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How Shiatsu can help manage some of the symptoms associated with Fibromyalgia.

Fibromyalgia is a chronic condition of widespread pain and profound fatigue. The pain tends to be

felt as diffuse aching or burning, often described as head to toe. It may be worse at some times than

at others. It may also change location, usually becoming more severe in parts of the body that are

used most. The fatigue ranges from feeling tired, to the exhaustion of a flu like illness. It may come and go and people can suddenly feel drained of all energy as if someone just 'pulled the plug'.



Fibromyalgia is a common illness. In fact, it is more common than rheumatoid arthritis and can even be more painful, some sources put the prevalence of Fibromyalgia at between 2.9% and 4.7% of the adult population. People with mild to moderate cases of fibromyalgia are usually able to live a normal life, given the appropriate treatment. If symptoms are severe however, people may not be able to hold down a paying job or enjoy much of a social life. The name fibromyalgia is made up from “fibro” for fibrous tissues such as tendons and ligaments; “ my ” indicating muscles and “algia”  meaning pain.

Source:: Fibromyalgia Association UK, December 2013

" On Thursday I had my second treatment with Dan . With the first my pain eased and I had a really good nights sleep and had more energy the following days. I thought maybe just a coincidence. Following this one I sleep like a baby for 6 hrs and the next 2 days felt more alive, maybe because I had slept well ? I am going to try for 6 sessions ... 1 a month. To see if there any real improvement so it is a wait and see job . But like most people I will try anything to help "  Jenifer Fibromialgia sufferer, Matlock.

Shiatsu therapy focuses on releasing muscular shortness and tightness. There are a number of conditions and symptoms that Shiatsu therapy addresses and Fibromyalgia is one. Many patients seek Shiatsu after losing flexibility or function following an injury or if experiencing ongoing back, shoulder, hip, or virtually pain in any area containing soft tissue. Shiatsu treats skeletal muscle immobility and pain by relaxing contracted muscles, improving blood and lymphatic circulation, and stimulating the stretch reflex in muscles.  When I work with a client who has Fibromyalgia I work with the Fascia. The connective tissue overlying the musculoskeletal soft tissues known as fascia can dysfunction in Fibromyalgia. The fascial dysfunction in fibromyalgia leads to widespread pain and central sensitisation (Liptan et al. 2010).

In my treatments I incorporate Myofascial release, often used to treat fascial restrictions that occur with fibromyalgia, where the aim of treatment focuses primarily on muscle relaxation.  This involves direct mechanical stimulation of connective tissue, this can potentially reverse connective tissue fibrosis in fibromyalgia. Myofascial fibrotic changes can theoretically be treated by breaking up excessive collagen adhesions through soft-tissue and myofascial release techniques. If there is excess tension in the fascial system in fibromyalgia due to chronic sympathetic nervous dominance, manual therapy may also help reduce that tension (Liptan et al. 2010).


​When Shiatsu therapy is delivered to soft and connective tissues, local biochemical changes are stimulated. This helps to improve muscle flexibility, and modulate local blood and lymph circulation. (Li et al. 2014).

Shiatsu treatments help improve the microcirculation of the muscles and fascia causing better fluid exchange bringing more nutrients to the soft tissues and preventing the accumulation of inflammation. This is because the connective tissue (fascia) encasing the muscles in fibromyalgia develops entrapment patterns which can appear when a body segment stops receiving appropriate stimuli, establishing a pathological process with deficient circulation and limitation in nutrient supply to the fundamental substance of connective tissue, with its consequent dis-ease.

Some studies have found that Shiatsu therapy improved pain by modulating serotonin levels in patients with Fibromyalgia. The local effects may change neural activity at the spinal cord, which is responsible for both mood and pain perception. Some studies maintained that Shiatsu therapy resulted in the reduction in the H-reflex. A large reduction in the H-reflex would seem to be desirable, because spinal hyperexcitability is associated with a variety of chronic pain syndromes (Li et al. 2014).

How Often Might I Need Shiatsu massage for managing symptoms of Fibromyalgia?

Everyone’s requirements are different and treatment is tailored to your needs. Though it has been suggested that fibromyalgia massage needs to be painless and performed once or twice a week, with intensity increasing gradually according to symptoms (Kalichman, 2010). I take people on a case by case basis but tend to see people more regularly to begin with, say once a week then once a month unless symptoms flare.

Evidence Base for Fibromyalgia Massage?

A systematic review found positive evidence that massage therapy with a duration of 5 weeks had beneficial and immediate effects on improving pain, anxiety, and depression in patients with Fibromyalgia. Massage therapy should be one of the viable complementary and alternative treatments for Fibromyalgia. However, given fewer eligible random control trials (RCT's) in subgroup meta-analyses and no evidence in follow-up effects, large-scale RCTs with long follow-up are warrant to confirm the current findings of massage therapy for Fibromyalgia (Li et al. 2014).

Where as a long term, 20-week massage-myofascial release program significantly improved the pain, anxiety, quality of sleep, and quality of life in Fibromyalgia patients. The treatment reduced the sensitivity to pain at sensitive points, mainly at the lower cervicals, gluteal muscles, and right greater trochanter (Castro-Sánchez et al. 2011).

Multi-Disciplinary Management of Fibromyalgia

Ultimately managing this condition is going to involve multiple treatments and therapies, so this will involve psychologists to do cognitive behavioral therapy, exercise and medication prescribed by a GP or rheumatology specialist doctor.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (to address maladaptive thoughts) and stress-reduction techniques have been shown to be effective in some patients. Recognizing and addressing behavioral issues of catastrophizing behavior and learned helplessness can aid in focusing treatment on self-management technique (Hawkins, 2013).

Exercise

Aerobic exercise and muscle strength training can reverse deconditioning and improve sleep, pain, and function in patients with fibromyalgia. Patients who choose activities they like (eg, walking, pool exercise, group activities) and who start at low levels of exercise are more likely to be successful in managing their fibromyalgia in the long term. Exercise intensity should be increased very slowly to avoid injury and flares of pain, which may cause the patient to abandon the activity. Patients with good coping skills are most likely to adhere to an exercise program (Hawkins, 2013).

Antidepressants

Antidepressants appear to exert their effects by modulating serotonin and norepinephrine pathways. Tricyclic antidepressants (TCAs) such as amitriptyline, desipramine, and nortriptyline have been shown in short-term studies to improve pain, sleep, fatigue, and overall sense of well-being. However, they are associated with more adverse effects when used at higher doses.Tricyclic antidepressants are often prescribed initially for patients with fibromyalgia who do not have depression (Hawkins, 2013).

Antiepileptic Drugs

Pregabalin, which is approved by the US Food and Drug Administration for the management of fibromyalgia, and gabapentin appear to inhibit the release of pain pathway neurotransmitters, including substance P and glutamate.They have been demonstrated to improve pain, sleep, fatigue, and overall quality of life in patients with fibromyalgia (Hawkins, 2013).

Combined Treatment Safety


One pilot study showed that combined Shiatsu,Osteopathic Manual Manipulative treatment and gabapentin are safe and clinically efficacious treatment of pain and other constitutional and somatic symptoms associated with fibromyalgia (Marske et al. 2018).








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