Issue link: https://www.massageandbodyworkdigital.com/i/766890
massage, except for Swedish massage, had a positive effect on fibromyalgia symptoms, but that myofascial release provided the most pain relief, followed by connective tissue massage. The most exciting aspect of the myofascial release studies was that in addition to short-term pain benefits, it provided durable pain reduction that persisted at one month and to a lesser extent at six months postintervention. 11 Myofascial release utilizes a combination of sustained manual traction and prolonged gentle stretching maneuvers to break up adhesions in the fascia. Essentially, the therapist slowly and gently tracts, then holds, the fascia at the barrier of resistance for 3–5 minutes to release "sticky" areas of excess collagen cross-links, called adhesions or restrictions. Connective tissue massage aims to produce an autonomic response by applying specialized strokes in areas of superficial fascia and at fascial attachments to bone. In the Yuan literature review, authors concluded that "although the focus of connective tissue massage differs from that of myofascial release, improvement in some outcomes might be explained by manipulation of the fascia in both styles." 12 Clinically, this is what we see on a daily basis with clients as well, especially when myofascial release is combined with self-care techniques between sessions. We've found that when clients are able to maintain the momentum of fascial realignment by replicating the gentle release of fascial restriction at home, their progress can be profound. And while releasing a fascial restriction in the thoracolumbar fascia of the lower back, for example, certainly provides pain relief in that area, connected tensions in the shoulder, neck, legs, or any other part of the body will reveal themselves. In this way, myofascial release can open up holding patterns from the chronically overactivated nervous system for the therapist to read and address. Moreover, we find a remarkable phenomenon occurs when the body begins to let go of these fascial holding patterns, some of which are decades- old: some of the original ability of the autonomic nervous system to fluidly balance sympathetic and parasympathetic returns, which can greatly lower the overactivated pain signal processing in fibromyalgia. The key to remember here is that the activation of the sympathetic nervous system makes pain signals louder, and activation of the parasympathetic response makes pain signals quieter. CHOOSING THE RIGHT TECHNIQUE As a bodyworker, consider fibromyalgia as inflamed and tight fascia along with a fight-or-flight response gone haywire. Modalities and techniques that gently stretch, release, and elongate fascia over 3–5 minutes are the most helpful (such as myofascial release), along with those that can calm the sympathetic nervous system (such as craniosacral therapy). Craniosacral therapy, developed from the osteopathic medical tradition, involves applying gentle manual pressure at the base of the skull and near the tailbone. Because the nerves of the parasympathetic (rest-and-digest) nervous system exit the spinal cord near the base of the skull (cranium) and near the tailbone (sacrum), gentle manipulation of fluid in those areas stimulates the relaxation response and lowers sympathetic nervous system activity. But what if you're not trained in these modalities? Can you still help clients with fibromyalgia? Of course! First, consider the specific pathophysiology of the disease. Remember that your fibromyalgia client has amplified pain signaling, and their body cannot recover from deep muscle manipulation in the same way a healthy client might. So, as much as the client may want a deep-tissue massage and feel they can grit their teeth through it, gently remind them that such a treatment may kick off a chain reaction in their nervous system that will lead to more pain. Next, consider receiving bodywork yourself from a therapist trained in myofascial release. As a bodyworker, you know there is no teacher quite like sensation. Allow yourself to feel what the release of fascial restrictions is like, and bring that intention to your work with fibromyalgia clients. If you perform Swedish massage primarily, focus on those strokes that give sustained pressure, and slow your pace way down. Again, think of de-escalating the autonomic nervous system. When you feel restriction in the tissue, keep a gentle pressure at that barrier, instead of pushing through it. After a couple minutes, you will feel a fascial release. It will feel like butter melting or taffy stretching. With fascia, gentle pressure plus time equals release. Also consider staying away from stimulating techniques such as tapotement, deep petrissage, or quick, pointed compression work. These strokes may not only hurt the fibromyalgia patient more during treatment, but can trigger a body- wide pain flare that may last for days. Instead, consider compression strokes that sink into the tissue very, very slowly. Addressing trigger points can also be helpful in fibromyalgia—just be sure to take a lot more time than you normally would. Make 52 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 7 Remember that your fibromyalgia client has amplified pain signaling and their body cannot recover from deep muscle manipulation in the same way a healthy client might.