Manual Therapy & Fibromyalgia
When starting your treatment path at Colorado Fibromyalgia Center, your introduction to the manual therapy healing process begins with Dr. Dean Wright DC. The main goal when starting out treatment is to slowly sensitize the body to become comfortable with manual therapies, which have proven to be effective in the reduction of fibromyalgia pain symptoms.
The manual therapy treatment process that we take with fibromyalgia patients highly depends on the initial exam, where we ask questions about medical history and current pain levels to determine what therapies our patients. Depending on his initial findings, Dr. Wright will create a strategy using a combination of different manipulation techniques that will benefit pain symptoms, and not be overwhelming for the patient.
The information on this page highlights only a few of the tools / methodologies that are available to our patients being treated for fibromyalgia. Every patient will have unique goals and needs when it comes to manual therapy, and will be treated as so.
Spinal Cord Pathways
The spinal cord has three main pathways that transmit information from your body to your brain, and vice versa.
- Sensation Pathway: determines the feel of tactile touch, vibration, movement, and knowing where your body part is any given time.
- The Motor Pathway: responsible for movement, muscle control, and even bowel control.
- Pain Pathway: any type of traumas to the body such as physical trauma, burning, and exposure to chemicals.
Why are the pathways of the spinal cord important?
The Pain Pathway is important in Fibromyalgia patients because it is usually activated more often and the body uses it more than the other pathways, when compared to people that do not have fibromyalgia. This overuse of the pain pathway causes a crossover.
If someone is sensitive to touch or movement, the brain may be mistakenly interpreting these normal sensations through the pain pathway, resulting in pain during these seemingly normal activities.
Goal of Manual Therapies
The goal with chiropractic adjustments and soft tissue work (mobilization, dry needling, instrument assisted soft tissue mobilization, cupping, massage therapy) is to increase the sensation input, and decrease the pain pathway output. Overall, we are trying to normalize the nervous system, reduce joint pain, and improve mobility which decreases the localized pressure and compression in the areas surrounding the joints.
When looking at manipulations, we change the velocity and amplitude of the adjustment to fit our patient’s needs. The main types of adjustment utilized are High Velocity Low Amplitude (HVLA) and Low Velocity Low Amplitude (LVLA). When using a HVLA adjustment, this means that the adjustment is done quickly but at a very low amplitude and thrust. An LVLA adjustment means that it’s not as quick as adjustments at a higher velocity, and it is really working into the end range of the joint space / joint capsule.
The end range is important because once the joint reaches the maximum range of motion, that is the point where the chiropractic adjustment occurs. For example: if a patient has a significant amount of joint pain in the low back and hips, low velocity and low amplitude techniques can be used to get the joint to its maximum range of motion and make an adjustment while using a low amount of force that the patient will be able to handle without causing pain or a flareup.
Chiropractic adjustments are an excellent way to reduce the pressure and compression on joints and the surrounding areas, which results in reduced pain of not only the joint itself but the surrounding areas.
Instrument Assisted Soft Tissue Mobilization
This technique of soft tissue work utilizes different tools to aide in soft tissue therapies. Modern day instrument assisted soft tissue mobilization (IASTM) originated from an ancient Chinese technique called “Gua Sha” which used smooth edged instruments to press into the soft tissue for pain relief.
The goal with IASTM at Colorado Fibromyalgia Center is to address the connective tissue, sometimes called the soft tissue system or myofascial system. All the muscles in our body are covered in connective tissue which literally links our muscles together. It doesn’t contract like muscle tissue but holds things together. Overuse and injuries such as sprains, strains, tendinitis, and chronic tight muscles can cause this connective tissue to shorten and clump up together.
This shortening / clumping of the tissue is called scar tissue adhesions. Imagine after you have a cut, it scabs up and heals, and eventually a scar will form. The discoloration that is associated with scarring is tissue adhesions, which the body makes in response to mechanical trauma or tightness. The overall goal is to help break up the connective tissue that has formed adhesions and keep it smooth. These adhesions can be easily located with IASTM tools, as they often feels like gravel underneath the skin.
