.

2. Ease of use: Having a topical preparation already prepared and conveniently dispensable will save the therapist time and effort.

3. Residue presence: Applications that rub in completely, are greaseless and non-staining are preferable for both therapists and clients. These characteristics prevent interrupting the practitioner’s tactile maneuverability due to slippage, ruining clients’ clothing and making clients’ skin oily.

4. Balanced formula: While each herbal ingredient has unique therapeutic properties, striking the right balance is critical for optimal results. Excessive amounts of one herb may be overly stimulating, especially without the presence of a different herb to offset it.

Trusted Choice
Taking the above factors into consideration, the Institute has searched far and wide for the topical preparations educated massage professionals seek. Herbal Heat and Herbal Ice are two formulations derived from Ayurvedic medicine’s rich herbal knowledge base. Both of these topical preparations are in an easy-to-use gel form, do not leave any residue, are not oily and consist of expertly balanced formulas.

Herbal Heat is a blend of eucalyptus (an excellent carrier to enhance skin absorption), wintergreen (reduces inflammation), clove and ginger (both of which block pain signals and increase muscular circulation). Without causing skin discomfort typical of a topical promoting blood flow, this gel relaxes and warms muscles while effectively enhancing circulation.

Herbal Ice is a blend of menthol (a cooling agent), cinnamon (an invigorating agent) and tea tree oil (a tissue healing enhancement agent), to assist with the reduction of muscle inflammation. This particular formula is helpful to clients suffering from an inflammatory response or those enduring vigorous and deep massage.

Choosing the right topical products contributes to the motion towards integrative medicine. Using a gel such as Herbal Ice on a client who recently incurred a soft tissue injury will assist your efforts in reducing muscle inflammation and encouraging healing. Using Herbal Heat on a person with chronic muscular pain will magnify the effectiveness of your massage strokes to enhance blood circulation and reduce pain. Herbal Heat and Herbal Ice are just two examples of well-designed topical preparations ideal for incorporating into massage therapy.

Practitioners of various healing methods are discovering the value to their practice and clients when drawing on tools within their legal scope of practice, yet outside their normal routine. Combining the effectiveness of massage therapy with the knowledge of herbal topical applications will lead your work into the next realm of integrative medicine.

Recommended Study:

Fibromyalgia and Massage
Neuromuscular Therapy

Posted by Editors at 11:02 AM

© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute.

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Apr 29 2009

Massage and Bodywork to Reduce Fatigue and Build Your Practice

Fatigue is the most frequently seen symptom in clinical practice. Learn how to implement a therapeutic protocol to support clients suffering from fatigue while enhancing the value of your services.

Nicole Cutler, L.Ac.

The explosion of research centering on the benefits offered by massage therapy clearly demonstrates the modality’s ability to reduce fatigue:

• As published in Alternative Therapies for Health and Medicine, hospital nursing and physician staff members were provided massage therapy, relaxation therapy and music therapy. All of these therapies significantly reduced anxiety, depression and fatigue as well as increased vigor.

• As published in the Journal of Chronic Fatigue Syndrome, patients with chronic fatigue syndrome experienced a reduction in depressed mood, fatigue, anxiety and stress hormone (cortisol) levels immediately following massage therapy.

• As published in the Journal of Clinical Rheumatology, massage therapy (as compared to transcutaneous electrical stimulation) improved sleep patterns and decreased pain, fatigue, anxiety, depression and cortisol levels in adults with fibromyalgia.

• As published in the Journal of Nursing Research, acupressure followed by leg massage eases fatigue and depression in people with end-stage renal disease.

Acupressure for Fatigue
While there are just as many variations of fatigue as there are ways to help it, acupressure provides a solid theoretical basis and effective means for its treatment. Traditional Chinese Medicine thoroughly chronicles and seeks to balance energy flow within the body’s meridians. This intricate system of healing has been thoroughly studied and relied upon by acupuncturists, but massage therapists performing acupressure can also utilize this vast pool of therapeutic information.

Traditional Chinese Medicine discovered that when performed excessively, certain activities strain the energetic balance in specific meridians. This strain can result in weakened immunity and fatigue. Administering acupressure to specific points along these meridians can correct the offending imbalance and increase the client’s energy.

According to Michael Reed Gach, PhD’s book, Acupressure’s Potent Points, the following activities can result in fatigue:

• Excessive standing damages the bladder and kidney meridians, which can cause fatigue and low backaches. To restore these meridians, stimulate the following points:

Bladder 23 – located approximately two-finger widths lateral to the lower border of the spinous process of the second lumbar vertebrae, on the quadratus lumborum muscle.

Bladder 52 – located approximately four-finger widths lateral to the lower border of the spinous process of the second lumbar vertebrae, on the quadratus lumborum muscle.

