Fibromyalgia and Reflexology
By Marianna Mare
Literature Study
Fybromyalgia syndrome (FMS) is a condition of pain in the ligaments and muscles. The word ‘fybromyalgia’ is a combination of the Latin roots ‘fibro’ (connective fibres), ‘my’ (muscle), ‘al’ (pain), and ‘gia’ (condition of). The word syndrome simply means a group of signs and symptoms that occur together which characterise a particular abnormality. FMS is often mistakenly called arthritis.
It is a pain from the muscles, but there is no inflammation; in other words, rheumatism by not myositis or arthritis. Sometimes the pain can feel as if it comes from a joint, but that is because the muscles around the joint are painful.
FMS is a condition of general pain and fatigue. The pain can occur in almost any muscle, but is normally spread over the whole body and not confined to just one muscle. The pain can be continuous and can even become worse if you sit still or lie down, and it can keep you from your sleep. The less you sleep, the worse the pain becomes and the worse the pain becomes, the less you sleep.
Ant-inflammatories do not help this condition and analgesics often result in just moderate relief. Repeated movements such as painting or scrubbing make the pain in those muscles much worse and it often happens that fibromyalgia sufferers cannot perform their daily tasks. After awhile exercise also becomes more of a pain than anything else, so these people become all the more unfit. The muscles then become more susceptible to pain and a shortage of oxygen.
Causes
As yet, there is no one specific cause.
Medical examinations and blood tests usually produce nothing. Many of these people therefore are suspected of psychological problems, depression or attention seeking behaviour. “Many patients don’t even tell their doctors all of their symptoms because they sense the doctors disbelief… To make things even more confusing, the signs and symptoms can, and frequently do, fluctuate from hour to hour and day to day.” (Starlanyl, 1996, p8)
“According to a recent study in Sweden the pain develops if for any reason there is too little oxygen in the muscles….There is still uncertainty about the many possible causes. Poor posture and the manner in which these people do certain tasks with the same movements can cause the muscles to contract in an abnormal manner. This again causes the muscles to contract in knots in certain places. Such a ‘knotted’ muscle does not get enough oxygen. The muscle then sends warning signs to the brain and so it continues.
Specialists in Canada believe it happens because of an imbalance between the muscles that we use to move and those that enable us to keep our balance. If our posture or balancing muscles don’t do their work well enough, you must remain upright with your movement muscles. These movement muscles become tired and sore.” (Christiaan, 2001, p99)
Lamb states that “the cause of most, if not all, fibromyalgics pain is a combination of nerve and muscle dysfunction. The deep spinal muscles cause minor or even major nerve entrapment syndromes. Those nerve injuries will cause pain that refers into our limbs, head and body. They can create dizziness, ringing of ears, abdominal pain and bloating. Palpitations may be created by sympathetic exaggeration. Visual blurring may originate from neck problems.
The weakest segments of the spine are the base of the neck and back but the middle of the back is also commonly affected.
Fatigue occurs for several reasons, commonly because of protracted disruption of sleep due to stimulation from chronic pain. Muscles will tighten up when a nerve is pinched. Injury factors will determine the age of onset, the severity, and the pains associated with the condition.” (Blair Lamb, http://www.drlamb.com/curefibromyalgia.htm 19-05-03)
“FMS runs in the family. . . People with FMS seem to be born with the tendency to develop it. (Pelligrino, 1989)
In October 1997, the newsletter of the Fibromyalgia Network published information compiled from the more than 6,000 responses they had received to a survey questionnaire.
When asked whether they could identify events which had ‘triggered’ their condition, 59 per cent indicated they could identify the trigger. The following were listed:
physical injury 39 per cent (of the 59 % who could identify a trigger)
major emotional shock such as a bereavement 27 per cent
infection 15 per cent
surgery 9 per cent
exposure to chemical agent or drug 5 per cent
“Chances are that whatever it is that causes the immune system to become depressed enough to allow a constant viral activity also causes many of the symptoms of FMS - probably involving a combination of allergies, toxicity, deficiency, stress and so on. Latent viruses can become active, and in turn start including ‘flu-like’ symptoms of aches and pains, due to the release of chemicals called cytokines. The virus in such a situation is simply taking the opportunity of disturbed immune function to proliferate, and is not the cause of the problem.” (Chaitow, 2001, p60) To date, there is certainly no single virus connected with fibromyalgia, although work continues in search of an elusive culprit on whom to blame this widespread condition.