When receiving IASTM, tools are used to scrape the skin and break up the adhesions under the surface. The amount of pressure that is most effective creates what is called “petechiae” which is little red dots where micro trauma is caused to the skin, resulting in the capillaries (very small blood vessels) rupturing. When this happens, it tells us that the tissue adhesions are being broken down and healing is going to occur along with new blood flow.
The micro trauma that provokes a healing response is important because often times areas that are effected by chronic pain for long periods of time can become ignored by natural healing responses. The re stimulation of the area reminds your body of areas that it may have ignored in the past.
In patients with fibromyalgia, IASTM can be a good way to address the soft tissue especially since there is often facial (tissue) pain with fibromyalgia. Similar to manipulations, this also helps increase sensation input into the nervous system, attempting to stimulate the Sensation Pathway and reduce output of the Pain Pathway.
Common areas I would use it on include: elbows, rotator cuff, front of the shoulder, lumbar, spinal low back, knees, feet, and plantar fasciitis. Many fibro patients have lower arm pain from the elbows down to the hands, and we often find a lot of tissue changes in their lateral compartment and medial compartment, we have seen pain relief in a lot of our fibromyalgia patients with work in these areas.
Functional Dry Needling (FDN)
We determine if a patient is ready for FDN with an initial exam, and also noting how they are handling other manual therapy treatments. Many fibromyalgia patients have received some form of treatment at other clinics and we make sure to ask if a patient has received needling before. Sometimes a patient is not ready for dry needling based on their pain symptoms and risk of a flare up, which is ok – we want to help relieve pain symptoms not make them worse.
Functional Dry Needling (FDN) is the use of needles to treat trigger points, areas of increased muscle tightness, and muscle spasms. A trigger point is a collection of muscle tissue that when palpated or pressed upon increases localized pain, and sometimes referred pain to different areas. With fibromyalgia patients, we utilize FDN for these trigger points, which reduces muscle tightness and helps ease localized and referred pain.
Depending on what muscle group is being treated, for example, the shoulders need a smaller needle, compared to the glute muscles that need a larger one. When the needle is inserted, there may be a twitching response in the muscle, which is a good.
When patients are comfortable with dry needling and want to get the most out of treatment, we utilize electric stimulation in conjunction with the needle. The stimulation is precisely controlled.
What we are looking for when adding the stimulation is the muscle reacting (jumping) synchronously. For example, when a muscle reacts to stimulation with the pattern “tap-tap-tap-tap” it is synchronous, if it reacts “tap–tap—tap-tap”, this would be non-synchronous. Muscles that react with a non-synchronous pattern tell us that it is not activating correctly and may need some extra attention.
The stimulation also helps with muscles that are sedentary or have not been used as often, to be activated. The more a muscle is used the easier it is to fire up, and the dry needling with added stimulation helps retrain a muscles proper firing pattern.
Frequently Asked Questions (FAQ's)
The manual therapy treatment process that we take with fibromyalgia patients highly depends on the initial exam, where we ask questions about medical history and current pain levels to determine what therapies our patients. Depending on our initial findings we will create a strategy using a combination of different manipulation techniques that will benefit pain symptoms, and not be overwhelming for the patient.
If at any time our patients feel that manual therapies are too much, we will find a different approach that works, often less intensity and slower paced.
Throughout treatment, there are many therapy methodologies that we utilize to give our patients different options to managing pain symptoms.
The most effective manual therapy types are:
- Chiropractic Manipulation Therapy
- Massage Therapy
- Instrument Assisted Soft Tissue Mobilization
- Functional Dry Needling
- Myofascial Release
- Trigger Point Therapy
- Cupping Therapy
The goal with manual therapy is to increase the sensation input, and decrease the pain pathway output. Overall, we are trying to normalize the nervous system, reduce joint pain, and improve mobility which decreases the localized pressure and compression in the areas surrounding the joints.