As a massage therapist, I encounter people in pain much of the time. Besides the occasional appointment for a relaxing massage, most of the people I see are seeking a therapeutic medical massage. There is a lot to be said for using massage therapy to help decrease pain, stress and anxiety and not entirely treating a massage as a once in a while luxury. In addition to my private practice, I work at a physical therapy office where I work with post-operative patients, recovering stroke victims, and injured weekend warriors among many others. Sometimes people come in for what is general pain that their physician is unable to diagnose or in some cases have misdiagnosed. I have noticed that some patients who have this generalized muscles achiness and pain have been easily if not lazily stamped with a diagnosis of fibromyalgia. Sometimes the diagnosis is correct and accompanied by other tests to verify results. Other times, the diagnosis misses the mark simply because other vital tests were not performed or worse the physician did not take the time to palpate the patient, instead relying on what the patient tells them instead.
Fibromyalgia, only recently accepted by the medical community as a legitimate condition affects from 2 to 6 percent of the adult population with women about four times as more likely to suffer from it than men. Typically beginning in young adulthood and increasing in intensity as you get older, the condition is insidious and the pain and other symptoms sneak up on you. It is a painful condition characterized by diffuse muscular aches and tender points on the body and presents itself in several ways. It can be chronic, remissive, or cyclical in a chronic pain followed by remission of pain pattern. Primary fibromyalgia is idiopathic or is unexplainable with an uncertain origin. Often times, it can develop secondary to a traumatic fall, whiplash or back strain and is known as post-traumatic fibromyalgia. Other causes are not as clear but there may be some connections with immunological abnormalities or even a genetic susceptibility. Other studies have linked fibromyalgia to a serotonin deficiency in which the hormone serontin does not bind to blood platelets causing a negative effect on the pain inhibitory pathways of the nervous system- therefore the body is more susceptible to pain. Other causes range from over exertion to lack of exercise and lack of or poor quality of sleep as well as infectious illnesses. From a chicken or the egg standpoint; stress, anxiety and depression are known psychological factors that may cause fibromyalgia as well as increase in intensity as a symptom of fibromyalgia. In some cases, a diagnosis of fibromyalgia provides some comfort as now the “condition” has a name and the person does not feel like a hypochondriac.
Getting back to what I wrote earlier, a diagnosis requires blood tests and x-rays in order to differentiate the condition from other conditions such chronic fatigue syndrome (CFS)/myalgic encephalomyelitis, lupus, and other forms of arthritis and trigger points. A diagnosis also requires the physician to palpate 18 points bilaterally on the body and assess at least 11 abnormal tender areas paired with no existing pain in the forehead, the flexors of the fingers or muscles of the forearm, the outside of the elbow and the middle of the upper arm where the deltoid muscle/s insert.
The 18 points are located and palpated in the upper body and lower body on both the left and the right sides and most correspond with Japanese Shiatsu tsubo points. Using the table below is an excellent guide in ascertaining if it is necessary to see a physician for further tests. (*It is out of the scope of practice for a licensed massage therapist to diagnose.*)
|Posterior (Back of the Body)||Anterior (Front of the Body)|
|Bladder 10: suboccipital muscle insertion just below the occiput (where the back of the head meets the back of the neck)||In the neck region just to the side of the SCM at C5 to c7|
|Gall Bladder 21: the midpoint of the shoulder halfway between the shoulder bone and the neck||Kidney 27: at the second rib just to the side of the sternum|
|Small Intestine 13: at the top of the scapula at the middle border near the spine of the scapula||Large Intestine 10: on the extensor digitorum muscle 2 cm below the outside of the elbow|
|Anterior portion of the gluteus medius muscle||Liver 8: middle of the knee just above the knee joint|
|Gall Bladder 30: the depression on the buttocks where you squat down to prepare to jump|
In order to be properly diagnosed with fibromyalgia, your physician must find 11 tender areas of the 18 palpated, the condition has to have been present for at least 3 months and he or she needs to verify with x rays and blood tests to differentiate from other conditions. After diagnosis, massage therapy will benefit greatly and decrease the stress and pain associated with the muscular achiness and tenderness. The massage session will in the beginning will be of shorter duration to avoid exhausting the muscles. In time over a series of sessions, the duration will be increased and any postural imbalances and other secondary conditions can be addressed. The amount of pressure is light to moderate in the beginning until the therapist and patient can best determine what is most suitable. As no two persons present with the same symptoms, it is best to check the comfort levels early and make any adjustments. I have worked with a patient with fibromyalgia who can take a fair amount of pressure while the next patient can barely stand my quietest touch. It all depends on the person. Careful consideration of the person’s body language and facial expressions are imperative.
If you are experiencing unexplained muscular pain that has lasted at least three months and you feel that you are abnormally tender in the points and areas mentioned above, then it may a good idea to make an appointment with your physician to make a determination. If you would like to see your massage therapist or other CAM therapist to determine if you have the necessary tenderness, that may not be a bad idea either. A good therapist will be able to palpate those points, make an assessment and then if necessary refer to your physician for any further tests. A diagnosis of fibromyalgia may not only be the beginning of an understanding of the existing condition but in knowing how to address the pain and keep it under control.
Kip Yates, LMT was trained at the Swedish Institute in New York City and is New York State and Texas State licensed. He is owner and operator of Massage Refresh in New York City where he provides Swedish wellness and recuperative Deep Tissue massage that encompasses myofascial release and trigger point therapy. Kip lives in Brooklyn with his wife and three children and also practices at Physiofitness Physical Therapy in Soho.