Does massage help fibromyalgia: with bonus self help advice

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?

More information on trigger points

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

Overview

As the clinical trial results show it is certainly possible to use massage to successfully treat fibromyalgia.

Professional advice

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.

In the section below we show you several excellent self massage options you can use. If you wish to use at least some professional therapy options the appendix below gives a summary of each.

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.

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.

CONTENTS

How to find your trigger points
Manual massage and "pressure points"
Vibration massage (best option)

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.

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/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.

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.

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.

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.