Kidney 27 – located in the depression on the lower border of the clavicle, approximately three finger widths lateral to the sternum.

Kidney 3 – located in the depression between the medial malleolus and tendo-calcaneus, level with the tip of the medial malleolus.

• Excess sitting can damage the stomach and spleen meridians, contributing to fatigue, anemia and digestive disorders. To restore these meridians, stimulate the following points:

Stomach 36 – located four finger breadths below the eye of the knee, one finger breadth lateral to the anterior crest of the tibia, in the tibialis anterior muscle.

Spleen 6 – located four finger breadths directly above the tip of the medial malleolus, on the posterior border of the medial aspect of the tibia.

• Excess lying down can damage the large intestine and lung meridians, which can cause fatigue, respiration difficulties and elimination problems. To restore these meridians, stimulate the following points:

Large Intestine 4 – located in the web on the dorsum of the hand, between the first and second metacarpal bones, approximately in the middle of the second metacarpal bone on the radial side. Note: This point is contraindicated during pregnancy.

Large Intestine 11 – When the elbow is flexed, in the depression at the lateral end of the transverse cubital crease, midway between the lateral epicondyle of the humerus and the biceps brachii tendon.

• Excess use of your eyes (as in close desk work) or emotional stress can damage the small intestine and heart meridians, causing fatigue. Pressure or tapping on the following can restore balance in these meridians:

Conception Vessel 17 – located on the anterior midline, level with the fourth intercostal space, on the sternum.

Heart 3 to 7 – runs along the palmar aspect of the forearm, in a line from Heart 7 (the ulnar end of the transverse wrist crease, on the radial side of the tendon flexor carpi ulnaris), to Heart 3 (in the depression between the medial end of the transverse cubital crease and the medial epicondyle of the humerus).

• Excess physical exertion can damage the gallbladder and liver meridians, which can cause cramps, spasms and fatigue. To restore these meridians, stimulate the following points:

Liver 3 – located in the web on the dorsum of the foot, in the depression distal to the junction of the first and second metatarsal bones.

Gallbladder 34 – located in the depression anterior and inferior to the head of the fibula.

Asking the proper questions of a client during an intake interview can reveal excessive activities in their lifestyle that may be creating a fatigue-causing imbalance. For example, a client experiencing fatigue who sits at a computer all day likely has imbalances in the spleen, stomach, heart and small intestine meridians. Applying acupressure to the points most likely to balance these meridians could provide enormous therapeutic benefit. Massage therapists can take advantage of Traditional Chinese Medicine’s knowledge in a hands-on, healing manner to conquer the typical clinical struggle with fatigue.


Field, T., Quintino, O., Henteleff, T., Wells-Keife, L., & Delvecchio-Feinberg, G., Job stress reduction therapies, Alternative Therapies in Health and Medicine, 1997.

Field, T, Sunshine, W., Hernandez-Reif, M., Quintino, O., Schanberg, S., Kuhn, C., & Burman, I. Chronic fatigue syndrome: Massage therapy effects on depression and somatic symptoms in chronic fatigue syndrome, Journal of Chronic Fatigue Syndrome, 1997.

Gach, Michael Reed, PhD, “Acupressure’s Potent Points”, Bantam Books, 1990.
Liangyue, Deng, et al., “Chinese Acupuncture and Moxibustion”, Foreign Languages Press, Beijuing, 1987.

Rho, Yi-Ching, RN, Shiow-Luan Tsay, RN, PhD, Acupressure for Fatigue and Depression in End-Stage Renal Disease, Journal of Nursing Research, 2004.

Sunshine, W., Field, T., Schanberg, S., Quintino, O., Fierro, K., Kuhn, C., Burman, I., and Schanberg, S., Fibromyalgia benefits from massage therapy and transcutaneous electrical stimulation, Journal of Clinical Rheumatology, 1996.

Posted by Editors at 11:51 AM

© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute.

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Apr 26 2009

How Integrative Medicine Helps Fatigue

Published by under fibromyalgia,Massage Therapy

The secret to fulfilling the New Year’s resolutions of your clients is providing them the oomph to follow through. Western and complementary medicines have united to create Lipid Replacement Therapy, a scientifically proven method of increasing energy.

Renewed desire for improved health surges with the start of a new year. While resolutions encompass all aspects of health, improved energy levels is a predominant wish. Healthcare practitioners frequently see clients complaining of fatigue. Unless there is a detectable pathological illness associated with the fatigue, most allopathic medical doctors have little to offer these individuals. Alternatively, bodywork professionals typically rely on energy invigoration techniques, however, their effects are temporary.

