Clinical trials have shown that massage is effective in relieving fibromyalgia. However, the results show that some are better than... Read Article
Does massage help fibromyalgia: with bonus self help advice
Clinical trials have shown that massage is effective in relieving fibromyalgia. However, the results show that some are better than others, and there are are some definite guidelines for getting decent results.
In this article we will go over:
Why massage helps fibromyalgia
As the summary table below shows massage has given excellent relief for fibromyalgia in many clinical trials. This is because pain from your muscles (mainly (myofascial) trigger points) contributes very heavily to fibromyalgia pain, and massage is an excellent therapy for this pain. How does muscular pain contribute to fibromyalgia?
Reason one: muscular pain is a major cause of fibromyalgia
Doctors will tell you that the cause of fibromyalgia is unknown, but scientists have found that the main cause is having pain bombarding your nervous system for a long time (1-9). This causes your nervous system to become sensitised. When your nervous system is sensitised it acts like an amplifier, making pain feel much worse. Also, because the nervous system is the master control system of the body it can cause may seemingly unrelated symptoms.
The good news is that scientists have found that if you remove the pain that is causing the sensitisation the fibromyalgia symptoms settle down, For more information: The root cause of fibromyalgia
Reason two: muscular pain is adds to the symptoms of fibromyalgia
Trigger points are arguably the biggest cause of musculoskeletal pain such as back, neck and shoulder pain. This pain can add to your fibromyalgia symptoms. For more information The root cause of fibromyalgia
The best massages for fibromyalgia
Most styles of massage improved fibromyalgia, but from the results of the trials and our our clinical experience we give the following advice.
Massage that targets trigger points is better
While general muscle tightness and soreness is an issue research shows that the main problem is the trigger points. Therefore the therapies that target trigger points gave better results than more general massages. We will discuss these therapies in our next section guidelines for the best results
Avoid painful techniques
Sensitisation makes any pain feel much worse, so painful techniques may not be tolerated and just make the condition worse. One trial used friction techniques which are painful and clearly a poor choice, but pressure techniques can also be very painful.
You will need a massage you are able to have repeated many times
The clinical trial results and our clinical experience show that you will need a large number of sessions of massage over time. A lot of the trials used from 10-20 sessions, but only gave partial relief. Also, in one trial where the massages were stopped after 15 sessions the fibromyalgia symptoms gradually returned over 6 months. If all those massages were done by professionals it would be prohibitively expensive, however below we give you self massage options that are at least as effective as professional therapies.
Guidelines for the best results
As the clinical trial results show it is certainly possible to use massage to successfully treat fibromyalgia.
Fibromyalgia is a difficult condition to treat. Although you may do a lot of the massage therapy yourself you should seek the advice and support of a professional qualified in dealing with these muscular issues, such as a Chiropractor, Osteopath or a Physiotherapist. Musculoskeletal conditions can be complex needing additional care, and they can help keep you safe. He or she will be also be able to advise on a lot of issues such as where to massage and how often.
What type of massage to use
The main issues in your choice of massage are:
- You need a massage that targets trigger points rather than a general massage.
- Because of the sensitisation you will need one that does not hurt, or at most is only minimally uncomfortable.
- Convenience and expense usually dictates that at least most of the massage is self massage.
Your massage program
Please be advised by your professional. However, the following is a guide.
Start very conservatively
Because of the sensitisation your body will be less tolerant, so start off very conservatively, then gradually increase the intensity as you improve. The massage should generally be relaxing your muscles and increasing their blood flow. You should not be feeling sore after a massage.
You will need repeated massages over a long period of time
All the trials used a large number of massages (and still gave incomplete relief). Rather than trying to accomplish too much at once you are far better off having multiple less intense massages, letting your body recover and adapt in between.
What if you get sore
Because of the sensitivity it is possible to have a flare up of symptoms after a massage. Discuss this with your professional, but generally the advice is to let it settle down then continue a bit more conservatively.
You will need to keep going
All of the trials only produces incomplete relief, and as one trial found if you discontinue the fibromyalgia symptoms gradually come back. As long as you are gradually improving definitely keep going. If you become completely symptom free or reach a plateau keep going with some sort of maintenance routine.
