If you’ve worked on more than one client with fibromyalgia, you know that this isn’t a matter of saying, “if the client has X symptom, do Y technique.” It’s more a matter of knowing what questions to ask, which alterations might help, and knowing when to err on the side of caution.

The most important question, in my opinion, is “have you ever been hurt by a massage?” This is something that I ask anyone who is medically vulnerable or who has pervasive pain, and the answer is often “yes.” From there I want to find out more about how and why. While it’s often a matter of too much pressure or too much digging, it can also have to do with improper positioning, or even quirks of the client’s unique body. The only way to avoid repeating these past mistakes is to ask!

For some clients with fibromyalgia, the ability to work with them effectively will require you to step back from your notion of what a massage is supposed to feel like. For the most sensitive clients, see if you can forget your ideal pressure and ideal speed, and even the concept of manipulating muscle. If a client finds the lightest massage stroke aversive, what about a broad hand resting across the area? From there, what happens if you traction the skin in one direction? If that doesn’t work, how about this direction?

Basically, meet their nervous system where it is, and gradually try to introduce new stimuli. As you work with the less sensitive parts of their body and acclimate them to touch in general, you’ll find that new avenues open up with each passing month. This isn’t a linear thing (rehabilitation never is), but it will be a trend over time. Their sensitivity took a long time to build up, and it can take a long time to convince their CNS to give it up.

In the meantime, massage is excellent for sleep quality and mood, both of which are big issues for people with fibromyalgia (and chronic fatigue syndrome, and other disorders that have symptoms in common). So, both you and your client should keep the long-term goals in mind, but know that you’re also doing immediate good.

Let me know what you think! I’d love to hear about changes that you made for your clients with fibromyalgia, and what you’ve achieved together.