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“Two or ore elements added

together may cause pain.”

“I know of no part of the body

that equals the fascia as a

hunting ground.”

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At the end of this lecture, the participants should be able to:

1. Recall the diagnostic criteria of fibromyalgia

based on patient history, signs and symptoms

2. Describe the pathophysiology of fibromyalgia

3. Utilize Osteopathic principles and the original

tenets of osteopathy in the approach to the

fibromyalgia patient

4. Describe and utilize several modalities of

osteopathic manipulation for the treatment of

fibromyalgia

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More than just a “supratentorial condition.”

Constellation of vague symptoms including: › Sleep disturbance

› Spontaneous, widespread soft tissue pain

› Fatigue

› Widespread tender points

Symptoms do not resolve with a break from stressors or a few nights of sleep

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Most common cause of

generalized musculoskeletal pain

› 20 – 65 years of age

› 2-4% of Women

› 0.5% of Men

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Etiology is unclear

Syndrome is unrecognized

Research into effective treatment

Clinical Diagnosis of Exclusion

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Sym

pto

ms

Ph

ysi

ca

l sig

ns

Widespread musculoskeletal pain

› Bilateral

› Above and below the waist

Paresthesias

Fatigue

Cognitive / mood disturbances

Other poorly understood pain symptoms

Specific point tenderness

› 9 pairs of bilateral tenderpoints

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ACR, 1990

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http://www.rheumatology.org/practice/clinical/classification/fibromyalgia/

fibro_2010.asp *

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1) History of steady /

intermittent aches

for 3 months or more

2) Pain on at least 11

out of 18 designated

points on the body

3) The presence of

another clinical

disorder does not

rule out FM

Other considerations

› Laboratory testing

› Sleep studies

11 * Diagnostic criteria according to the American College of Rheumatology

Laboratory Testing

› CBC, ESR, CRP

› Serologic Tests

› TSH & CKMB

› Virology

› Vit D

Sleep disorder

Mood disorders

Autonomic

dysfunction

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Neuroendocrine axis

› Cascades into multi-system

dysfunction

Psychoneuroimmunology

Hypothalamic dysfuction

› 2o to Mitochondrial Dysfunction

› Huh!?

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Mitochondria

› The “Powerhouse” of

the cell

› Mitochondria exhausts

its power faster during

ANS dysfunction

Infections

Stresses

Hormonal deficiencies

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1) The human being is a dynamic unit of

function.

2) The body possesses self-regulatory

mechanisms which are self-healing in

nature.

3) Structure and function are interrelated

at all levels.

4) Rational treatment is based on these

principles.

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Structure and function are interrelated at all levels. › If function is impaired, structure will be impaired

and visa-versa

The body possesses self-regulatory mechanisms which are self-healing in nature. › Disease will ensue when factors that affect the

body are beyond its ability to compensate

› Homeostasis vs. Allostasis

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Sympathetic response to

stress

A protective reflex

› endocrine

› neural

Continuous stimulation of the arousal systems

prolonged allostasis

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Symptoms are typically chronic, patients require much supports

Goals › Alleviate allostatic

load › Support return to

homeostasis › ↓ fatigue and pain

› ↑ daily functional abilities

› Eliminate identifiable contributing factors

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Gentle indirect techniques

› Use caution with direct techniques

Caution with potentially overtreating

patients

Encourage copious water intake after

OMT

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Normalize nerve function

Balancing ANS tone

Normalize function of HPA

Normalize CSF fluctuation

Release membranous tension

Modifying gross structural patterns

Counteracting stress-producing factors

Alleviating pain

Improving lymphatic function

Improving circulation

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Treatment Plan for Fibromyalgia

Somatic

Parasympathetic

Sympathetic

Lymphatics

MFR of feet, knees, & LE

Pelvic diaphragm release

Sacrum

Relax / dome abdominal diaphragm

Rib raising

› With T1 – L2 paraspinal inhibition

Thoracic inlet release

Lymphatic pump

CV-4

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IT band / TFL release IT band / TFL release Supine leg traction Supine leg traction

Plantar Fascial Release Plantar Fascial Release

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Gastrocnemius Gastrocnemius Femorotibial Dysfunction Femorotibial Dysfunction

Posterior Fibular Head Posterior Fibular Head

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Ischiorectal fossa Release Ischiorectal fossa Release Sacral – Coccygeal Release Sacral – Coccygeal Release

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Myofascial Release Myofascial Release Balance Ligamentous Tension Balance Ligamentous Tension

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Balanced Ligamentous Tension Balanced Ligamentous Tension Doming the Diaphragm Doming the Diaphragm

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Pedal Pump Pedal Pump

Thoracic Pump Thoracic Pump

Pectoral Traction Pectoral Traction

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Chila AG, ed. Foundations of Osteopathic Medicine. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2011; 974-978.

Nelson, KE. Somatic Dysfunction in Osteopathic Family Medicine. Philadelphia: Lippincott Williams & Wilkins, 2007; 56-72, 360-382.

Nicholas, AS. Atlas of Osteopathic Techniques. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2012.

Jones LH. Strain and Counterstrain. Indianapolis, IN: American Academy of Osteopathy, 1981.

American College of Rheumatology (www.rheumatology.org)

UpToDate online (www.uptodate.com)

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