An Integrated Solution
Integrative medicine borrows both from allopathic and complementary medical knowledge to offer state-of-the-art health solutions. When it comes to fatigue, integrative medicine successfully bridges the gap between healthcare systems. The approach to combating fatigue supplied by Lipid Replacement Therapy (LRT) is integrative medicine at its best. Components of LRT include:

• Western science chronicles the body’s energy manufacturing process on a cellular level.
• Breakdown of the energy production system is confirmed by contemporary research.
• Nutritional medicine provides a safe and proven method to repair the damaged structures responsible for energy production.

Lipid Replacement Therapy
Representing multiple medical perspectives, LRT is an effective, supplement-based, non-stimulant approach to naturally increase physical energy levels. LRT replaces phospholipids in cell membranes, resulting in improved function. Researchers Dr. Denham Harman and Dr. Bruce Ames have demonstrated that nutritional intervention can provide a healthier, more energetic life by supporting the health of energy-producing mitochondria. While many holistic healthcare practitioners have been schooled to examine how every system affects every other, looking at body dysfunction from a microscopic perspective is illuminating. Working backwards to understand energy’s abundance begins with the question, “What is energy and where does it come from?”

Basics of Energy Production
Although numerous factors can cause fatigue, solutions to increasing energy levels are restricted by the available metabolic energy supply. Remembering back to biology class, the human body’s principal energy molecule is adenosine triphosphate (ATP). ATP production occurs primarily in mitochondria, where an electrical chemical gradient is generated from the pumping of protons across its inner membrane (much like a battery). The charge builds, reaches a threshold and releases, providing the power to create ATP’s high-energy phosphate bond, the foundation of our body’s fuel.

The ability of the mitochondria to host the production of energy relies on the health of its membranes. The membrane’s lipid component allows it to remain fluid-like, ensuring an effective gradient for energy transfer. Oxidation by free radicals stiffens the membrane, making it less conductive, reducing energy levels. Spurred by age, disease, trauma and toxins, oxidative damage to the lipid membrane is considered to be the predominant cause of impaired mitochondrial function. Several clinical studies document the relationship between oxidation, membrane phospholipid loss, membrane damage and fatigue. Protecting cell membrane integrity is the key to enhancing cellular health, energy and metabolic efficiency.

Nutritional Medicine Protects and Heals the Membrane
Nutritional medicine is based on the premise that a healthy body requires the correct balance of foods, vitamins and nutrients. LRT is the actual replacement of damaged cellular lipids with healthy lipids. Essential for restoring membrane fluidity and function, LRT employs the following lipids to repair cell membranes:

• polyunsaturated phosphatidylcholine
• other polyunsaturated phosphatidyl lipids
• glycolipids

Clinical studies demonstrate a reversal of damage, restoration of cellular function and a return to normal energy levels when high concentrations of unoxidized, undamaged lipids are delivered to cells.

LRT requires several additional nutrients to be effective. Unfortunately, individuals whose weakened digestive systems pass nutrients quickly are unable to reap lipids’ benefits. In order to ensure lipids are utilized, nutritional medicine specifies the inclusion of essential fatty acids and probiotics (good bacteria) to nourish and balance the digestive tract, aiding nutrient absorption.

While lipids rebuild membranes, and fatty acids and probiotics ensure their delivery, antioxidants can stop the damage from occurring. The inclusion of antioxidants, found in amino acids, vitamins and minerals, adds another dimension of protection by preventing phospholipid oxidation and free radical production. LRT supplies nutritional supplementation with the appropriate balance of lipids, fatty acids, probiotics and antioxidants to support, protect and heal our microscopic, energy-supplying structures.

How You Can Help
In addition to the short-term benefits of invigorating massage techniques, bodyworkers can offer a proven long-term solution to fatigued clients by suggesting or selling a nutritional supplement based on LRT. Incorporating this approach to membrane health can make the difference between clients dragging through the day as opposed to being vibrant and energetic. Integrative medicine’s LRT combines the wisdom of nutritional therapy with a comprehension of biochemistry to end fatigue, making achievement of your clients’ 2006 health goals possible.

Editor’s Note: For information about Lipid Replacement Therapy products, e-mail


Agadjanyan, M., V. Vasilevko, Ghochikyan, et al. Nutritional supplement (NT Factor®) restores mitochondrial function and reduces moderately severe fatigue in aged subjects. J Chronic Fatigue Syndr. 2003; 11(4): in press.

Beckman, K., B. Ames, The Free Radical Theory Of Aging Matures. Physiol Rev. 1998; (78): 548-81.

Goldberg, Burton, L. Trivieri, Jr., Chronic Fatigue, Fibromyalgia and Lyme Disease. Celestial Arts, 2004: 324-51.

Harman, D., The Biological Clock: The Mitochondria. J Am Ger Soc. 1972; (2): 145-47.

Nicolson G.L., Lipid Replacement Therapy as an Adjunct for Chronic Fatigue, Anti-Aging and Restoration of Mitochondrial Function. JANA. 2003; 6(3): 22-28.

