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