How (myofascial) trigger points and other chronic myofascial issue cause fibromyalgia
Fibromyalgia is understood to be a sensitisation of the nervous system. Most cases of sensitisation are cause by prolonged or repeated exposure to something. In the case of Fibromyalgia researchers have found that the most common exposure is to chronic pain from (myofascial) trigger points. They call these “peripheral pain generators” and the sensitivity “central sensitisation”. The main evidence for this is:
- the neurological mechanisms have been established
- fibromyalgia sufferers are typically riddled with trigger points
- stimulation of trigger points reproduces fibromyalgia symptoms
- injection of trigger points with anaesthetic relieves fibromyalgia.
It is important to note that the nervous system has a large range of inputs so there are a large range of other possibilities, and sources can add together for a combined effect.
Undiagnosed myofascial pain labelled as fibromyalgia
Simply speaking the diagnostic criteria for fibromyalgia is widespread pain for which no cause can be found. Trigger points and other chronic myofascial issues cause pain, but do not show up in scans or laboratory test and GPs are not taught about them. Therefore it is common for people to be diagnosed with fibromyalgia when they really have chronic myofascial issues.
Removing the cause of sensitisation
Prolonged undiagnosed or poorly treated myofascial pain and the psychological stress this causes can eventually sensitise the nervous system, causing pain pain to be experienced at far higher levels. As a general rule medics treat this by either treating symptoms or lowering the sensitivity (activity) of the nervous system. On the other hand the researchers discussed above relieved the symptoms injecting the trigger points with lidocaine.They called this approach “eliminating the peripheral pain generators". The problem with their experimental approach is that the effects of lidocaine are only temporary. For a permanent solution one would need to eliminate the trigger points, which I will discuss in the next section.
Practical advice on using massage with fibromyalgia
Patient tolerance vs effectiveness
The trial results from using massage to relieve fibromyalgia have varied considerably. The main reasons are:
- The trigger points are the source of peripheral pain. Massage needs to target these rather than be superficial and soothing.
- Fibromyalgia sufferers are very sensitive so may not tolerate aggressive techniques.
If using conventional massage techniques it will be difficult (possibly impossible) to find a level that was effective yet tolerable.
The chronic nature of the trigger points
In a previous summary I discussed that courses of trigger point therapy typically just give symptomatic relief and do not eliminate the trigger points. Elimination requires repeated applications of therapy for long after the symptoms subside. Fibromyalgia will require even more applications over a longer time because:
- the myofascial issues will have been there longer and be more entrenched
- treatments may be restricted due to sensitivity
The potential massage solution
Start conservatively
The basic principle when using massage on fibromyalgia sufferers is to start very conservatively and gradually increase the therapy as the patient’s condition and tolerance improves. If the condition is aggravated let it settle then start again more conservatively.
Choose an easily tolerated therapy
It will be better to use therapies that are more easily tolerated. For example manual pressure techniques are generally painful so are unlikely to be tolerated by a sensitised person, whereas techniques such as laser or vibration massage that do not use physical penetration are more easily tolerated.
More frequent applications of therapy will likely be better. For example, smaller daily applications of therapy may be tolerated better than trying to accomplish the same with a weekly session.
The practicalities of a long process
For the reasons discussed above eliminating the peripheral pain generators fueling fibromyalgia (trigger points and other myofascial issues) can be a long process involving a very large number of applications of therapy. For most the only practical solution will include at least some supplementary home therapy. Of the home therapies available simple, the only well tolerated but very effective option is the use of vibration massage.
Vibration massage
Vibration massagers have a head or pad that sits on the surface and sends in therapeutic vibrations (like ultrasound). The therapeutic vibrations are very effective at treating trigger points, while because the heads do not physically penetrate and the vibrations are generally very comfortable this therapy is usually well tolerated.
Vibration massage is ideal for self use: basically all you need to do is sit the massager on the surface and let the vibrations penetrate. To illustrate the advantages of this consider a person who may only be able to tolerate a few minutes of low intensity therapy. It is unlikely that they would very frequently see a professional for this therapy, whereas they could easily do it at home several times a day if necessary. Fibromyalgia is a difficult and often complex condition so this self therapy should be under the guidance of a professional.
Massage guns are not suitable
Please note that massage guns or “percussion massagers” are not vibration massagers and not suitable for this therapy. As discussed in our guide Vibration vs percussion , massage guns are designed to pummel like jackhammers rather than send in therapeutic vibrations. Their pummelling will be harsh and not well tolerated, while any vibration they deliver will be limited and not at the proper therapeutic frequencies.
Try this therapy
P.S. If you or a colleague might benefit from this but do not have a genuine vibration massager please check out our Professional sample page .