Nicolson G.L., Chronic Fatigue, Aging, Mitochondrial Function and Nutritional Supplements. Townsend Letter For Doctors 2003; July/August.

Posted by Nicole at 11:05 AM

© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute.

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Apr 05 2009

Fibromyalgia Part 2: Nine Massage Techniques

Published by under fibromyalgia

Fibromyalgia sufferers know massage can be their most powerful ally, as long as the therapist knows how to handle this painful syndrome. Read which techniques are the most helpful, and what bodyworkers need to be aware of when handling clients with fibromyalgia.

The chronic, widespread pain of fibromyalgia syndrome (FMS) typically manifests itself as stiffness and pain migrating throughout the body. Symptoms of FMS can include deep aching, burning, stabbing or throbbing pain, draining fatigue, joint stiffness and muscle weakness. While allopathic medicine has little to offer FMS sufferers, bodyworkers have the skills to manually address and relieve intense fascial and musculoskeletal pain.

Due to the invigoration of blood and lymph circulation, massage facilitates tissue oxygenation, rendering it ideal to reduce stiffness and pain. A therapist may notice that an FMS client’s tender points are typically cold to the touch, indicating an inhibition of circulation. As reported in Fibromyalgia and Massage, a new continuing education course from the Institute for Integrative Healthcare Studies, clinical research indicates that regular massage sessions normalize these temperature variations, and in doing so, reduce the severity of painful and stiff locations.

Fibromyalgia recuperation does not progress linearly. Even a comprehensive pain management program will intermittently experience setbacks, otherwise known as flare-ups. The symptoms of a flare-up indicate oxygen insufficiency in the muscles and brain. Since massage increases tissue oxygenation, flare-ups present an ideal time to receive massage.

Bodyworkers must proceed carefully and slowly with FMS clients, especially when flare-ups are involved. During a flare-up, symptoms intensify and new symptoms can develop. For some clients, massage involving vigorous strokes or deep pressure can cause rebound tenderness, exacerbating pain. Prior to, and during flare-ups, certain areas may be too tender for deep work, and can result in further tensing of the involved muscles. Respected fibromyalgia researcher, Devin J. Starlanyl, MD, recommends avoiding deep tissue massage or neuromuscular therapy during these times.

Signs of an impending flare-up include:

• Fasciculations – small twitches caused by groups of muscles that fire randomly. The jerks or spasms indicate that muscles or nerves are irritated. Before a flare-up, these twitches may worsen.
• Muscle strength can become unreliable. Those affected have a tendency to drop things more frequently and lose coordination.
• Circulation may be impaired due to constricted blood vessels. One hand or foot may feel colder than the other.
• Memory and thinking may become impaired.
• Depression may worsen.

The right type of massage or energy technique can produce the relaxation and therapeutic results needed during a flare-up. Either during the onset or active phase of a flare-up, cranial-sacral or myofascial release may be the most effective therapies to restore musculoskeletal balance. Energy techniques can always be safely included in a massage to dissolve blockages, induce relaxation and harmonize the body.

In order to obtain a successful outcome with FMS, the massage technique used must match the immediate needs and preferences of your client. Listed below are nine massage techniques that may greatly benefit someone with FMS:

1. Myofascial Release is a technique developed by a physical therapist to gently relieve restrictions and tightness in connective tissue (fascia). When properly performed, it may decrease connective tissue’s pull on bones, allowing muscle fibers to relax and lengthen and organs to expand.

2. Swedish Massage techniques are gentle, but deep enough to be effective in reducing the pain associated with FMS. Massage researcher Richard Van Why (1994) reports that Swedish vibration techniques, either administered by hand or by mechanical means, powerfully relieve pain and cause release of long-held tension in the muscles of those with FMS.

3. Positional release techniques, frequently practiced by osteopathic physicians, are finding their way into the realm of massage therapy. The muscle energy technique (MET) and strain counterstrain technique (SCS) are two positional release techniques capable of normalizing dysfunctional neuromuscular relationships typical of FMS.

These techniques work with restriction barriers to improve local circulation, lengthen hypertonic tissue and restore range of motion. MET utilizes elements of post-isometric relaxation and reciprocal inhibition to relax a muscular contraction and prepare the client for stretching or mobilizing a restricted joint. Ideal for clients with a high level of sensitivity, SCS involves shortening the tissue in acute spasm.

4. Reflexology is another suitable massage technique to address both acute and chronic conditions associated with FMS. Reflex areas on the feet and hands correspond with all of the areas and organs of the body. Gentle enough to use for all ages and conditions, this approach encourages the body to naturally restore its own healthy balance.

