Tuesday 31st August, 2021

Does massage help fibromyalgia: with bonus self help advice

Lady with fibromyalgia
We show you massage self help options for fibromyalgia

Clinical trials have shown that massage is effective in relieving fibromyalgia. Although some types of massage are better than others most are effective, but they need to be applied regularly over a long period of time. Best results are obtained if the massages are painless and increase in intensity over time as the condition improves.

Despite being effective medical guidelines tend to discount massage due to the cost, however there are effective self massage options. In this article we discuss why massage is such an important fibromyalgia therapy, what the clinical trials tell us about how best to apply it, then discuss your best options.

CONTENTS

Why massage is an important therapy for fibromyalgia
What the clinical trials say about massage therapy for fibromyalgia

  • what type of massage is effective for fibromyalgia
  • the number of massage sessions needed
  • treatment recommendations

Our recommendations for using massage to help with fibromyalgia
Your home massage options
Professionals
Appendix: professional therapy options
References

Why massage is an important therapy for fibromyalgia

As the many clinical trials have shown (see table summary below) massage is a very important therapy for fibromyalgia. This is because although the cause of fibromyalgia is said to be unknown, scientists have found most to be caused by (myfascial) trigger points. Trigger points are those tender lumps in muscles that therapists find, and massage is an effective trigger point therapy.

Fibromyalgia overview 2
Prolonged trigger point pain causes the nervous system to become sensitised

How trigger points cause fibromyalgia

Scientists have found that if your nervous system is bombarded with pain over a long period of time it will become sensitised. When it is sensitised your nervous system acts like a big amplifier. Normal stimuli become painful, and pain is felt out of all proportion. Also, because your nervous system controls your body you can get seemingly unrelated symptoms such as sleep difficulties, anxiety and depression. Sensitisation can be caused by any source of prolonged pain, such as an arthritic condition, but scientists have found that trigger points are the most common (1–9)⁠.

Fibromyalgia treatment: scientific
The way the scientists successfully treated fibromyalgia

Effective treatment of fibromyalgia: eliminate the source of this pain

Understanding this, many scientists say that the priority in fibromyalgia treatment should be to eliminate the pain that is sensitising the nervous system. They have actually done this successfully (2)⁠. In a clinical trial scientists found that (temporarily) stopping the pain from trigger points using anaesthetic injections relieved the symptoms of fibromyalgia.

Fibromyalgia: medical treatment
The medical treatment of fibromyalgia

The medical way of treating fibromyalgia

Medicine ignores what these scientists have found. Instead they continue to claim that the cause is unknown, and use drugs to suppress the symptoms and the sensitisation of the nervous system. This is not good for fibromyalgia sufferers, but very lucrative for drug companies, medical laboratories and doctors.

What the clinical trials say about massage therapy for fibromyalgia

The table below has results of the 10 clinical trials we could find where massage was used to treat fibromyalgia. The following is a summary of what works and what doesn't, as interpretted by our self and several scientists (10–13)⁠.

What type of massage is effective for fibromyalgia

Most styles of massage improved fibromyalgia, but the ones that target trigger points (eg myofascial release and shiatsu) were slightly better. In one trial where a painful massage that does not target trigger points (friction massage) was used there was no improvement.

The number of massage sessions

Successful treatment of fibromyalgia requires a large number of massage sessions over time. Improvement was gradual. In one trial where the massages were stopped after 15 sessions the fibromyalgia symptoms gradually returned over 6 months.

Some recommendations

It is recommended that painless therapy be used, with intensity gradually increasing from session to session as the condition improves.

Summary of clinical trials of massage for fibromyalgia

NOTE: You may need to scroll the table below left/right for more information

Trial

Type of massage

Duration, frequency, number

Outcome

15

Friction massage vs stretching vs analgesics

Uncertain

Friction massage not beneficial. Friction massage is a painful massage not suited for trigger points

16

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

17

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

18

Swedish massage compared with standard physician care

Ten sessions over 24 weeks

Massage showed improvement, but only small numbers in trial

19

Combination of styles

30 minutes, twice a week for 5 weeks

Less, pain, less anxiety and better sleep

20

Myofascial release massage

Weekly 90 minute session for 20 weeks

Improved pain and quality of life

21

Myofascial release

Ten 60 minute sessions over 20 weeks

Less tender spots, improved physical function

22

Swedish massage vs myofascial release

90 minute session weekly for 4 weeks

Both produced pain reduction and improved movement. Myofascial release had better results