Summary of clinical trials of massage for fibromyalgia
Treating fibromyalgia can sometimes be tough and discouraging. To help you through this please check out the results of the trials below showing that it can work.
Type of massage
Duration, frequency, number
Friction massage vs stretching vs analgesics
Friction massage not beneficial. Friction massage is a painful massage not suited for trigger points
Compared Swedish massage with TENS machine
Ten 30 minute sessions @ 2 per week
Massage resulted in less pain, less fatigue, better sleep and lower anxiety
Connective tissue massage
15 sessions @ 1.5 per week
Massage gives pain relief, relieved anxiety and improved quality of life. After treatments finished improvements gradually diminished over 6 months
Swedish massage compared with standard physician care
Ten sessions over 24 weeks
Massage showed improvement, but only small numbers in trial
Combination of styles
30 minutes, twice a week for 5 weeks
Less, pain, less anxiety and better sleep
Myofascial release massage
Weekly 90 minute session for 20 weeks
Improved pain and quality of life
Ten 60 minute sessions over 20 weeks
Less tender spots, improved physical function
Swedish massage vs myofascial release
90 minute session weekly for 4 weeks
Both produced pain reduction and improved movement. Myofascial release had better results
Full body Shiatsu
Sixteen 40 minute sessions @ twice a week
Improved pain, tenderness and sleep
Mechanical massage device called Cellu M6
Fifteen weekly 35 minute sessions
Improved pain and function, and reduced number of trigger points
Your self massage/trigger point therapy options
Because of the large number of application needed most will use at least some self therapy. In this section we will give you some excellent self massage techniques that emphasise trigger points.
How to find your trigger points
Trigger points are tender lumps within tight bands of muscle. When you press on them they will shoot pain and sometimes cause the muscle to twitch. We thoroughly recommend that you consult a professional who deals with trigger points to help identify the ones affecting you and show you how to find them, but we share with you the basic examination procedure. These are demonstrated in our video on treating forearm muscles
Flat fingers examination technique (the one we use in clinic)
Gently press on the muscle with flat fingers, examining for areas of general tightness and tenderness. When found, use one or two fingers to explore more deeply for tightness and a tender lump.
Home trigger point therapies using manual massage
Manual massage techniques performed by professional therapist can be an effective trigger point therapy. There are home techniques that mimic these. As we discuss in our article Do foam rollers work we have reservations about the use of tools such as balls and foam rollers to apply painful pressure, but will show you two relatively safe and effective techniques.
Combining squeezing massage with holds
One of main massage techniques is called “stripping” (technical name= effleurage). Think of gradually moving along the muscle like squeezing out an old sponge. To do this lubricate your skin, apply moderate pressure and move along the muscle slowly. As the veins and lymphatic vessels have one way valves this needs to be done towards your heart.
To turn this stripping technique into a very effective trigger point therapy, when you get to a tight spot or trigger point stop and hold the pressure for 5-10 seconds, then slowly move on. The safest and best way to do this technique is to start with light to moderate pressure then gradually repeat with more pressure. For a demonstration of this please see our video on treating forearm muscles
Professional therapists use various techniques that apply pressure direct to the trigger point. There are a lot of people advising to do this at home with balls and rollers. As discussed though we have reservations about the risks and benefits of doing this. In clinic we have seen seen way to many patients hurt themselves and get very little benefit. However, there is a very safe and effective way to use pressure techniques at home. In a trial of a traditional Thai home massage (24) a special tool with a long handle was used to apply moderate pressure to relaxed muscles. Each day each trigger point was given five applications of this moderate pressure for five seconds each. This tells us painful pressure is not needed. Multiple applications of moderate safe pressure work very well.
Safe and effective Thai technique
Using the tool allowed the muscles treated to be relaxed. 5 seconds of moderate pressure pressure was applied five times. This was repeated each day. To use this technique find each trigger point, make sure the muscle is relaxed, then use either your hands or some sort of tool to give multiple applications of moderate pressure.