5. Passive stretching, alternatively called relaxed or static-passive stretching, is another approach to relieving muscle tension and spasms associated with FMS. A massage therapist can assist with this stretch by moving the limb or head to its restricted barrier, then maintaining the stretched position while the client fully relaxes. An appropriate passive stretch can increase range of motion and help the loss of flexibility that typically develops with FMS. Empower your clients to reduce their own muscle fatigue and soreness by providing instructions on passive stretching exercises to perform at home.

6. Proprioceptor neuromuscular facilitation (PNF), in conjunction with passive stretching, can be administered to further stretch a muscle. PNF involves the client pushing against the therapist’s resistance to allow individual muscles and muscle groups to lengthen, reducing muscle hypertonicity.

7. Energy healing is considered noninvasive, subtle, highly relaxing and effective, prompting many FMS sufferers to seek energy healing practitioners. Energy techniques can promote tissue change without the application of pressure on tender areas. While there are many energy techniques to choose from, two of the most highly respected and researched forms are Reiki and Therapeutic Touch.

8. Cranial-Sacral Therapy (CST) resets and normalizes the rhythm of cerebrospinal fluid, bringing about physical adjustments to the myofascia. Emotional release often accompanies the release of myofasical tension, requiring active listening skills and a focused presence on the part of the therapist. Emotional releases are capable of reducing or eliminating physically-based chronic pain.

9. Neuromuscular Therapy (NMT) is a specific and scientific approach to relieve muscular pain by balancing the musculoskeletal system with the nervous system. As NMT involves working directly on trigger and tender points, accurate detection of FMS flare-ups and continual communication with FMS clients are crucial practitioner skills. When appropriate, this therapy can dramatically reduce pain and improve flexibility, balance and strength by interrupting the transmission of pain and improving circulation in and around the affected musculature.

Effective fibromyalgia massage hinges on a bodyworker’s tactile sensitivity and ability to communicate and respond accordingly. While many bodyworkers value their intuition and minimize discussion during a session, this lack of verbal communication is inappropriate for FMS clients. Relying on a client to verbalize discomfort in-the-moment is accompanied by the risk of doing that client harm. Additionally, people with FMS may be skilled at masking their pain, so depending on your detection of a client’s discomfort may be unreliable.

A successful bodyworker must be proactive by constantly evaluating tissue quality for resistance to touch and verbally checking on the client’s experience. When incorporated with sensitivity and communication, understanding the what, how, when, where and why of the various massage applications listed above will benefit any FMS client in your care.

Editor’s Note: More information for massage therapists about fibromyalgia can be accessed in this series’ first article, Fibromyalgia Relief with Massage.

Recommended Study:

Fibromyalgia and Massage, Myofascial Release, Reflexology, Cranial-Sacral Therapy, Swedish Massage, Neuromuscular Therapy

Singh Khalsa, Karta Purkh, Fibromyalgia: A Guide for Massage Therapists, Institute for Integrative Healthcare Studies, 2006.

Posted by Nicole at 04:56 PM

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Mar 25 2009

The Benefits of Exercise for Fibromyalgia: Tips to Share With Clients

As one of the more common chronic pain syndromes, massage therapists are likely to encounter and counsel clients with fibromyalgia. Find out more about the value exercise has for those with this debilitating condition as well as information you can share with clients who have turned to you for treatment.

by Nicole Cutler, L.Ac.

Seeking ways to reduce pain, increase energy and enhance quality of life are common goals of those living with fibromyalgia. Ideal complements to massage therapy, certain types of exercise are proven to reduce the pain associated with this condition. When working with fibromyalgia clients, incorporating exercise into your treatment plan (through teaching, suggesting or referring to an expert) will increase the effectiveness of all therapies being received.

About Fibromyalgia
Fibromyalgia is a medically recognized, chronic condition characterized by fatigue, widespread pain, stiffness, muscular aching and burning. Because there isn’t a specific diagnostic laboratory test for fibromyalgia, its diagnosis poses a challenge. Prior to receiving a diagnosis of fibromyalgia, many people endure several medical tests that are returned with normal results, such as blood tests and X-rays. Although these tests may rule out other conditions, such as rheumatoid arthritis, lupus and multiple sclerosis, they cannot confirm fibromyalgia.

The American College of Rheumatology has established general classification guidelines for fibromyalgia to help in the assessment of this condition. According to these guidelines, a diagnosis of fibromyalgia includes widespread aching pain for at least three months and a minimum of 11 out of 18 specified locations on the body that are abnormally tender under relatively mild, firm pressure.

While the cause of fibromyalgia is hotly debated, researchers are making steady progress in uncovering its mysteries. One such discovery is that a regular exercise program is of tremendous therapeutic value to a person suffering with fibromyalgia. One of the many possible theories explaining fibromyalgia is a lack of oxygen in muscle tissue. Whether deficient oxygen is a cause or effect of fibromyalgia, exercise is an excellent way to increase circulation and supply oxygen to our body’s cells.

