Fibromyalgia and Massage: How to Help without Hurting

What is fibromyalgia, and how should we deal with it as massage therapists? Should we press directly on tender points, or avoid them? Should we use deeper pressure, or only lighter work?

If you’re completely unfamiliar with this condition, it means widespread pain that isn’t related to injury or overuse. If you’ve got fibromyalgia, a lot of your body hurts, and no one can quite tell you why. There are no lesions on MRI or CT scans, there are no strains or sprains; you just hurt. On top of that, there are other common symptoms: Poor sleep quality, fatigue, memory problems (often described as “brain fog”), and depression. You can read more at this Mayo Clinic article.

Fibromyalgia tends to be cyclical, with many sufferers noticing periods of flare-up and remission. Your clients will have bad weeks and good weeks, and finding out where they are in that cycle can help you determine how to proceed. More on that in a second.

Every case of fibromyalgia is different, which is going to be a theme for this post. Not everyone will have the sleep or memory problems, not everyone will feel fatigue. Some people will only have pain in certain areas, others will feel it all over. Some clients will respond well to specific pressure, others will just feel worse if you focus too much. Some like deeper pressure, others can only enjoy lighter pressure.

So, what type of massage should I give them?

It depends! Many of your clients with fibromyalgia will have gotten massage in the past. If that’s the case, ask what works and what doesn’t. Ask if any massages have helped with their symptoms; if so, what were those massages like? What was the pressure like? Were they general massages, or more focused?

Ask if any massages have worsened their symptoms. What was the pressure like? Was it broad or specific? Did any techniques in particular seem to be too much?

Let these answers be your guide. I’ve had clients with fibromyalgia that got relief from specific work, treating their painful areas with deeper pressure. Much more often, these clients will request that you don’t overwork any specific spot.

If your client has never received massage before, start broad, light, and slow. Explain to your client that you’re seeing how their body responds to massage, and that you can experiment with deeper or more specific work in future sessions. Make sure to follow up to see how their symptoms responded.

Ask whether their symptoms are currently in a flare-up. If so, even if they’ve had plenty of massage in the past, err on the side of caution. Think soothing and calming rather than “fixing.”

How are they supposed to get better if I just use light pressure?

Plain old Swedish massage is good medicine, comparing well with structurally-focused massage modalities in pain research. I’m not a fan of “digging out knots” in general (see my video on “massage knots”), and it’s even less advisable in clients with fibromyalgia. While they may have pain stemming from specific muscles, the severity of that pain and the widespread nature of it is probably a matter of central sensitization.

In simple terms, their pain volume knob is turned up to 11, and more pain is only going to increase that sensitivity further. To decrease sensitivity, we need to interact with the body in a way that proves that it can receive touch stimulus in a painless and comfortable way. My goal during these massages isn’t to “work out” any specific muscle, but rather to tell the nervous system that pressure can feel good, and that movement can feel good. Afterward, I want them to walk out with a feel-good glow that says, “hey, my body doesn’t always have to feel crappy.”

This isn’t about getting them out of pain in one session. Rather, it’s about slowly convincing their nervous system that there’s no need for hypersensitivity, that there’s no injury to listen hard for, and that their body is hearty and whole. So far, the research on massage for fibromyalgia is mighty promising.

If you want to become an expert on the topic (and on lots of stuff having to do with massage and pathology), check out Ruth Werner’s online courses (and try to catch her in-person if you can!).

Are there any particular strategies that you’ve found useful for your clients with fibromyalgia? Any intake questions that have been especially helpful? Thanks for reading!
Featured image via muffinbasket, CC BY-NC-ND 2.0

Comments? Stories? Tell me stuff.

  1. My wife has, over the years, dealt with Fibromyalgia, then Lupus, and now RA (collect the whole set!). She’s tough, but the flares often get the best of her. What I’ve found that works really well, at least for her, is snail-slow, gentle horizontal pressure.
    I wanted to find out why this seems to work so well, so I did some research. It turns out I was accidentally doing something right. Ruffini corpuscles in the dermis respond to horizontal pressure, calming the central nervous system and, at least for my wife, reducing the pain associated with her auto-immunue variety pack.
    It’s worked so well for her I’ve adapted it for my regular clients and they seem to love it!

    • Great stuff, Alan! That angled pressure is also how I prefer to work with my clients, so I’ve never really compared it to more direct pressure in my massage clients. I think there might be something special about that sustained skin traction in my sensitive clients, but I had never connected it to the Ruffini corpuscles. Definitely going to look into that further!

  2. Thank you for helping me to think about this issue in a better way!

    My only client with fibromyalgia flat out told me that they like massage because it seems to help them get a good night of sleep, and I should not bother with trying to reduce pain.

    I appreciated this client’s empowered directive, so my approach to them has tended to be “zonk ’em out with Swedish”.

    But now I will add the intelligent questions for the client you propose to the mix, and “think calming and soothing”. I feel like it will take the therapeutic relationship to a more considered and nuanced place.

    And I think it will help me to be prepared for the next client with fibromyalgia, who might not be as assertive and self-aware as the one I am working with now.

    • Absolutely, Joyce! I’m glad your first client with fibromyalgia was so self-possessed and aware of their own needs. I’m also glad that they found a therapist who would listen to them 🙂

  3. Great article, thank you for addressing how unique each fibromyalgia case is, this was confusing for me when I first began working with fibro clients.

    My general philosophy has been to perform light and calming massage, and at the very least cause no pain. But the interesting thing is that as time went on with a few patients, they started asking for more targeted work and firmer pressure. That is to say, I think they began tolerating deeper work as their nervous system relaxed and trust was achieved. Not the case for everyone, and like you said, it can change week to week. The sustained pressure is great as well, and I use a lot of forearm and broader pressure in the beginning.