Maybe therapeutic ref lexology and meridian therapy can shed some new light on
fibromyalgia syndrome, bringing us closer to an understanding of our wonderful, but complex bodies and minds!
FMS and MPS
THE MYOFASCIA
One “part” that is never mentioned in elementary overviews of the body is the myofascia. Myofascia, a thin almost translucent film that wraps around muscle tissue, is the tissue that holds all the other parts together. It gives shape to and supports all of the body’s musculature.
For people with FMS the myofascia takes on a new importance:
When responding to stress, the body undergoes certain complex physiological changes that will enable it either to fight the stressor or flee from it. When some patients respond to repeated stressors with the fight or flight response again and again, calciphylaxis occurs in their tissues. Dr. Hans Selye, the “Father of Stress Theory”, defines calciphylaxis as “an induced hypersensitivity in which tissues respond to various challenging agents with sudden calcification” (Selye, 1975). It doesn’t matter whether the stressor is chronic illness, severe emotional trauma, or multiple injuries, repeated experience of the fight or flight response causes tissue changes.
It appears that this “calcification” or tightening in the myafascia occurs in many cases of FMS. When the myofascial tissues become thickened and lose their elasticity, the neurotransmitters’ ability to send and receive messages between the mind and body is damaged, and the communication between the mind and body is disrupted. Myafascia, then, may well be the key to what is wrong with people with FMS.
The fascial changes cause lumps and taut bands called trigger points (TrPs). Fascia changed in this way can entrap nerves, constrict blood vessels, and tighten around lymph vessels. That is why TrPs can cause many different kinds of symptoms. Fascia also forms adhesions and scar tissue. People with FMS seem to have a lot of thickened tissues. Once fascia changes, it needs help to return to its previous form. This is where bodywork is particularly helpful.
Unlike tender points - those used to diagnose FMS - (see later in this chapter), trigger points (TrPs) can and do refer to other parts of the body. Note that trigger points are not part of FMS. The trigger point is an exquisitely sore point that not only hurts where it is pressed, like an FMS tender point, but also “triggers” a referred pain pattern to somewhere else in the body. The term MPS refers to chronic, body-wide Myofascial Pain Syndrome. Trigger points form part of MPS.
To add to the diagnostic confusion, TrPs can often overlay FMS tender points, and in many patients FMS and MPS occur together.
DIFFERENCES BETWEEN FMS AND MPS
FMS and MPS are different syndromes. However, the vast majority of physicians tend to lump them together because they see many patients with the FMS I MPS Complex. (FMS and MPS not only occur together, they reinforce each other.)
One difference between the two is that muscles in locations that are some distance from the trigger points of MPS have normal sensitivity. In fibromyalgia, there is a generalized sensitivity. This means there is a body-wide, diffuse achiness with FMS, whereas with MPS there are specific pains in specific areas.
Fibrormyalgia is a biochemical disorder. It occurs as part of a biochemical imbalance, and we are far from understanding the “whys” of it. Myafascial Pain Syndrome, however, is a neuromuscular condition. MPS happens because of mechanical failures - the mechanics of physics, not biochemistry.
The Official Definition
At present there are no absolute diagnostic laboratory tests for FMS, only ones that rule out other conditions or suggest a possible diagnosis.
A far more satisfactory method of finding out what is going on is to use old-fashioned, low-tech interview, case history, examination and palpation (feeling the body by hand) methods, supported by tests that rule out other possible causes and help the practitioner to come to a diagnosis of what it is by a process of elimination.
Among the most common are:
blood tests
nutritional evaluation tests
X-rays
brain scans
electrical conduction tests
muscle enzyme assessments
analysis of stool samples
thermography
palpation
Many people suffer from generalized muscle aching and pain. However, this only officially becomes the medical condition labeled ‘fibromyalgia syndrome (FMS) when this aching muscle pain is accompanied by pain when pressure is applied to certain specific body areas. The most commonly accepted definition (devised by the American College or Rheumatology in 1990) is that a person has fibromyalgia when they show the following.
A history of widespread pain. Pain is considered ‘widespread’ when all of the following are present:
pain in the left side of the body
pain in the right side of the body
pain above the waist and pain below it
pain in the spine or the neck or front of the chest or thoracic spine or lower back.
