THERAPEUTIC  MASSAGE & BODYWORK

by Rachael Noell LMT,NCTMB
04/08/2010

What is Fibromyalgia Syndrom (FMS)?

By looking at the name we can gather the basic concepts regarding this disorder. Lets break the world down.  Fibro (latin) tells us it affects fibrous tissue.  Myo (greek) translate to muscle and Algos (greek) means muscle/connective tissue pain.

Fibromyalgia Syndrome or FMS has a very interesting and equally frustrating history.  Although the first documentation of this disorder was recorder by Dr. William Balfour in 1816, it wasn't recognized until 1993.  I can still be somewhat difficult to get a diagnosis. This is strongly due to the Idopathic (unknown) nature of this pathology.  What was once thought to be a muscle disorder, as the name suggests has shown that it is so much more.

While the medical community is aware of FMS, it has been an equally frustrating process for them as well, as the people FMS afflicts.  Research is showing that it may have more to do with the neurological system and more specifically the Central Nervous System than to do with the muscles.  FMS has a host of other pathologies that often accompany the disorder.

As the name suggests, the most common symptom is pain.  If you speak with a person with FMS they will tell you they have excruciating pain that is felt from the superficial layers of the dermis (skin)  all the way down to the deepest layer, bone.  Something as gentle as a hug can be painful.  From a medical point of view the disorder presents with a recognizable pattern of tender points that are distributed all over the body.  As seen in the figure below.

Possible Causes of FMS
Sleep studies conducted on persons with FMS have shown they seldom or never enter the 4th  level of sleep, also known as the restorative level of sleep.  They may sleep for 8 hours a night, but they still wake up feeling tired.  The complications due to the deprivation of restorative sleep are a decrease in the secretions of both serotonin (feel good hormone)  and growth hormones.  Serotonin is needed to modulate pain sensation, and growth hormone stimulates the production of new cells and collagen fibers.  The result is having a higher sensitivity to pain.  In addition the muscles and connective tissues are unable to heal from daily wear and tear.  This creates a cycle.  Pain is experienced, this interferes with the ability to sleep which results in even more pain.  This cycle repeats and intensifies for the individual dealing with this syndrome.

Another sign or symptom of FMS is fatigue.  Some research suggests that the fatigue FMS persons experience may have more to do with the mitochondrial (cells that turn nutrient into energy) dysfunction than a sleep disorder. Ineffective muscle contraction and chronic fatigue may be a result of a problem with the production of energy and the re-absorption of calcium.

One of the most mysterious aspects of the FMS pain is it's origin.  Current studies suggest that pain does not originate in the muscles/ connective tissues.  Examinations of Cerebrospinal fluid in FMS persons shows high levels of substance P and nerve growth factor.  Substance P is a neuropeptide that is responsible for the perception of pain.  This, combined with the high levels of nerve growth factor, is going to yield debilitating pain. 

 Accompanying Disorders
So far we have gathered that FMS comes with a decrease in serotonin and growth hormones.  This is accompanied by the dysfunction of mitochondria and the increased levels of substance P and nerve growth factor. This combination appears to have a snowball effect on the body opening up the door to other pathologies that seem to accompany FMS.  Pathologies like

• Irritable Bowl Syndrome (IBS),
• Depression,
• Anxiety,
• Restless Legs Syndrome,
• Lowered Immune System,
• Cognitive Dysfunction,
• Interstitial Cysts,
• Tempromandibular Joint Disorder (TMJ)
• Head Aches,
• Joint Stiffness,
• Paresthesias (pins and needles)

                                           This is just to name a few!

Risk Factors
The medical community has yet to determine a specific cause for FMS.  Speculatively they have composed a list of potential causative factors.  The old riddle of the chicken and the egg comes to mind with these hypotheses.  These factors include

• Stress
• Genetic Predisposition
• Central dopamine dysfunction
• Abnormal serotonin metabolism
• Deficient growth hormone production
• Food allergies
• Traumatic muscle injuries
• Emotional Trauma

Plus the additional pathologies listed in paragraph above.  The question being is it causative or is it symptomatic?

continued top right

Who gets FMS?
Research has shown that FMS affects one in fifty Americans.  Women are more commonly affected than men (9:1 ratio) But some skeptics offer it may simply be that men don't seek treatment.  In addition on in six diagnosed with FMS is under the age of 18. 

