Massage & Bodywork

JANUARY | FEBRUARY 2017

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C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 53 sure your client feels empowered to ask for less pressure, and respect it when they do. Lastly, try beginning and ending your session with "still touch" for 3–5 minutes, such as cradling the occiput with soft hands (with the client supine) or gently laying one hand on the sacrum and the other on the occiput (with the client prone). We find this leaves the client with an elevated parasympathetic response, which not only helps them feel calmer, but also reduces the tightness of their muscles and has the added benefit of lowering excess pain-signaling. TIPS AND TRICKS Finally, here are some tips and tricks we have learned the hard way about what works and does not work for fibromyalgia on the massage table: • Develop trust: even more than you normally would, develop a sense of trust with your fibromyalgia clients, ensuring they know you will ease up or stop when they ask. • Start and end gently: still touch is a great tool for calming an overactive sympathetic nervous system. • Don't rush: focus on fewer techniques done more slowly. With fascia, gentle pressure plus time equals release. • Don't get discouraged: bodywork for fibromyalgia is not easy. It may take time for you and your client to see significant results. • Assess the pelvis: tension and misalignment in the pelvis can cause pain everywhere in the body. Look at the tilt and rotation of the pelvis as a starting point for assessment. • Watch the prone position: don't let fibromyalgia clients lie for too long in the face cradle. Many have temporomandibular joint disorder and pelvic tension that can be exacerbated in the prone position. • Keep it warm: the fibromyalgia body does not like the cold; consider a table warmer. • Watch out for trigger points: these are common with fibromyalgia clients. When you find them, address them with sustained, focused pressure for at least 3 minutes. • Offer client homework: give guidance on self-treatment to do between sessions, such as stretching or applying gentle pressure from a soft ball into tight areas. Bodyworkers have an important role to play in helping fibromyalgia sufferers. With the right intention and some patience, you can make a huge difference in their daily lives. Feeling even a small measure of improvement can mean the world to these clients. Although we have found techniques that focus on releasing fascial restrictions to be the most helpful for fibromyalgia pain relief, we agree with the conclusion found by authors of the 2015 literature review article: "Overall, most styles of massage therapy consistently improved the quality of life of fibromyalgia patients." 13 Notes 1. C. Barbour, "Use of Complementary and Alternative Treatments by Individuals with Fibromyalgia Syndrome," Journal of the American Academy of Nurse Practitioners 12, no. 8 (August 2000): 311–16; D. L. Wahner- Roedler et al., "Use of Complementary and Alternative Therapies by Patients Referred to a Fibromyalgia Treatment Program at a Tertiary Care Center," Mayo Clinic Proceedings 80, no. 1 (January 2005): 55–60. 2. G. L. Liptan, "Fascia: A Missing Link in our Understanding of the Pathology of Fibromyalgia," Journal of Bodywork and Movement Therapies 14, no. 1 (January 2010): 3–12. 3. W. Klingler et al., "Clinical Relevance of Fascial Tissue and Dysfunctions," Current Pain and Headache Reports 18, no. 8 (2014): 439. 4. K. A. Sluka and D. J. Clauw, "Neurobiology of Fibromyalgia and Chronic Widespread Pain," Neuroscience 338 (December 2016): 114–129. 5. D. J. Torpy et al., "Responses of the Sympathetic Nervous System and the Hypothalamic- Pituitary-Adrenal Axis to Interleukin-6: A Pilot Study in Fibromyalgia," Arthritis and Rheumatology 43, no. 4 (April 2000): 872–80. 6. W. Klingler et al., "Clinical Relevance of Fascial Tissue and Dysfunctions," Current Pain and Headache Reports 18, no. 8 (2014): 439. 7. R. Kokebie et al., "Muscle Tension is Increased in Fibromyalgia: Use of a Pressure Gauge," American College of Rheumatology abstracts (2008): 685; L. Bazzichi et al., "Muscle Modifications in Fibromyalgic Patients Revealed by Surface Electromyography (SEMG) Analysis," BMC Musculoskeletal Disorders 10 (April 2009): 36; C. Anders, H. Sprott, and H. C. Scholle, "Surface EMG of the Lumbar Part of the Erector Trunci Muscle in Patients with Fibromyalgia," Clinical Experimental Rheumatology 19, no. 4 (July 2001): 453–55. 8. M. Spaeth et al., "Increase of Collagen IV in Skeletal Muscle of Fibromyalgia Patients," Journal of Musculoskeletal Pain 12 (2005): 67; M. Rüster et al., "Detection of Elevated N ε -carboxymethyllysine Levels in Muscular Tissue and Serum of Patients with Fibromyalgia," Scandinavian Journal of Rheumatology 34, no. 6 (2005): 460–63. 9. L. Chaitow and J. DeLany, Clinical Applications of Neuromuscular Techniques (London: Churchill Livingstone, 2000): 3. 10. S. L. Yuan, L. A. Matsutani, and A. P. Marques, "Effectiveness of Different Styles of Massage Therapy in Fibromyalgia: A Systematic Review and Meta-Analysis," Manual Therapy 20, no. 2 (April 2015): 257–64. 11. A. M. Castro-Sánchez et al., "Benefits of Massage- Myofascial Release Therapy on Pain, Anxiety, Quality of Sleep, Depression and Quality of Life in Patients with Fibromyalgia," Evidence-Based Complementary and Alternative Medicine (2011): 561753; A. M. Castro-Sánchez et al., "Effects of Myofascial Release Technique on Pain, Physical Function, and Postural Stability in Patients with Fibromyalgia: A Randomized Controlled Trial," Clinical Rehabilitation 25, no. 9 (September 2011): 800–13. 12. S. L. Yuan, L. A. Matsutani, and A. P. Marques, "Effectiveness of Different Styles of Massage Therapy in Fibromyalgia: A Systematic Review and Meta-Analysis." 13. Ibid. Jamie Liptan, LMT, with advanced training in the John F. Barnes Myofascial Release Technique, cofounded the Frida Center for Fibromyalgia with his wife, Ginevra Liptan, MD. The Frida Center (www.fridacenter.com) is a fibromyalgia specialty clinic named for Frida Kahlo, the Mexican artist who endured years of chronic pain and is thought to have been a fibromyalgia sufferer. Ginevra Liptan is a graduate of Tufts University School of Medicine, board-certified in internal medicine, and author of The FibroManual: A Complete Fibromyalgia Treatment Guide for You and Your Doctor (Ballantine Books, 2016).

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