Pain in 11 out of 18 tender point sites when these are pressed with the fingers. There should be pain on pressure (around 4 kg of pressure maximum) in no fewer than 11 of the following sites:
either side of the base of the skull, where the suboccipital muscles insert
either side of the neck, between the fifth and seventh cervical vertebrae
either side of the body on the midpoint of the muscle that runs from the neck to the shoulder (upper trapezius)
either side of the body on the origin of the muscle muscle that runs along the upper border of the shoulder blade (the supraspinatus)
either side, on the upper surface of the rib, where the second rib meets the breastbone, and in the pectoral muscle on the outer aspect of either elbow, just below the main bone which can be felt (epicondyle)
in the large buttock muscles, either side, on the upper outer aspect, in the fold in front of the muscle (gluteus medius)
just behind the large bump of either hip joint where the piriformis muscle inserts
on either knee, in the fatty pad just above the inner aspect of the joint.
When the specific sites are being pressed, some health-care professionals will also press ‘neutral’ or ‘dummy’ sites in order to see whether or not the person being assessed is suffering from a more widespread, generalized sensitivity that might be something other than fibromyalgia.
How many people are affected?
“FMS is a ‘chronic invisible illness. . . We think 4% or more of all people have FMS.” (Starlanyl, 2002)
According to leading medical experts, 10 per cent of young women with chronic muscuskeletal pain (aged 20 to 49) fully meet the strict criteria for the diagnosis of FMS.
“Experts say that there seems to be some variation in sensitivity of the tender points, due to age, sex and race. For example:
Caucasians (white people of European stock) report more tender point sensitivity than do black races or Hispanics
women report more tender points than men
the number of tender sites reported increased with age with the maximum noted around the age of 70, on average” (Chaitow, 2001, p5).
Aim
The aim of this project was to determine
The effect of therapeutic reflexology on the general condition of patients suffering from fibromyalgia syndrome,
Whether reflexology treatments could bring relief from symptoms of FMS,
Whether reflexology could reverse the process, and eliminate some of the causes of FMS.
Methodology
Ten patients diagnosed with fybromyalgia syndrome by their doctors, volunteered to be case studies for this project. They received reflexology treatments twice a week for 5 weeks, i.e. a series of 10 treatments.
Conclusion
There was a marked improvement in the general condition of all the patients.
Reflexology treatments can bring relief from some of the symptoms of FMS.
It was not possible to prove without a doubt, that reflexology can reverse the process, and eliminate some of the causes of FMS.
References
Published Sources:
CHAITOW, L. (2001). Fibromyalgia and Muscle Pain: Your Self-Treatment Guide, London: Thorsons
CHRISTIAAN, D. (2001). Lifetime Health, Cape Town: Tafelberg
DOUGANS, I. (1998). Reflexology A Practical Introduction, Shaftesbury: Element
SELYE, H. (1975). Hans Selye The Stress of My Life, New York: Van Nostrand-Reinholdt
STARLANYL, D. (1996). Fibromyalgia & Chronic Myofascial Pain Syndrome: A Survival Manual, Oakland: New Harbinger
THOMPSON, K. (1956). Great House, London: George G. Harrap
UNDERWOOD, JOE. (2000). General and Systemic Pathology (Third edition), London: Churchill Livingston
VAN ELFEN, J. (2001). Dokter in die Huis (Tweede uitgawe), Cape Town: Tafelberg STORMER, C. (1995). Reflexology, the definitive guide, London:Hodder & Stroughton
Articles:
Fibromyalgia Network Newsletter, 1993, 1994,1997
GOLDENBERO, 0. (1993). Fibromyalgia, chronic fatigue syndrome and myafascial pain
syndrome, Current Opinion in Rheumatology 1993, Vol. 5, pp. 199-208
LOWE, J. et al. (1997). Effectiveness and safety of T3 therapy for euthyroid fibromyalgia
Clinical Bulletin of Myofascial Therapy, Vol. 2, pp. 31-58
MACINTYRE, A. (1993). What causes M.E.? - The Immune Dysfunction Hypothesis Journal of Action for ME, 1993, Vol. 14, pp. 24-5
MOLDOFSKY, H. (1993). Fibromyalgia, sleep disorder and chronic fatigue syndrome, Ciba Foundation symposium 173. Chronic Fatigue Syndrome, 1993, pp. 262-79
PELLIGRINO, MJ. (1989). Familial occurrence of primary fibromyalgia. Archives of Physical Medicine and Rehabilitation, 1989 70 (1).
YUNUS, M. (1989). Fibromyalgia and other functional syndromes, Journal of Rheumatology Vol. 16, Supplement 19, No. 69
Internet:
STARLANYL, D. (2002). http://www.tidalweb.com/fms/rhg.shtml 31 January 2002
LAMB, B. (2003). http://www.drlamb.com/curefibromyalgia.htm. 19 June 2003