A client who presents consistently with widespread pain or fatigue might be suffering from fibromyalgia or chronic fatigue syndrome (or both). Myofascial release can be effective for addressing fibromyalgia and chronic fatigue syndrome. As when any underlying medical condition is present, the client should obtain a diagnosis before beginning a course of hands-on bodywork.
What are Fibromyalgia & Chronic Fatigue Syndrome?
Fibromyalgia and chronic fatigue syndrome are both marked by chronic pain and fatigue, and both are underdiagnosed conditions. (Chronic fatigue syndrome alone is misdiagnosed as depression as much as 80% of the time by physicians, according to the National Institutes of Health.) Fibromyalgia affects about 4 million U.S. adults, or about 2% of the adult population.
Between 836,000 and 2.5 million Americans have chronic fatigue syndrome, also known as myalgic encephalomyelitis, and 25% of people with chronic fatigue syndrome become bedbound or housebound at some point, with most never regaining their pre-disease level of functioning.
Fibromyalgia and chronic fatigue syndrome symptoms are remarkably similar. A person presenting with either condition can have pain throughout their body, headaches, joint tightness, limited range of motion, elimination problems, menstrual pain, depression, anxiety, exhaustion, sleep problems, mental lethargy and what has been called fibro fog or brain fog.
Myofascial release combined with massage therapy can be helpful in a short period of time for most people who present with these diagnoses. One systematic review, for example, determined there was “[a] large significant effect of myofascial release on pain post-treatment and a moderate effect at six months post-treatment.”
Most people with these diagnoses are exhausted, depressed and anxious. They have difficulty going to sleep and getting rest because of fascial restrictions that have not been recognized or properly treated.
Unfortunately, many fibromyalgia and chronic fatigue syndrome sufferers are told by their doctors that they will never get better or will never walk again. Therefore, we have to let clients know they are not their condition; they are powerful human beings.
Check for Glide
When a person lies down, the restrictions of the fascia can pull the joints together, which puts pressure on nerves, which affects sleep. Fibromyalgia and chronic fatigue clients often do not achieve the deep REM sleep they need for rejuvenation. Too many times, clients report that they wake up more tired than when they went to bed. Life can be quite a downward spiral for this clientele.
Clients can be very tender to touch, so using lighter myofascial release techniques, which include gentle, constant pressure, held until tightness releases, can be very helpful. A tactile examination will find the areas that are hot, hard, tender or immobile.
The fascial system is a glide system, so you are always checking for glide or lack of glide. Wherever the motion is blocked is where they have fascial restrictions. This gives the therapist uncanny accuracy as to where to treat a client, and changes to motion will morph constantly.
We have close to 8 billion people in the world today; therefore, we have close to 8 billion unique fascial train patterns. This is why the protocols we learned have nothing to do with the person lying on the table.
In fact, the art of myofascial release is learning to quiet your mind as the therapist. You always move slowly. When myofascial release is done properly, you never use force, because too much force throws the client into mental protection.
We find the barrier that is unique to each client and we apply gentle but firm sustained pressure. As the fascia releases, there is a feeling similar to butter melting or taffy stretching. You don’t slide, you just take the slack out, because there are multiple barriers in most people.
Inflammation
Inflammation is an important part of the healing process, but when it becomes thwarted, it shuts the inflammatory process down and the ground substance of fascia, which is meant to be fluid, becomes increasingly viscous. Over time, the ground substance turns into hardened tissue with a crushing pressure on pain-sensitive structures.
Fascial restrictions can generate up to approximately 2,000 pounds of pressure per square inch. This crushing pressure does not show up on standard testing like X-rays, myelograms, CAT scans or bloodwork. Myofascial release is important for clients’ recovery because its sustained pressure will release interleukin 8, which mediates the body’s inflammatory response.
Cumulative Microtrauma
In my experience, approximately 90% of clients who present with fibromyalgia or chronic fatigue syndrome have torsion in their pelvis. Commonly, the right ilia anteriorly rotates. As that occurs, the acetabulum drops down, lengthening the leg on that side.
Because we are bilateral beings, the left side tends to posterior rotate, pulling the acetabulum up on the left side, shortening the leg on that side. This sends microtrauma down through the joints with every step the client takes.
This microtrauma is cumulative. It builds and builds until the tipping point is hit and the client moves into massive dysfunction. As the pelvis torques, the pubic symphysis is forced to shear, so the client’s subconscious interprets, now that it is shearing, that it is very unstable. This sets the client up for a fight-flight-freeze response.
Then we have the other part of the scenario with a long and short leg, and so with every step the client takes, the subconscious is perceiving that the world is not under them and exaggerates the fight-flight-freeze response.
Ultimately, this whole-body torsion creates exhaustion, pain and tightness throughout the body in a very unique way. Eventually the exhaustion leads to anxiety and depression for many people.
Myofascial structural work, myofascial unwinding or myofascial rebounding allow the pelvis to level again and be mobile again. The legs will even out and the fight-flight-freeze response will be relinquished. What is amazing is that many times, people report their depression has lifted and they are not anxious anymore. They feel more like themselves again.
The Emotional Component
Most people with chronic pain and headaches, particularly those with fibromyalgia or chronic fatigue syndrome, are locked into a fight-flight-freeze response. They are in a state of mental hypervigilance, their internal alarms ringing as if danger is present constantly—and they have no conscious control over it. As long as one is in a fight-flight-freeze response, no healing is possible.
This creates what I call the broken-record effect, where the original problem that initiated everything keeps playing over and over again at the subconscious level. In other words, the person is constantly bracing internally from the car that hit them, their fall down the steps, a very difficult delivery or being attacked. They move into a state of exhaustion, anxiety and depression.
In my experience, clients who present with fibromyalgia or chronic fatigue syndrome are stuck in a rational state. This is a very simplistic yet quite accurate way of viewing trauma and the mental state of most people. Our rational state is the basis of all of our education. It is the basis of health care, which demands order and control, which would be fine it if worked; unfortunately, many times it doesn’t work well.
The power and beauty of myofascial release is that it allows the individual to move out of the rational state in a very safe, efficient and effective way, into their intuitive and instinctive side. This is the healing zone. Our intuitive, instinctive side is home to our feeling intelligence.
Another word for intuition and instinct is wisdom, which I believe we were all born with. Intuition is one of our most valuable faculties, and what I consider to be the highest form of intelligence.
Although you cannot guarantee anything in health care, there is hope for those suffering with fibromyalgia or chronic pain syndrome who seek a combination of massage and myofascial release.
About the Author
John F. Barnes, PT, is an internationally recognized physical therapist, lecturer, author and leading authority on myofascial release. Through his 50 years of experience and creative insight, he has developed an innovative and highly effective whole-body approach for the evaluation and treatment of pain and dysfunction.