Treatments for FMS
Given that the very nature of FMS is multifaceted, the treatments for FMS are also multifaceted.  The most effect treatments for managing FMS are treatments that educate the individual and place the treatment in the patients hands. 

• Cognitive Therapy
• Behavioral  Therapy
• Physical Therapy
• Massage Therapy*

The combination of these therapies work in re-balancing the mind/body connection.  They are sited as being some of the most beneficial treatments for those suffering from FMS.

The pharmaceutical approach offers:

• Anti-Depressants
• Anti-Seizure Medications
• Dopamine agonist
• Analgesics
• Muscle relaxors
• Hormone Replacement Therapy

There are also many alternative therapies that are suggested to help those with FMS including

• Light therapy
• Acupuncture
• Acupressure*
• Aroma Therapy*
• Bio-Feedback
• Neuro-Feedback
• Cupping
• Chelation Therapy
• Reflexology*
• Hypnosis
• Magnetic Therapy
• Low Frequency Sound Therapy
• Reiki & Energy Therapy*
• Dance Therapy
• Craniosacral Therapy*
• Environmental Therapy*
• Therapies involving detoxification*
• Herbal Treatments.

* Therapies offered at Kentucky Healing Arts.

Therapeutic Massage, Bodywork, & Aromatherapy

It is important to check all medications, pain medications may contraindicate (not suggested) massage.  Other medications may also contraindicate massage because of the effects on the liver.  While it is not necessary to work with a health care team, it is vital to have a full medical history.  Open communication between the Client and Therapists is critical in order to yield the best results and prevent the body from being over worked. 

Massage is Indicated (suggested) for FMS and can be extremely helpful by

• Restoring the balance of the Central Nervous System
• Reducing Stress & Anxiety
• Reducing Pain
• Increasing the production of Serotonin and re-balacing hormones (treats depression)
• Assisting in the elimination of wastes from muscles and tissues. 
• Increasing Circulation
• Increasing the supply of nutrients to the afflicted areas
• Inducing restorative sleep
• Supports the digestive system increasing absorption and preventing flare ups of IBS.
• Massage can be beneficial for managing and treating almost every aspect of FMS.
• Aromatherapy & Topical applications can be used to sucessfully treat Paresthesia (pins & needles) and restless legs.

How does Massage Help?
The physiological effects brought about by massage are simply amazing.  Massage is effective because it helps to restore the balance of the autonomic nervous system which is responsible for the dominance of the sympathetic state.  The sympathetic state (fight or flight) is responsible for the high levels of Cortisol/stress hormone, Substance P, nerve growth factor, epinephrine, adrenaline, it constricts blood vessels, impairs proper digestion, and elimination.  This explains all the signs and symptoms pertaining to FMS! 
The parasympathetic state (restorative state) is almost dormant in FMS patients.  Restoring this state has an astonishing physiological effect.  The restorative state controls the secretions and productions of serotonin, dopamine, enkephalins, endorphins, dynophins, and oxytocin.  These are your indigenous feel good chemicals and hormones.  These are also the chemicals the pharmaceuticals attempt to simulate, but nothing is better than the real thing.  Massage assist the body with cleansing, restoration, and healing itself.

Bibliography

A Massage Therapist Guide to Pathology 4th Edition by Ruth Werner

Mosby's Fundamentals to Therapeutic Massage 4th Edition by Sandy Fritze

Online resources

www.enwikipedi.org/wiki/Fibromyalgia
www.fmscommunity.org/stud.htm
www.fmscommunity.org/res.htm
www.fibromyalgia-symptoms.org/fibromyalgia_complimentary_

To Schedule your appointment you can call 606-261-7251. 

We look forward to hearing from you.