In the March 2005 edition of Current Opinion in Rheumatology, Swedish researchers reported:

“Previous studies indicate that aerobic exercise performed at adequate intensity for an individual can improve function, symptoms, and well-being. A recent study of aerobic exercise showed that training in sedentary women with fibromyalgia using short bouts of exercise produces improvements in health outcomes. A study of aerobic walking resulted in improvements in physical function, symptoms, and distress. Two studies of low-intensity pool exercise reported a positive impact on fibromyalgia symptoms and distress. Two studies of qigong movement therapy were reported, one indicating improvements in symptoms and the other in movement harmony.”

Clients suffering with fibromyalgia may be dubious about physical exercise. Understanding why a person whose muscles already hurt and is physically exhausted would be suspicious of the benefits of working out, will help you communicate compassionately with them. While exercise is probably the last thing a person with fibromyalgia feels like doing, it is crucial for muscular health and pain relief. By increasing oxygenation of muscle tissue, exercise improves flexibility, range of motion, strength, endurance and energy levels.

When clients complain that prior attempts at exercise have been disappointing, explain that this is likely due to the increased pain that can occur from unaccustomed muscle use. In those with fibromyalgia, the brain misinterprets signals from the muscles, causing your body to act protectively as if the muscles were injured. Instead of its well-meaning purpose, this misinterpreted signal feeds the cycle of fibromyalgia by perpetuating muscle weakness, pain and fatigue.

While helping your client begin or stick with an exercise program demonstrates invaluable support, make certain a physician has approved of their activities. Listed below are some helpful tips on exercising with fibromyalgia from industry experts:

1. Start slowly – Frustration for not being able to accomplish what used to be simple can easily result in giving up or doing too much. The rule for fibromyalgia is to start small, and only increase exercise gradually.

2. Progress sequentially – Always start the journey to fitness with a regular stretching program. Stretching will release some muscle tightness, decreasing the number of pain signals going to the brain. The next phase is muscle strengthening. After flexibility and strength are increased, aerobic and endurance activities can be added.

3. Minimize eccentric muscle loading – Simultaneous muscle contraction and lengthening is typically too demanding with fibromyalgia. When working with any muscle group, separate stretching the muscle from contracting the muscle into different exercises.

4. Focus on posture – Making sure to find one’s center of balance will correctly distribute the body’s weight and reduce how quickly the muscles fatigue. Proper posture can help reduce unnecessarily held muscle tension.

5. Limit muscle contraction time – Prolonged muscle contraction can perpetuate pain by fatiguing muscles too quickly. Make certain to take regular breaks from any activity. This can range from taking a break from swimming to do a two-minute stretch, or pausing for three seconds after every minute of vacuuming.

Working with fibromyalgia can be a terrifically rewarding niche for massage therapists. As one of the most encountered chronic pain syndromes in women, there is currently no medical cure for this mysterious condition. While massage therapy is one of the top-rated options for fibromyalgia, results are magnified when accompanied by a regular exercise program. The five tips listed above can help clients with fibromyalgia incorporate exercise into their health maintenance routine. By recruiting both massage and exercise into a treatment plan, fibromyalgia sufferers have a better chance of conquering this increasingly common syndrome.

Recommended Study:
Fibromyalgia and Massage


Mannerkorpi, K, Exercise in Fibromyalgia, Current Opinion in Rheumatology, March 2005., Exercising with Fibromyalgia, Paige Waehner, About, Inc., 2007., Starting an Exercise Program with Fibromyalgia, Lisa Lorden, National Fibromyalgia Association, 2007., Fibromyalgia, Mayo Foundation for Medical Education and Research, 2007., Everyday Flexibility Moves, Janice H. Hoffman, Fibromyalgia Information Foundation, 2007., A Fibromyalgia Patients Guide to Exercise, Sharon R. Clark, PhD, FNP, Fibromyalgia Information Foundation, 2007.

Posted by Editors at 11:28 AM

© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute.

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Mar 02 2009

Chronic Pain, Fibromyalgia and Therapeutic Touch

Living with fibromyalgia often means having different kinds of pain on any given day. Because gentle, energetic bodywork is occasionally called for with fibromyalgia, practitioners who can include Therapeutic Touch have an advantage when working with this chronic pain syndrome.

by Nicole Cutler, L.Ac.

As the predominant gender afflicted with fibromyalgia, more and more women are being diagnosed with this chronic pain syndrome. Even though an estimated two to five percent of our population lives with this painful disorder, Western medicine can only offer side-effect laden symptom relief for a relatively small portion of those affected. As an alternative to taking prescription drugs, the pain identifying this ailment can be reduced by safe, non-invasive bodywork techniques. For those interested in a natural approach, massage therapists are one of the most likely sources a person with fibromyalgia will tap to fulfill their pain relief needs. As such, practitioners who include Therapeutic Touch in their treatments have a proven practice for providing relief to those suffering from this condition.

