Fibromyalgia Treatment – What can the Myotherapist do for the Fibromyalgic client?

1. Be understanding; encourage self-help; explain the reasons

Many fibromyalgics have been told by uninformed health professionals, sometimes for years, that there is nothing wrong with them and that it is all in their head. Imagine the relief when they hear that what they have is a recognized syndrome, there are things they can do to help themselves, and that although there is as yet no known cure there is much that can be done to relieve the symptoms and the pain. That in fact with proper management many fibromyalgics lead an almost normal and productive life.

Above all the fibromyalgic must be encouraged to take an active role in controlling their condition, thereby taking them out of the victim mode into the "I can do something about it " mode. This shift in attitude can do wonders for the person who has been in a state of exhausted, painful, hopelessness for years.

2. Myofascial Stretches

Since much of the pain of fibromyalgia is the result of excessively tight fascia, stretching the myofascia can be really useful. The three techniques that I find work well are: Myofascial release, PNF stretching, and Passive Myofascial stretching using spray and stretch Travell style, this technique also helps to eliminate trigger points that have developed in the muscles in response to the tight fascia and the pain.

Don't be put off if the client's muscles don't seem to improve as much as a normal person would. In my experience the recovery rate of fibromyalgic muscles is very slow. Many of my clients don't notice any improvement for many hours, or even days after I treat them, but persistence does pay off, four to six weeks into treatment most are feeling better than they have in years.

3. Cross friction, gently

Because the collagen fibers have probably cross-linked restricting fascia movement, a certain amount of cross friction massage is useful in realigning the fibers, and loosening the fascia.

Avoid deep tissue massage, it should NOT be used, as it will almost always cause a painful "flare up." The reason for this is that really deep tissue massage actually damages some of the minute muscle fibers or "fibrils" The body's top priority is the repair of any damage, so it diverts its limited resources to repairing the damage done by deep tissue massage. Any sort of damage can cause a flare up, even having your teeth de-scaled by the dentist.

4. Supplements, iodine, B complex, Co Q10, Magnesium etc.

As thyroid insufficiency seems to be a major contributor to fibromyalgia, and iodine and vitamin B are essential for proper thyroid function, it is just common sense to make sure the client receives enough in their diet. Co enzyme Q10 is used by the mitochondria in the production of ATP (Adenosine triphosphate) the energy source of muscles, this helps reduce the exhaustion felt by fibromyalgics.  The minerals, calcium, potassium, iron, and magnesium are needed for normal muscle function. Deficiency of the first three tends to increase the irritation of myofascial TPs and Magnesium is essential to the contractile mechanism of the myofilaments (Travell & Simons 1983 )

5. Appropriate shoes/insoles for foot cushioning & support

Ineffective foot support, especially for people with Morton's Foot, ( 2nd metatarsal longer than the 1st ) can cause Peroneal and Gluteus pain, even in normal people, and doubly so for the fibromyalgic.

6. Refer to friendly GP for Thyroid Hormone

T3 is the most biologically active form of thyroid hormone, consequently insufficient T3 can cause extreme tiredness and lack of energy.

Unfortunately many GPs don't know what T3 is, so it may take some searching to find one who not only knows what T3 is and how it's used,  but is also willing to prescribe it.

Armour Thyroid  or desiccated thyroid gland from animals, may be easier to get.  Some GPs prefer it to synthetic thyroid hormone as it naturally has the right balance of all the thyroid hormones.

7. Epsom salts baths

Since Epsom salts are a source of raw magnesium, by soaking in a bath of it, a certain amount will be absorbed through the skin, so helping the muscles relax.

8. Antihistamine for allergies; avoid known allergens where possible
For some reason that as yet is not fully understood, many people with fibromyalgia seem to be sensitive to allergens, it may be pollens or it may be food allergies, but whatever the cause, the effect is the same. Allergies cause the body to generate histamines. According to Travell, histamine, seratonin, kinins and prostaglandins are nerve-sensitizing substances. These can cause pain and the generation of myofascial TPs. .As Travell has said. " More research is needed".

9. Provide regular treatment

Because to date no cure for fibromyalgia has been found, the problem and associated pain is not going to just go away. Never the less fibromyalgia can be managed, regular massaging and myofascial stretching can bring the pain down to a bearable level, the client should also be taught to do self stretches as a way to control their problem.

10. Recommend simple lifestyle changes

One of the most useful things a fibromyalgia sufferer can do, is change their lifestyle:
1. Avoid excess cold and drafts. Cold seems to aggravate FMS
2. Avoid overuse of their muscles. Their muscles don't have much staying   power, if exercising make it light and only for 5 or 15 minutes
3. Use a softer or more comfortable mattress on the bed.
4. Use warm baths or a spa. Relaxing the muscles before bedtime does help.
5. Try swimming as a form of exercise, in a heated pool.
6. Do relaxation exercises. The pain of FMS does tighten up the muscles.
7. Develop regular sleeping habits. Fibromyalgics frequently lack sufficient DELTA sleep, and that lack only makes the FMS worse.

11. Recommend dietary changes ( low carbohydrates & plenty of water )

According to the many reports by the members of the fibromyalgia self help groups on the internet, it seems that despite what we are told by the media, a diet high in carbohydrates does not help. Rather a diet with a 30/ 30/40 carbohydrate, fat, protein, ratio seems to help many fibromyalgics.

Independent research by several universities and a number of private researchers, have shown that a diet high in protein and fiber, and low in carbohydrates, not only causes significant fat loss, but also lowers elevated blood pressure and improves cholesterol ratios. ( Reuters & radio national )
Finally, a person with fibromyalgia, needs to drink at least two liters of water daily, as dehydration of the myofascia only makes the problem worse.

For more information about low carbohydrate diets see http://www.lowcarb.com.au.

Gary Clark

Tags: Health Medical Pharma, food allergies, Adenosine triphosphate, trigger points

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1. Ten things we do at Pain Busters Clinic to help fight fibromyalgia
2. Fibromyalgia:  What is it? and do you have it?