MASSAGE FOR SPECIAL NEEDS
FIBROMYALGIA CLIENTS
Copyright, 2006 ~ Lisa Ledger

FIBROMYALGIA is a devastating form of chronic pain that exacerbates itself in the muscles, ligaments and tendons of the body. The syndrome is often referred to as FIBROMYALGIA Syndrome or FMS. Clients affected by FMS are 80-90% women of all ages, race, and socio-economic status. Often FMS is brought on by a virus, such as Epstein-Barr, or a traumatic accident such as Post Traumatic Stress Syndrome. Medical research has yet to “discover” the cause of this debilitating disorder. Symptoms include:

• Headaches and facial pain, TMJ symptoms
• Sensitivity to touch, light, sound, or ordors
• Fatigue
• Weakness
• Mood swings (not related to PMS)
• Poor sleep or no restorative sleep
• Difficulties with memory and concentration
• Irritable Bowel Syndrome (IBS)
• Depression
• Other chronic pain disorders, Chronic Fatigue Syndrome
• Pain in the four quadrants of the body
• Pain, numbness without evidence of nerve damage

There are 18 tender points that are considered when diagnosing FMS. These are:

(1 & 2) Occiput: on both sides (bilateral), at the sub-occipital muscle insertions.

(3 & 4) Low Cervical: bilateral, at the anterior aspects of the inter-transverse spaces.

(5 & 6) Lateral Epicondyle: bilateral, 2 cm distal to the epicondyles

(7 & 8) Knee: bilateral, at the medial fat pad proximal to the joint line.

(9 & 10) Second Rib: bilateral, at the second costochondral junction, just lateral to the junctions on upper surfaces.

(11 & 12) Trapeziums: bilateral, at the midpoint of the upper border of the muscle.

(13 & 14) Supraspinatus: bilateral, at origins, above the spine of the scapula (shoulder blade) near the medial border

(15 & 16) Glutei: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle.

(17 & 18) Greater Trochanter: bilateral, posterior to the trochanteric prominence.

These tender points are shown below on the model.

TREATMENT FOR FIBROMALYGIA
Therapeutic massage affects the neurochemicals involved by increasing dopamine and serotonin levels and increasing the norepinephrine level during the first 15 minutes of massage. If massage stimulates the same neurochemicals as medications, it might be possible to lower the dosage of medications. Close monitoring of a patient’s medications by the primary care physician along with the pharmacist would be necessary.

As part of treatment for a FMS client, massage therapy should be incorporated to help the client build health, prevent disease and change what is necessary. Massage therapy would be used to improve the circulation in the muscle, increase the flow of nutrients in the muscle, and eliminate toxic waste in the muscle. Nutritional aspects of the client’s life, along with stress inducers need to be evaluated and modified if necessary. Therapy goals would be:

• Get pain under control
• ROM exercises and stretching to regain muscle function
• Professional therapy to help with emotional scars from long-term pain
• Return to activities of daily living

The therapeutic massage would include compression techniques and effleurage. If the client can tolerate touch on that day, then light petrissage could be used. Range of motion techniques along with stretching exercises for the shoulders would be indicated. Stretching of the pelvic area would also be indicated. The client would be taught these ROM and stretches for use at home. Deep tissue massage is contraindicated as this is usually too painful for the client.

A bodywork modality that I highly recommend is CranioSacral Therapy. I have had wonderful luck in treating those with FMS and CFS and migraines. CranioSacral Therapy does not require the client to disrobe. Lights are dimmed, soft relaxing music is played, and the Therapist places their hands on key points of the spinal and cranial system to allow the body to release restrictions that contribute to the symptoms of FMS and CFS. Migraines are greatly diminished using this technique.

Healing through massage may find resistance in the chronically ill client. Without the disease in one’s life, the client may have difficulty coping with personal or job related issues. In addition to professional counselling, healing massage should focus on short-term benefits with the emphasis on the act of reasserting control over one’s life. If this is the case, then I recommend Reiki Healing in addition to massage therapy. Reiki allows a wonderful peace to penetrate the whole being of the client. The disease may never go away. However, in conjunction with the client’s other health care professionals, the massage therapist can help the client to achieve the highest quality of life possible.

Other alternative help might be to develop a plan to avoid stress or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. Try not to change your routine completely. People who quit work or drop all activity tend to do worse than those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.

Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient SLEEP is essential. While some might consider taking naps in the afternoon, naps may interfere with the quality of your sleep later on. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.

At first, EXERCISE may increase your pain. The FMS client should not embark upon a club or gym workout at first - intentions are great, but the body will rebel against it. However, doing a light exercise program regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful. Pace yourself. Keep your activity on an even level. A problem that I have is when I feel good, I want to totally clean the house, top to bottom. Then, I crash for the next two weeks. If you do too much on your good days, you may have more bad days.

MAINTAIN A HEALTHY LIFESTYLE . Eat healthy foods. Limit your caffeine intake. Slowly make dietary changes, maybe one healthy change a week. One way might be to correct your grocery shopping habits - no one wants to throw away food (even if it is “bad” for you) that has already been paid for! For those with IBS symptoms, you might want to cut out dairy products, replacing with organic yogurt or Lifeway Kefir to add probiotics to your intestinal system. Eating healthy will be more expensive that you are used to. However, I feel that the benefits of a healthy life has more than outweighed the monetary difference in work productivity, and especially just being able to enjoy the day with my kids.

References
http://www.fibromyalgia-symptoms.org/fibromyalgia_diagnosis.html
Fritz, Sandy, Mosby’s Fundamentals of Therapeutic Massage, St. Louis, 2004, Mosby. P 508
http://www.mayoclinic.com/health/fibromyalgia/DS00079/DSECTION=11

Breath of Life

Most clients that come to me for stress relief and pain reduction do not know how to breathe. How can a person not know how to breathe? Isn't it a natural thing to do? Well, yes and no. Yes, it is natural. No, we forget. When we are babies, we automatically know how to breathe. As we grow up and become stressed, frightened, we forget how.

Breathing does more than just provide oxygen to our system, keeping us alive. As we breathe, we begin to remember how to expand our lungs completely. The lung is made up of different segments to help us breath. When we don't expand our abdomens during breathe, we do not use our lower lobes to push down on the diaphragm. As our diaphram expands downward, pushing onto our organs, notably the liver, gallbladder, and stomach. These organs in turn, push downward onto the rest of our organs. And suddenly, there is no room to push down anymore, so taking the path of least resistance, out goes our stomach. This is a type of massage for our organs, a much needed massage. Organs are squeezed, pushed out of all extra fluids, including our intestines. When a person starts breathing correctly, he will notice increased bowel sounds. No, that does not mean you are hungry, either!

As you return to breathing correctly, you will notice an increase in energy, more clear thinking, less sinus congestion, less intestinal issues (IBS, constipation, etc.) among other wonderful benefits!

So, let's get started!

Breathing Exercises
The following exercise may make you feel tired at first. Do keep at it as you will begin to notice that it takes less effort to breath, less energy is used when breathing plus it helps you learn to co-ordinate the diaphragm and abdominal muscles when breathing. To find out if you are breathing correctly, place a hand on your belly button. This area should expand first when you breathe in and then spread upwards until your chest is expanded (don't lift the shoulders or push the stomach out). If you feel you are not breathing properly, practice the following exercise. Lay flat on your back. Place your hands on your waist, fingers pointing towards your belly button. Focus on filling up your stomach from the bottom to the top taking a slow deep breath. (The aim is not to fill yourself to bursting but to inhale enough air so that you can feel the difference between a shallow breath taken when breathing from the chest). You should feel your stomach rise and your hands being raised gently up and outward until you feel your chest expanding. The expansion is not only at the front of the body but also to the sides and back as well. Breath out slowly to a count of 5. Repeat the exercise 10 times.

Exercise 1
Stand with your feet apart and bend over so that your hands are almost touching the floor. Make sure that your head and neck are completely relaxed. While in this position, breathe in a little way, allowing your torso to rise with the intake of breath, then exhale and flop back down again. On the third intake of breath, slowly stand up, gradually raising arms above your head, thus lifting your whole rib cage. On the exhale, flop back down. Do this 3-4 times.

Exercise 2
Stand comfortably upright, with body weight a bit more on one foot than the other. Relax your lower abdominal muscles and breathe in slowly as you raise your arms to the sides at shoulder level; bring them forward, really feeling a stretch. Do this during one complete inhale. As you exhale, reverse the movement, slowly bringing arms back to sides.

Exercise 3 - Pant.