Because bodywork is being increasingly recognized by the healthcare community as a means to reduce pain, massage therapists are often recruited for fibromyalgia. However, the complexity of fibromyalgia requires extensive knowledge and skills to competently address it. Knowing about its nuances means understanding that having one set massage regimen for people with fibromyalgia is insufficient. Since the needs of a person with fibromyalgia can vary form day-to-day and from person-to-person, a practitioner must possess the following to be most effective:

· A variety of modalities mastered to choose from
· Good communication skills to adjust their treatment based on client feedback
· Flexibility to change their style mid-session
· A gentle, energetic approach for highly sensitive clients (or those having a highly sensitive day).

As published in the June 2007 edition of The Nursing Clinics of North America, researchers from Texas affirm that although the clinical proof is in the beginning stages, the value of energy therapies is promising. They confirm that studies of Therapeutic Touch, Healing Touch and Reiki suggest that these healing modalities are effective in reducing anxiety, improving muscle relaxation, aiding in stress reduction, relaxation, and sense of well-being, promoting wound healing and reducing pain.

About Fibromyalgia
Fibromyalgia is an illness that causes chronic pain in the soft tissues of the body. A person with this syndrome likely has pain in their muscles, ligaments and tendons. Most people with fibromyalgia report aching all over, often saying their muscles feel like they are pulled or overworked. Sometimes symptoms include muscle twitches and burning sensations. In addition to muscular pain and stiffness, this ailment can also cause fatigue, sleep problems, depression and an inability to think clearly.
Scientists have several theories but no concrete understanding of what causes fibromyalgia. While a simple blood test or x-ray will not indicate fibromyalgia, the American College of Rheumatology has outlined the requirements for a fibromyalgia diagnosis:

· Muscle pain must be present for longer than three months
· Pain must occur at 11 out of 18 specific tender points on the body.

Because the quality, location and severity of fibromyalgia pain is constantly changing, therapists dealing with this disorder must be equally adaptable.

Therapeutic Touch
Developed by Delores Krieger, RN, Ph.D., and Dora Kunz in the early 1970s, Therapeutic Touch (TT) is an energetic style of bodywork adapted from several different healing traditions. Commonly applied by nurses for a wide range of health conditions, TT has been shown to help reduce the pain and anxiety associated with fibromyalgia:

· As published in the May/June 2004 issue of Holistic Nursing Practice, Kansas researchers tested the effectiveness of TT on the experience of pain and quality of life for people with fibromyalgia. Their findings demonstrated that those with fibromyalgia had a statistically significant decrease in pain and improvement in quality of life associated with each TT application.

· As reported in 2007 by the Midwest Nursing Research Society, medications, exercise and stress reduction is only moderately effective in controlling the pain of fibromyalgia syndrome. Lead researcher Cate Stiller, Ph.D., conducted a study comparing the effects of TT and placebo on the pain and anxiety of 46 participants with fibromyalgia. The investigators concluded that the most important recommendation for nursing is that nurses can help their fibromyalgia patients manage their pain and anxiety by recommending TT as an effective therapy.

With an estimated 5 million Americans living with fibromyalgia, massage therapists who are well-versed in this chronic pain syndrome are best equipped to help those affected. The inconsistency of fibromyalgia pain’s location, quality and severity requires bodyworkers to have various skills ready to match their client’s current experience. Especially appreciated when a person with fibromyalgia is particularly sensitive, practicing an energetic type of bodywork is often the best fit. When included in a therapist’s repertoire, Therapeutic Touch can be a key modality for gently bringing pain relief to a fibromyalgia sufferer.

Recommended Study:
Fibromyalgia and Massage
Healing Energy and Touch


Denison, B., Touch the pain away: new research on therapeutic touch and persons with fibromyalgia syndrome, Holistic Nursing Practice, May-June 2004.

Engebretson J, Wardell DW, Energy Based Modalities, The Nursing Clinics of North America, June 2007., Symptoms, Fibromyalgia Network, 2008., Therapeutic Touch, Aetna Intelihealth, Inc., 2008., The Effect of Therapeutic Touch on Fibromyalgia Pain and Anxiety, Cate Stiller, PhD, Virginia Henderson International Nursing Library, 2007.

Posted by Editors at 10:58 AM
© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute.

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Nov 21 2008

Trigger Point Massage Therapy Tools – The Body Back Buddy Massage Cane

Published by under fibromyalgia,Massage Therapy

Have you ever noticed that when you are stressed or overworked a massage can work wonders? The problem is that you’ll often find that the one place you can’t reach yourself is the place that needs massaging the most.

Between the shoulder blades or lower down your back seem to be the worst culprits. Even if you can reach some of the knots like the back of your neck or should you can’t apply enough pressure to work out the knots.

