Download - MASSAGE Fibromyalgia F · resources that can offer talk therapy, such as cognitive behavioural therapy, gentle yoga, strength training or meditation, will be extremely helpful in

MASSAGE | Fibromyalgia

36 FHT.ORG.UK

Facing fi bromyalgia

JING’S RACHEL FAIRWEATHER DISCUSSES

HOW ADVANCED MASSAGE TECHNIQUES

CAN HELP CLIENTS WITH FIBROMYALGIA

Fibromyalgia syndrome (FMS) can be one of the most challenging conditions for a therapist to work with. Seemingly random and unrelated symptoms such as dizziness, aches, pains, sleep disturbance, brain fog, sore throat, heightened sensitivity and exhaustion are typical of the pathology, and that’s

just for starters. When you add into the mix the commonly co-related stress and mental health issues such as anxiety, depression and post-traumatic stress disorder, you can see why some therapists’ hearts might sink a little at the prospect of successful treatment.

To make things even more complex, the delicate balance of fi bromyalgia means that it is not unusual for ‘normal’ massage

treatment to result in increased pain and symptoms for the client.

Yet, with a little knowledge and time, a well-trained massage therapist can provide great relief for clients affected by this complex condition. The use of appropriate soft tissue techniques twinned with an understanding of the underlying psychological and physiological processes can bring about radical and long-lasting change.

SYMPTOMS OF FMSThe list of common symptoms associated with FMS can seem long, and often appear unrelated (see fi gure, right). The typical FMS client is likely to experience a combination of symptoms including widespread constant pain in muscles, soft tissue and joints; painful and tender skin; shooting pains; restless legs; numbness and fogginess; aching; stiffness; muscle weakness; nausea; giddiness; visual disturbances; irritable bowel syndrome; allergies; heightened sensitivity to light, sound, smell or touch; sore throat; increased sensitivity to pain; chronic fatigue; fl u-like symptoms; mental health issues; sleep disturbances; poor concentration and memory loss, and more.

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Fibromyalgia | MASSAGE

The symptoms of FMS are so diverse it is common for sufferers to have spent months or years undergoing medical tests in an attempt to fi nd a cause. This process in itself brings intense frustration for clients who may have been told that the symptoms are psychological or exaggerated. There is often an intense feeling of not being believed that clients carry around with them.

CENTRAL SENSITISATION IN FMS AND CHRONIC PAINFMS can be diffi cult to understand because although clients can be in terrible pain, there is no actual damage to any tissues or organs of the body.

The system that has gone awry in FMS is actually the central nervous system – the brain and spinal cord – which has gone into overdrive, often because of stress or trauma. A key factor in FMS (and other chronic pain conditions) is a phenomenon known as central sensitisation. In central sensitisation, the sympathetic nervous system is in a persistent state of high sensitivity (known as ‘wind-up’). This results in the spinal cord and brain acting like a faulty amplifi er that turns up the volume of any pain signals.

Central sensitisation has two main features: allodynia and hyperalgesia.⦁ Allodynia – when an neutral stimulus is

interpreted by the brain as painful⦁ Hyperalgesia – a normally painful

stimulus is interpreted as being much more painful.

This explains why a client with fi bromyalgia might be jumping off the treatment table when you are barely touching them.

In addition, central sensitisation can lead to heightened sensitivities across all senses and is associated with the cognitive defi cits common to FMS, such as poor concentration and short-term memory. Central sensitisation is also correlated with increased levels of emotional distress, especially anxiety.

It is vitally important when treating clients with fi bromyalgia to understand that a main part of our job is to address this over-sensitised alarm system.

FIBROMYALGIA AND FASCIA: THE MISSING LINKI always joke with my students that if they fall asleep in class and I ask them a question, the answer is most likely to be fascia (or the psoas). This is defi nitely the case with FMS as although no defi nitive evidence of muscle pathology has been found, there P

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⦁ Be extra careful with basic client care. For example, have plenty of blankets and pillows ready, as basic positioning might be uncomfortable. Check the temperature as your room might need to be warmer than usual.

⦁ Allow clients to change position often if they want to; staying in one position can be painful.

⦁ Expect the smallest amount of treatment to have a disproportionately large effect; don’t think you have to pack very much into one treatment.

⦁ Remember the main issue in FMS is central sensitisation. Treatment that is too intense may trigger the warning system and make things worse.

⦁ Listen to your client – take their word for everything they say. They know best. If they say ‘Don’t touch my stomach’, don’t.

⦁ Keep treatments short if necessary: 20- to 30-minute pain release at the most, followed with relaxation massage.

⦁ Be very gentle – light rather than deep. What for us is felt as discomfort can be extremely painful to an FMS client.