Ball and roller techniques
For comparison this picture shows applying pressure to the same muscles using a ball. Note that the muscles are far from relaxed, and being an awkward position it would be far harder to control the pressure.
Self massage/trigger point therapy using vibration massage (our recommendation)
Vibration massage is widely used by professionals to treat trigger points. It is done by simply placing the vibration massager over the trigger point allowing the vibrations to penetrate and have their effect. Because it does not require penetrating pressure it is relatively safe, and because no special skills are required it is far easier to self apply.
Dr Graeme's comments: you can get professional results from self therapy
Manual therapies rely on skilled application and it can be difficult to get into some positions for self massage, so self applied manual massage is often no where as effective as professional therapy. On the other hand because a vibration massager just sits on the surface and does the work, as long as it is applied in the right place self applied vibration massage can be as effective and professionally applied vibration.
Why vibration massage works
As shown in this diagram the key parts of a trigger point are muscle spasm, muscle tightness, restricted blood flow, and a build up of toxic wastes. Vibrations have been shown to help all of these. For more information please see our guide The scientifically proven effects of vibration massage- with clinical applications.
How to use vibration massage
Using vibration massage is extra-ordinarily easy. We ask you to check our our instructions for the fine points and precautions, but basically all you need to do is place the vibration massager on the muscle over the trigger point and let the vibrations penetrate for 30-60 seconds. This can easily be repeated every day.
How to choose a massager
For how to choose an quality massager that will do a great job and that you will be extremely happy with please see our article How to choose a massager, or you can go straight and check out our economical, easy to use professional standard machines: the General Purpose Massager or our Ultimate Quad Head Massager.
Please continue these therapies after your pain has gone
Most people just use these therapies for pain relief, but as discussed in our article Why trigger point pain keeps coming back trigger points don’t go so the pain returns. However, if you continue using regular trigger point therapy after the pain goes it will continue to diminish the trigger points and you will be much better off than those who just do pain relief.
Dr Graeme's comments: combining professional help with home therapy
Typically professionals who deal with trigger points must examine and determine the problem, provide care for things other than trigger points, provide advice, and provide trigger point therapy. If you are able to do a lot of the therapy yourself this will free up your professional to spend more times doing the other things. If you don’t have a professional a good place to look would be to go to our massager order section, select your country, then select the first option: from a clinic that sells and recommend them. The website has these clinics on a map, plus listed in post code order.
If you are a professional wishing to help your patients/clients with home trigger poing therapy DrGraeme massagers were originally built by Dr Graeme for use in his clinic for this purpose and are now used by colleagues and other professionals for similar purposes. If you are a professional and wish to know more about this therapy, or possibly get a sample massager to trial please check out our practitioner page.
Appendix: What the research says about individual trigger point therapies
Below is a summary of the findings of several scientific reviews of trigger point therapies (25-31).
The goal of trigger point therapy
As said previously, the goal of trigger point therapy, according to the scientists, is to deactivate the trigger points. None mention having the goal of eliminating trigger points.
Most trials show that dry needling provides some short term pain relief and improved function. The risks and potential to cause pain are obvious. The mode of how needles work is still speculation. Where dry needling had been compared with laser the laser has given slightly better results.
Trial results for laser have been marginally better than those for dry needling, but still only temporary relief. Scientists attribute it’s effect to increasing micro-circulation, improving oxygenation and helping remove waste products. However, this is something that can easily be achieved, if not better, by any competent massage therapist.
The big concern with laser is the sheer number of applications of therapy sessions needed for only temporary benefits. For example one trial (32) used 10 daily applications of laser on patients with upper back and neck pain to get a reduction in pain and tenderness for three weeks. Further, according to one review (33) applications of laser should be given from 2-3 times a week though to 5 times a week, with a total of 30 applications of therapy for long term cases. Keep in mind this is just to achieve deactivation, not to eliminate the problem. Assuming each laser consultation costs $50 and takes an hour out of your day that’s $1,500 and 30 hours of your life just for some temporary pain relief, leaving you to front up again next time the problem is aggravated.
