Tuesday 21st September, 2021

Trigger point therapy for fibromyalgia: inc. self help advice

Trigger point therapy for fibromyalgia
Scientists recommend trigger point therapy for fibromyalgia

Trigger point therapy is not only good for fibromyalgia, scientists have found that trigger points are the main cause of fibromyalgia and treating them should be the first thing considered.

In this article we will go over why trigger points are the major cause of fibromyalgia, then discuss your best treatment options, including home trigger point therapy

CONTENTS

What are trigger points
How treating trigger points helps fibromyalgia
How to treat your trigger points for fibromyalgia
Your home trigger point therapy options
Professionals
Appendix: summary of the clinical trials of massage for fibromyalgia
Appendix: what the research says about individual trigger point therapies
References

What are trigger points

Trigger points are those tender lumps in your muscles that therapists find. For more information on them please see our article trigger point basics

How trigger points cause fibromyalgia

Fibromyalgia overview
An overview of fibromyalgia

Scientists have found that fibromyalgia is caused by your nervous system being bombarded by pain over long periods of time until it becomes sensitised and acts like an amplifier, making normal stimuli painful and pain to be much worse. The biggest source of this bombarding pain is trigger points. This is because they are arguably the largest cause of musculoskeletal pain such as back, neck and shoulder pain, yet are often not diagnosed or poorly treated. Please see our article How scientists have sucessfully treated fibromyalgia for more details.

How treating trigger points helps fibromyalgia

Fibromyalgia treatment: scientific
The way the scientists successfully treated fibromyalgia

Knowing the cause of fibromyalgia is continual bombardment with pain, the logical treatment is to stop that pain. Scientists did this. They stopped the trigger point pain by injecting the trigger points with anaesthetic (1)⁠. This not only relieved the pain from trigger points, it relieved fibromyalgia symptoms across the whole body. Knowing this, scientists recommended that the first thing to do when someone has fibromyalgia is to find and treat the trigger points.

A more practical alternative is needed

Injecting trigger points like the scientists did is a great way to prove that trigger points are the main cause of fibromyalgia, but it’s not practical to give sufferers multiple injections each day. Instead we need to actually eliminate the trigger points themselves. We’ll show you how to do this in the next section.

How to treat your trigger points for fibromyalgia

There are three basic things we need to consider to successfully treat your trigger points.

You need more than just therapies

Therapies are things like massage, laser, needles and vibration massage. Therapies are very important, but trigger points are usually part of a more complex musculoskeletal problem, plus there are usually things that cause or aggravate them. You’ll need some professional advice to help handle those other things.

Therapies usually just relieve pain

As discussed in our article Why trigger points keep coming back courses of trigger point therapy usually just relieve their pain, not get rid of the problem. To properly get rid of trigger points you will need to continue with those therapies over a long period of time, so the trigger points will continue to diminish and hopefully go altogether. Of course this will need a very large number of applications, which is why we provide our home therapy solutions. Otherwise, it will be very expensive and time consuming. To give you an idea of just how many applications of professional therapy are needed the following two appendices show what is typically used just to get temporary pain relief.

  1. Table: summary of clinical trials using massage for fibromyalgia
  2. summary of clinical trial results for common trigger point therapies

Fibromyalgia creates further complications

  1. Having been there longer the trigger points will be more entrenched and harder to treat.
  2. Because of sensitisation you will not tolerate therapy as well. Therapy usually needs to be more conservative at the start, then gradually increase in intensity as the condition improves.
  3. Sensitisation can create further complications.
Dr Graeme's comments
Dr Graeme's comments

I’m now going to share with you the best way to deal with trigger points of fibromyalgia properly, but in a way that is not horrendously expensive or time consuming. You will need some professional advice as just discussed, but the bulk of what you need will be trigger point therapy. If you can do a lot of that yourself at home you can make this very effective strategy very affordable.

What you need to do

The usual way of using professional help

What usually happens when you get professional help for trigger points is you see a professional and he or she spends most of their time applying massage, needles or whatever. As discussed, to properly deal with your trigger points you will need a large number of applications of therapy so this will become very expensive very fast, and as discussed in Why trigger point pain keeps coming back all you’ll likely get is temporary pain relief.

The more efficient alternative

Instead you use your professional’s time to do things like check you for bio-mechanical problems, doing some detective work to find the causes, and provide general management advice. You find a qualified professionals and discuss that as part of your management you will be doing a lot of the therapy yourself at home using one of the very effective home therapies we’re about to share.

Finding a professional

You’ll need to find an appropriate professional. I’m a Chiropractor. My colleagues and I spent five years in university learning about all those extra things, but there are also other professions. If your don't have a professional a good place to start would be the clinics that use and recommend our massagers. Go to our order page, select your country, the the clinic option.

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 (2) 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. Please note that you need a proper effective vibration massager. As discussed in our article Should I get a massage gun or a vibration massager most of the common massage guns and percussion massagers will be ineffective. This video shows our very effective vibration 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.

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.

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

14

Friction massage vs stretching vs analgesics

Uncertain

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

15

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

16

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

17

Swedish massage compared with standard physician care

Ten sessions over 24 weeks

Massage showed improvement, but only small numbers in trial

18

Combination of styles

30 minutes, twice a week for 5 weeks

Less, pain, less anxiety and better sleep

19

Myofascial release massage

Weekly 90 minute session for 20 weeks

Improved pain and quality of life

20

Myofascial release

Ten 60 minute sessions over 20 weeks

Less tender spots, improved physical function

21

Swedish massage vs myofascial release

90 minute session weekly for 4 weeks

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

12

Full body Shiatsu

Sixteen 40 minute sessions @ twice a week

Improved pain, tenderness and sleep

13

Mechanical massage device called Cellu M6

Fifteen weekly 35 minute sessions

Improved pain and function, and reduced number of trigger points

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 (3-9)⁠⁠.

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 (10)⁠ 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 (22)⁠ 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 (4)⁠ one study did show residual benefit after six months.

References

  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;
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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 . 2009;13(1):3–10.
  7. 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.
  8. 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.
  9. Rickards LD. The effectiveness of non-invasive treatments for active myofascial trigger point pain : A systematic review of the literature. 2006;9:120–36.
  10. 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.
  11. Uemoto L, Nascimento De Azevedo R, Almeida Alfaya T, Nunes Jardim Reis R, Depes De Gouvêa CV, Cavalcanti Garcia MA. Myofascial trigger point therapy: Laser therapy and dry needling. Curr Pain Headache Rep. 2013;17(9).
  12. Gordon C, Emiliozzi C, Zartarian M. Use of a mechanical massage technique in the treatment of fibromyalgia: A preliminary study:145–7.
  13. 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.
  14. Sunshine W. Fibromyalgia benefits from massage therapy and transcutaneous electrical stimulation. J Clin Rheumatol. 1996;2(1):18–22.
  15. Brattberg G. Connective tissue massage in the treatment of fibromyalgia. Eur J Pain. 1999;3(3):235–44.
  16. Alnigenis M. Massage Therapy in the Management of Fibromyalgia: A Pilot Study. J Musculoskelet Pain. 2001;9(2):55–67.
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. 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.
  22. 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.

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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



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