This is where trigger point therapy tools come into play. A trigger point therapy tool such as the Body Back Buddy Massage Cane or the Thera Cane Back Massager can allow you to reach the trigger points that you can’t reach yourself.

These massage therapy tools have been developed over recent years by chiropractors and massage professionals to allow you to self massage with amazing accuracy and results . You only need to read the reviews on sites such as amazon to see how useful they are. Out of 57 reviews 48 gave the Body Back Buddy 5 stars and 7 gave it 4 stars. Basically these things work and do what they are supposed to do.

These tools have many benefits such as:

They can help to release sore muscle trigger points with shiatsu massage/ pressure massage

They make it easy to reach hard to reach shoulder and back trigger points

They can be beneficial for shiatsu treatment of Fibromyalgia trigger points

Allows you to self treat knotted muscles in your neck and back

They may help to reduce muscle pain by means of direct applied pressure

They can work out knots in hard to reach places.

Massage Therapy tools generally come in two types, collapsible which are great for traveling and the sturdier one piece cane which is perfect for use at home or in the office. The canes are simple to use just locate the area that needs treatment and then apply the cane. No matter where the ache or know you’ll always have a ball within reach of just the right area.

If you are looking for an ideal gift for a friend or family member a trigger point therapy tool coupled with a book on shiatsu massage will make the perfect gift this Christmas. Just make sure that before you wrap it up you try it on yourself and then hope that they have bought one for you!

Find more about the Body Back Buddy and massage therapy tools at Learning Massage Therapy where you’ll find free massage articles and reviews

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Oct 04 2008

Massage Improves Sleep, Decreases Pain and Substance P in Fibromyalgia Patients

After receiving massage twice weekly for five weeks, fibromyalgia patients experienced improved mood and sleep, and their levels of substance P, a neurotransmitter in the pain fiber system, decreased, along with the number of tender spots throughout their bodies, according to recent research.

The study, “Fibromyalgia Pain and Substance P Decrease and Sleep Improves After Massage Therapy,” was conducted by Tiffany Field, Ph.D., Miguel Diego, Christy Cullen, Maria Hernandez-Reif, Ph.D., William Sunshine and Steven Douglas of the Touch Research Institute at the University of Miami.

According to the American College of Rheumatology, fibromyalgia is defined as “widespread chronic musculoskeletal pain of unknown cause and multiple tender points.” Levels of substance P are significantly higher in people with fibromyalgia. Twenty-four adults with this condition were randomly assigned to either a massage-therapy or relaxation group.

Subjects in the massage group received 30-minute massages twice a week for five weeks. The sessions combined several types of bodywork, such as Swedish massage, shiatsu and Trager® work. The routine consisted of moderate pressure and stroking of the head, neck, shoulders, back, arms, hands, legs and feet.

Participants in the relaxation-therapy group met for a half-hour twice weekly for five weeks and were given instructions on progressive muscle relaxation while lying quietly on the massage table.
The State Trait Anxiety Inventory was used before and after sessions on the first and last days of the study to measure how subjects felt at that time.

Both the massage and the relaxation group showed a decrease in anxiety and depressed mood immediately after sessions on the first and last days of this study.

More long-term effects were also evaluated. The Center for Epidemiological Studies Depression Scale was used to measure depressive symptoms. Subjects wore a motion recorder at night to record activity during sleep and kept a log of the time they went to bed and awoke. A physician assessed participants’ illness, medication use, tender points and pain; and saliva samples were taken before the first and last sessions to measure levels of substance P.

The results revealed that, over the course of the study, the massage group, as compared with the relaxation group, experienced decreased depression; improved sleep; decreased pain, fatigue and stiffness; improved physician assessments; decreased tender points; and a reduced level of substance P.

According to the study’s authors, these findings “highlight the clinical significance of using massage therapy as a complementary treatment.”

– Source: Touch Research Institute. Authors: Tiffany Field, Ph.D., Miguel Diego, Christy Cullen, Maria Hernandez-Reif, Ph.D., William Sunshine and Steven Douglas. Originally published in the Journal of Clinical Rheumatology, April 2002, Vol. 8, No. 2, pp. 72-76.

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Sep 23 2008

Five Reasons to Get a Massage Today

Published by under fibromyalgia,Massage Therapy

Massage offers real health benefits, so much so that some conventional hospitals are making them a standard therapy for surgery patients and others.

This interesting CNN article details many of these benefits (including some that may surprise you). Along with promoting relaxation and improving your sense of well-being, getting a massage has been shown to:

Relieve pain (from migraines, labor, fibromyalgia and even cancer)
Boost your level of alertness and attention
Increase your body’s natural killer cells, which help your immune system to defend against illness
Reduce stress, anxiety and depression, and ease insomnia
Decrease symptoms of PMS

Sources: March 8, 2007

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