There are various types of manual therapies that involve pressure, massage and stretching of muscles. The trial results for them tend to be similar to those of laser and dry needling. However, according to one review (26) one study did show residual benefit after six months.
- Fernández-De-Las-Peñas C, Dommerholt J. Myofascial trigger points: Peripheral or central phenomenon? Curr Rheumatol Rep. 2014;16(1).
- Affaitati G, Costantini R, Fabrizio A, Lapenna D, Tafuri E, Giamberardino MA. Effects of treatment of peripheral pain generators in fibromyalgia patients. Eur J Pain. 2011;
- Shah J et al. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. HHS Public Access. 2015;7(7):746–61.
- Giamberardino MA, Affaitati G, Fabrizio A, Costantini R. Effects of treatment of myofascial trigger points on the pain of fibromyalgia. Curr Pain Headache Rep. 2011;15(5):393–9.
- Franklyn KL, Guymer EK, Littlejohn GO. Targeting fibromyalgia pain: Brain-spinal cord and peripheral contributions. International Journal of Clinical Rheumatology. 2011.
- Alonso-Blanco C, Fernández-De-Las-Peñas C, Morales-Cabezas M, Zarco-Moreno P, Ge HY, Florez-García M. Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. Clin J Pain. 2011;
- Ge HY, Wang Y, Danneskiold-Samsøe B, Graven-Nielsen T, Arendt-Nielsen L. The Predetermined Sites of Examination for Tender Points in Fibromyalgia Syndrome Are Frequently Associated With Myofascial Trigger Points. J Pain. 2010;
- Staud R, Vierck CJ, Robinson ME, Price DD. Overall fibromyalgia pain is predicted by ratings of local pain and pain-related negative affect - Possible role of peripheral tissues. Rheumatology. 2006;
- Staud R. Peripheral Pain Mechanisms in Chronic Widespread Pain. Best Pr Res Clin Rheumatol. 2012;25(2):155–64.
- Terry R, Perry R, Ernst E. An overview of systematic reviews of complementary and alternative medicine for fibromyalgia. Clin Rheumatol. 2012;31(1):55–66.
- Li YH, Wang FY, Feng CQ, Yang XF, Sun YH. Massage therapy for fibromyalgia: A systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014;
- Kalichman L. Massage therapy for fibromyalgia symptoms. Rheumatol Int. 2010;30(9):1151–7.
- Yuan SLK, Matsutani LA, Marques AP. Effectiveness of different styles of massage therapy in fibromyalgia: A systematic review and meta-analysis. Man Ther . 2015;20(2):257–64.
- Gordon C, Emiliozzi C, Zartarian M. Use of a mechanical massage technique in the treatment of fibromyalgia: A preliminary study. Arch Phys Med Rehabil. 2006;87(1):145–7.
- Amanollahi A, Naghizadeh J, Khatibi A, Hollisaz MT, Shamseddini AR, Saburi A. Comparison of impacts of friction massage, stretching exercises and analgesics on pain relief in primary fibromyalgia syndrome: A randomized clinical trial. Tehran Univ Med J. 2013;70(10):616–22.
- Sunshine W. Fibromyalgia benefits from massage therapy and transcutaneous electrical stimulation. J Clin Rheumatol. 1996;2(1):18–22.
- Brattberg G. Connective tissue massage in the treatment of fibromyalgia. Eur J Pain. 1999;3(3):235–44.
- Alnigenis M. Massage Therapy in the Management of Fibromyalgia: A Pilot Study. J Musculoskelet Pain. 2001;9(2):55–67.
- Field T, Diego M, Cullen C, Hernandez-reif M, Sunshine W. Fibromyalgia pain and substance P decrease and sleep improves after massage therapy. J Clin Rheumatol. 2002;8:72–6.
- Castro-Sánchez AM, Matarán-Pearrocha GA, Granero-Molina J, Aguilera-Manrique G, Quesada-Rubio JM, Moreno-Lorenzo C. Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Evidence-based Complement Altern Med. 2011;2011.