23

Full body Shiatsu

Sixteen 40 minute sessions @ twice a week

Improved pain, tenderness and sleep

14

Mechanical massage device called Cellu M6

Fifteen weekly 35 minute sessions

Improved pain and function, and reduced number of trigger points

Our recommendations for using massage to help with fibromyalgia

Dr Graeme's comments
Dr Graeme's comments

With that background information lets look at how you can use massage to help with fibromyalgia. Please keep in mind that this is for general information only. For specific advice you need to ask a professional familiar with your own needs. In the case of fibromyalgia this is a bit more than just a general disclaimer to cover our backsides.

  • Trigger points are usually part of a more complex musculoskeletal problem, plus usually have things that cause or aggravate them.
  • The sensitisation often adds further complications and increases the risk of adverse reactions.

You need to find a professional who deals with trigger points, such as a chiropractor, osteopath or an appropriately qualified therapist. We will provide you with information about trigger point therapies, and allow him or her to provide the overall management of your condition.

Your trigger point therapy options

If you are very wealthy and have lots of spare time you may ask your professional to recommend a good therapist who does trigger point therapy. We've put the information about the effectiveness of each of the common professional trigger point therapies in the appendix. That said, you might get tired of continually attending appointments and want to do some therapy yourself. For everyone else the following will give you several excellent options for home trigger point therapy.

Your home trigger point therapy options

There are two basic types of trigger point therapy you can use at home: those based on manual massage techniques and those using vibration massage. In this section we’ll show you how to find your trigger points and how to do both of these therapies.

Trigger point examination
Simple trigger point examination: start with flat fingers to find tightness and tenderness

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.

Forearm self massage
Using thumb pressure to self massage forearm muscles

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

Pressure techniques

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.

Self massage tool: Wilai stick
Using this simple tool and a conservative technique was effective (click image for details)

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.

Trigger point self therapy: balls
Please compare with Thai technique: awkwardness, control, tension in the muscles

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.

Home 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

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.

Trigger point: positive feedback loop

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.

Self massage allows the benefits of quality massage at home for little cost

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

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.

Professional at desk

Professionals

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.

Dry needling

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.

Laser

Laser

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.

Manual trigger point therapy

Manual therapies

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.

References

  1. Fernández-De-Las-Peñas C, Dommerholt J. Myofascial trigger points: Peripheral or central phenomenon? Curr Rheumatol Rep. 2014;16(1).
  2. 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;
  3. Shah J et al. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. HHS Public Access. 2015;7(7):746–61.
  4. 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.
  5. Franklyn KL, Guymer EK, Littlejohn GO. Targeting fibromyalgia pain: Brain-spinal cord and peripheral contributions. International Journal of Clinical Rheumatology. 2011.
  6. 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;
  7. 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;
  8. 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;
  9. Staud R. Peripheral Pain Mechanisms in Chronic Widespread Pain. Best Pr Res Clin Rheumatol. 2012;25(2):155–64.
  10. 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.
  11. 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;
  12. Kalichman L. Massage therapy for fibromyalgia symptoms. Rheumatol Int. 2010;30(9):1151–7.
  13. 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.
  14. 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.
  15. 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.
  16. Sunshine W. Fibromyalgia benefits from massage therapy and transcutaneous electrical stimulation. J Clin Rheumatol. 1996;2(1):18–22.
  17. Brattberg G. Connective tissue massage in the treatment of fibromyalgia. Eur J Pain. 1999;3(3):235–44.
  18. Alnigenis M. Massage Therapy in the Management of Fibromyalgia: A Pilot Study. J Musculoskelet Pain. 2001;9(2):55–67.
  19. 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.
  20. 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.
  21. 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.
  22. 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.
  23. 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.
  24. 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.
  25. 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.
  26. 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.
  27. 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.
  28. 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
  29. 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.
  30. 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.
  31. Rickards LD. The effectiveness of non-invasive treatments for active myofascial trigger point pain : A systematic review of the literature. 2006;9:120–36.
  32. 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.
  33. 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".

Dr Graeme

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

Self massage for high blood pressure

Clinical trials have shown that massage is effective in relieving fibromyalgia. Although some types of massage are better than others... Read Article