⦁ With FMS, progress can be very slow, over several treatments, and often it may not seem as if there has been much progress.

is some evidence for dysfunction of the intramuscular connective tissue, or fascia. Research by Liptan (2010) proposes that infl ammation of the fascia is the source of peripheral nociceptive input that leads to central sensitisation in fi bromyalgia.

Interestingly, the infl ammation of the fascia is similar to that described in conditions such as plantar fasciitis and lateral epicondylitis, which also respond well to myofascial techniques.

MASSAGE TREATMENT FOR FMSTreating clients with FMS can be challenging because of the extreme sensitivity of their systems. Every detail of the treatment process must be thought through – from the smells in the room, to the client’s positioning on the table, to the techniques and quality of your touch. Here are some top tips for working with FMS clients:⦁ Allow a good half hour for your initial

consultation assessment and interview. FMS clients often have complex histories, and it is vitally important that they feel truly heard.

⦁ Share your treatment plan: tell them what you are doing and why, and expect their input.

Fatigue, sleep disturbance, cognitive problems, memory problems,

headaches, dizziness

Problems with vision

Jaw pain

Pain in muscles

Paired tender joints

Nausea

Urinary problems;dysmenorrhea

(in women)

Skinproblems

Joint painand morning

stiffness

Restless legsyndrome

FIBROMYALGIA SYMPTOMS


MASSAGE | Fibromyalgia

FHT.ORG.UK38 INTERNATIONAL THERAPIST WINTER 2019

TREATMENT TECHNIQUESAND TIPSMy own approach to treating chronic pain conditions has been developed through clinical practice with thousands of clients. For most chronic pain conditions, including FMS, I recommend a multi-modal approach incorporating several elements, including the use of fascial techniques, heat, acupressure, stretching, and self-care suggestions.

A sample treatment for FMS could include the following:

1 MFR cross-hand stretches. Myofascial release is the go-to technique for fi bromyalgia. Place your crossed hands adjacent to one another in the area to be released – they should be a few inches apart at this point. Sink down until you have a sense of being on the deep fascial

layer that runs around and through the muscles. Then put a stretch on this tissue so you have a sense of tension between your two hands, like a piece of material being stretched to a barrier. After a while you will start to feel the sensation of the tissue starting to move beneath your hands. Make sure you maintain the stretch and follow the tissues until you feel the tissue release. This whole process takes around three to fi ve minutes, so you will need to be patient. Repeat cross-hand stretches on anywhere that is needed.

2 Power effl eurage with hot stones. Heat is fantastic for many chronic conditions, including fi bromyalgia. If you are trained in hot stone work, this is a great time to introduce some dynamic stone strokes. Stand at the head of the table in forward tai chi stance with a hot stone in each hand. Ask the client to take a breath in and let them know there will be heat coming – they should be sure to tell you if it is too much. Apply the stones with a few quick strokes to the top of the client’s upper arms fi rst, as this is a less heat sensitive area. Then glide down either side of the spine using your body weight to work into the erector spinae muscles with the stones. Work down to the lower back with the stroke, working slowly and deeply, then come back up with a light return stroke and repeat. Breathe out as you work down the body and imagine energy or qi fl owing down your arms.

3 Acupressure. Acupressure points that address the emotional component of FMS can be very helpful. Conception vessel 17 (chest centre) is a wonderful point for helping to calm and release emotional energy. Its location is on the sternum, level with the fourth intercostal space. Use the third fi nger to hold the point for three to fi ve breaths. It feels nice to have the other hand under the head as you do this.

4 Stretching. Gentle static stretching can be very helpful in areas of pain. The stretch shown is helpful for low back pain.

Rachel Fairweather is the co-founder and director of Jing Advanced Massage Training. She is an author and international lecturer with more than 25

years’ experience in the industry. Rachel also holds a degree in psychology and a postgraduate diploma in social work.jingmassage.com

LEARN MOREJing will be holding a seminar on myofascial release for fi bromyalgia and other chronic pain conditions at the 2019 FHT Training Congress on Monday 20 May, as well as a talk on sacroiliac joint dysfunction on Sunday 19 May. See page 33 for more details. We are also delighted to partner with Jing in a forthcoming webinar on myofascial release for fi bromyalgia and other chronic pain conditions on Wednesday 27 March. Register for your place at the webinar at fht.org.uk/Jing-webinar

5 Self-care suggestions. Fibromyalgia clients often feel they lack control over their health, so self-help techniques that allow them some sense of empowerment are vital. Teach your clients gentle stretches and meditation/breathing exercises for home care. Fibromyalgia is such a complex condition that a multidisciplinary approach works best for treatment. Referring your client to resources that can offer talk therapy, such as cognitive behavioural therapy, gentle yoga, strength training or meditation, will be extremely helpful in their recovery.

Most of all, help your client to feel that there is hope. Recovery is certainly not quick but it is possible and, as an understanding and well-trained massage therapist, you can be a key piece in this process.

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