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The word fibromyalgia comes from the Latin
term for fibrous tissue (fibro) and the Greek
ones for muscle (myo) and pain (algia).
Fibromyalgia syndrome is chronic disorder which includes
widespread muscle pain, fatigue, and multiple tender
points that affects 3-6 million people in the United
States. For reasons that are unclear, more than 90% of
those who develop fibromyalgia are women. It is not
currently known whether the predominance of women who
suffer from fibromyalgia is a phenomenon of the
socialization of women in the American culture or
whether it is some combination of the female
reproductive hormones and other genetic predispositions.
According to the American College of Rheumatology
(ACR), fibromyalgia is defined as a history of pain in
all four quadrants of the body lasting more than 3
months. Pain in all four quadrants means that you have
pain in both your right and left sides, as well as above
and below the waist. The ACR also described 18
characteristic tender points on the body that are
associated with fibromyalgia. In order to be diagnosed
with fibromyalgia, a person must have 11 or more tender
points. In addition to pain and fatigue, people who have
fibromyalgia may experience:
- sleep disturbances
- morning stiffness
- headaches
- irritable bowel syndrome
- painful menstrual periods
- numbness or tingling of the extremities
- restless legs syndrome
- temperature sensitivity
- cognitive and memory problems (sometimes
referred to as "fibro fog")
Fibromyalgia is often confused with another condition
called “myofascial pain syndrome” or “myofascitis.” Both
fibromyalgia and myofascitis can cause pain in all four
quadrants of the body and tend to have similar tender
point locations, but the two conditions are worlds
apart. Myofascitis is an inflammatory condition due to
overuse or injury to your muscles, whereas fibromyalgia
is caused by a stress-induced change in metabolism and
healing. Myofascitis tend to come on rather suddenly and
is usually associated with a particular activity or
injury, true fibromyalgia has a slow, insidious onset,
usually beginning in early adulthood. It is very
important to diagnose each of these correctly, for they
require very different approaches to treatment.
Unfortunately, fibromyalgia is a chronic condition,
meaning it lasts a long time - possibly a lifetime.
However. it won't cause damage to your joints, muscles,
or internal organs.
The Basics of Fibromyalgia
The latest research indicates that fibromyalgia is a
stress-related condition that is a cousin in Systemic
Lupus Erythematosis (often referred to as simply
‘lupus’) and Chronic Fatigue Syndrome. In all three of
these conditions, there is the same predominantly female
distribution, chronic fatigue, sleep disturbances,
irritable bowel, as well as many other similarities. You
can think about these three conditions as lying on a
continuum with Fibromyalgia on one end, Lupus on the
other and Chronic Fatigue Syndrome in the middle. All
three of these conditions are caused by an abnormal
stress response in the body, but with Lupus, the immune
system is primarily affected, causing an autoimmune
reaction that attacks your healthy tissues. On the other
end of the spectrum is fibromyalgia, where metabolic
abnormalities are primary. These metabolic changes are
the result of a stress-induced decrease in blood flow to
an area of the brain called the pituitary. This, in turn
causes a decrease in a number of important hormones,
such as the growth hormone releasing hormone
(somatotropin) and the thyroid stimulating hormone.
These hormonal changes lead to abnormal muscle healing,
borderline or full-blown hypothyroid, as well as memory
and cognitive changes.
One of the major physical abnormalities that occurs
with fibromyalgia lies in the muscle itself, where there
is a build up of a protein called “Ground Substance.”
Ground substance is normally found in muscle, bone and
connective tissue all over the body and is responsible
for making the tissues stronger and less susceptible to
tearing. In a normal person, when a muscle is injured,
the muscle tissue itself is able to regenerate and over
time, completely heal itself. In a person with
fibromyalgia, the muscle is unable to completely heal
itself. Instead, an abnormally large amount of ground
substance builds up in the injured area. It is the
ground substance, coupled with local muscle spasm it
creates that creates the muscle ‘knots’ associated with
fibromyalgia.
A number of tests may be done to rule out other
disorders and an examination can reveal whether a person
has the characteristic tender areas on the back of the
neck, shoulders, sternum, lower back, hips, shins,
elbows, or knees. Unlike its cousin lupus, there are
currently no diagnostic laboratory tests for
fibromyalgia. Because there are no clinical tests for
fibromyalgia, some doctors, unfortunately, conclude that
a patient's pain is not real, or they may tell them that
there is little they can do. But a combination of
chiropractic, trigger point therapy, and lifestyle
changes has proven to be very effective in decreasing
the severity and duration of the physical pain and
disability of fibromyalgia.
Fibromyalgia can be difficult to treat. Not all
doctors are familiar with fibromyalgia and its
treatment, so it is important to find a doctor who is.
Fibromyalgia treatment often requires a team approach,
utilizing chiropractic care, trigger point therapy,
massage, dietary changes, as well as exercises and
stretching.
Treating Fibromyalgia With Chiropractic
Chiropractic care is critical for those who suffer
from fibromyalgia in order to keep the spine and muscles
from losing too much movement. Because fibromyalgia
causes the muscles to tighten up and lose some of their
natural pliability, it results in a global loss of
movement in the spine. The loss of movement in the spine
results in a neurological reflex that causes the muscles
to tighten further. This vicious cycle will continue and
over time will lead to increased pain, increased muscle
tightness, a loss of movement, more difficulty sleeping
and the development of more and more trigger points.
The only option is to continually adjust the spine
and keep it moving. It is not uncommon for those with
fibromyalgia to be adjusted three to four times per
month to keep everything mobile and relaxed. The biggest
concern in treating people with fibromyalgia is that
their muscles have a diminished healing ability. For
this reason, chiropractic adjustments are usually
modified slightly to be more gentle than normal. This
helps to decrease the stress on all of the small
supporting muscles of the spine, which can be easily
injured. It is important when seeking chiropractic care,
to make sure that the doctor is familiar with the
muscular changes that occur with fibromyalgia so that
they can adjust their treatment accordingly.
Treating Fibromyalgia with Trigger Point Therapy
The overwhelming characteristic of fibromyalgia is
long-standing, body-wide pain with defined tender
points, and frequently, trigger points. Trigger points
are often confused with “tender points.” They are not
the same. A trigger point needs firm pressure to elicit
pain, while tender points are painful with even very
light pressure. Trigger points will refer pain to other
areas of the body, whereas tender points will not.
Unlike tender points, trigger points can occur in
isolation and represent a source of radiating pain, even
in the absence of direct pressure. As discussed earlier,
trigger points are purely comprised of spasmed muscle
fibers, whereas tender points are knots filled with
ground substance. Those with fibromyalgia almost always
have a combination of the two – trigger points and
tender points – and can improve dramatically with light
trigger point therapy.
Trigger point therapy for fibromyalgia is much like
trigger point therapy for low back pain, neck pain or
headaches. The points are the same. The difference is
just intensity. Since the muscles in patients with
fibromyalgia are easily injured and take longer to heal,
it is necessary to use less pressure on their trigger
points.
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