- Castro-Sánchez A et. al. Effects of myofascial release techniques on pain , physical function , and postural stability in patients with fibromyalgia : a randomized controlled trial. Clin Rehabil. 2011;25(9):800–13.
- Liptan G, Mist S, Wright C, Arzt A, Jones KD. A pilot study of myofascial release therapy compared to Swedish massage in Fibromyalgia. J Bodyw Mov Ther. 2013;17(3):365–70.
- Yuan SLK, Berssaneti AA, Marques AP. Effects of Shiatsu in the management of fibromyalgia symptoms: A controlled pilot study. J Manipulative Physiol Ther . 2013;36(7):436–43.
- Wamontree P, Kanchanakhan N, Eungpinichpong W, Jeensawek A. Effects of traditional Thai self-massage using a Wilai massage stickTM versus ibuprofen in patients with upper back pain associated with myofascial trigger points: a randomized controlled trial. J Phys Ther Sci. 2015;27(11):3493–7.
- Boyles R, Fowler R, Ramsey D, Burrows E. Effectiveness of trigger point dry needling for multiple body regions: A systematic review. J Man Manip Ther . 2015;23(5):276–92.
- Denneny, Diarmuid et al. Trigger point manual therapy for the treatment of chronic noncancer pain in adults: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2019;100(3):562–77.
- De Las Peñas CF, Sohrbeck Campo M, Fernández Carnero J, Miangolarra Page JC. Manual therapies in myofascial trigger point treatment: A systematic review. J Bodyw Mov Ther. 2005;9(1):27–34.
- Tough EA, White AR, Cummings TM, Richards SH, Campbell JL. Acupuncture and dry needling in the management of myofascial trigger point pain: A systematic review and meta-analysis of randomised controlled trials. Eur J Pain [Internet]. 2009;13(1):3–10. Available from: http://dx.doi.org/10.1016/j.ejpain.2008.02.006
- Cagnie B, Castelein B, Pollie F, Steelant L, Verhoeyen H, Cools A. Evidence for the use of ischemic compression and dry needling in the management of trigger points of the upper trapezius in Patients with Neck Pain: A Systematic Review. Am J Phys Med Rehabil. 2015;94(7):573–83.
- Espejo-Antúnez L, Tejeda JFH, Albornoz-Cabello M, Rodríguez-Mansilla J, de la Cruz-Torres B, Ribeiro F, et al. Dry needling in the management of myofascial trigger points: A systematic review of randomized controlled trials. Complement Ther Med . 2017;33(December 2018):46–57.
- Rickards LD. The effectiveness of non-invasive treatments for active myofascial trigger point pain : A systematic review of the literature. 2006;9:120–36.
- Hakgüder A, Birtane M, Gürcan S, Kokino S, Tura FN. Efficacy of Low Level Laser Therapy in Myofascial Pain Syndrome: An Algometric and Thermographic Evaluation. Lasers Surg Med. 2003;33(5):339–43.
- Uemoto L, Garcia MAC, Gouvêa CVD, Vilella O V., Alfaya TA. Laser therapy and needling in myofascial trigger point deactivation. J Oral Sci. 2013;55(2):175–81.
We are continually adding more information on research and uses. Subscribe below to have us email them to you "hot off the press".
About Dr Graeme
Several years ago Dr Graeme, a Chiropractor practicing in Victoria, Australia was looking for a serious hand held massager his patients could use at home to get the extra quality massage they needed. The ones he found in the shops and on-line for home use looked nice but were not serious, and... read more
Other Articles You May Like
Trigger points are those tender lumps in muscles that therapists find. This article covers what they are, what they do, and how they are... Read Article
As a chiropractor for over 27 years vertebral subluxation complexes are a very real problem that can cause pain, long term spinal damage... Read Article
In this summary we investigate the science behind the use of vibration massage. This helps us envisage uses and to develop protocols. ... Read Article
You will find a well designed vibration massager easier to use, safer, and will do a much better job. This is because the scientific... Read Article
Massage and trigger point therapy are widely used to treat back pain. I this article we’ll discuss how these may help with your problem,... Read Article