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Needing advice from any who have experience working with fibromyalgia clients
I have a new client who has fairly severe firbomyalgia. Most of her pain is in her calves, just above her knee, her hands, and upper back.
I've just completed the second session. I did tell her (based on what I've read) that she may feel more pain after the first few sessions, but that it would lessen and help overall after many more sessions.
The site I went to recommended starting out twice a week. I've been using very gentle swedish massage, along with myofascial release.
She experiences pain, not during the massage, but immediately afterward. Then it gets better, and then worse again. I'm not sure if this is normal or not. It's hard to find concrete details on what to expect.
Can anyone suggest a good site on firbo that is from a massage perspective? Or share your own experiences with me?
For the second session I tried working on each area less, in case I spent too much time there and thus, aggravated the muscles.
I appreciate any advice you all have to give me. ~ Jennifer Baker LMT
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Permalink Reply by Gordon J. Wallis on
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These kind of questions are impossible to answer online. If I was there, I could offer advice. But, now Im just guessing, it sounds like trigger points to me. The last two fibro clients I had. One had it for 15 years. In six sessions I had her 80% pain free. The other one had three years of fibro. She is completely pain free now(six sessions). She has less pain in her body then me now. lol. It was all trigger points in both cases. Massive trigger points. Stings of them. One right next to the other. However both were very different. The 3 year person, most of her pain was on the right side of her back. Becasue it was one sided I had a completely different approach for her..The 15 year one , the pain was all over the body. And Im sure your client is different then both of mine. The 3 year client. Just touching her with light pressure made her jump. So I had to down grade her extreem sensitiveity before I could eliminate the trigger points ..It would take too long to type what I did. And then it may mean nothing for your client.. So maybe we can talk on the phone at some point. But one of the things I do is... For example.. You said her calves are an area of pain. Above her knee, her upper back, and her hands. I would palpate for the most tender spot within each of those areas. Let your client tell you the most tender spot within the painful areas. Thats what I do.. Then my objective is to downgrade or eliminate those most tender spots. Because when Im able to do that, I often eliminate the problem. As for specific techniques, thats difficult to say because Im not there. Find the most tender areas within the tender area..Note where they are.and we will go from there... Then maybe we can talk on the phone. Just typing here wont help much. My goal would be to find the most sensitive points within the painful area, and eliminate them. Finding them should not be difficult. Eliminateing them, could be. But if you can do that its over, usually.
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I havent read this book. Sounds comprehensive, and should help you, with your fibro client as well as others.
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Permalink Reply by Jennifer Baker on
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Thank-you for the great advice Gordon. Sorry, I was not able to reply to your response sooner. Since posting this, I've spoken with her again and was told that after the initial pain she experiences for a couple hours after each session, she is virtually pain-free for the next two days. Then, after this most recent session, she said the next day that there was no pain and whatever I did was 'bomb-diggity'. lol I find this very encouraging, but I will try what you suggested if I get to a point where I'm not really advancing in what I'm doing now.
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Permalink Reply by Gary W Addis, LMT on
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Jennifer, with that list of pain sites, she may have been misdiagnosed. Are you skilled in NMT trigger point therapies? The pain in hands is likely caused by trigger points. Look for them in scalenes, pec minor, coracobrachialis, upper serratus posterior, in the paraspinals. Calf pain, triggers in the soleus, or in the quads pulling on the gastroc origin. The reason it goes away then comes back, you may be partially releasing the triggers...either not finding the primary triggers or holding the pressure long enough or deep enough to kill the damned things.
Granted, her doctor may have diagnosed fibro-- when there's pain that they cannot fix, more and more of them are calling it fibromyalgia, telling them, Well, it's something you are going to have to live with.
Gordon Wallis has completed eliminated diagnosed fibromyalgia in several clients. I have myself treated a sister in law and a regular client by going after the trigger points, and one year in one case and 1 1/2 years in the other with no relapse.
MFR is great, and can in fact take out trigger points but the way most do MFR it's almost an accident. And it is usually more painful than just plain ol' ischemic compression on the specific spot.
My suggestion? Tell the client that if she can withstand a bit of pain, you can help her. Begin by locating the trigger points in the normal way, then creating a sensory nerve flood using very light rubbing in the area you'll be working--lighter than Swedish, just brisk rubbing to excite the skin's sensory nerves which will lessen the pain signal getting through. Then apply pressure to the trigger point(s). Note that there may be a primary and several satellite triggers in that area: find the most sensitive spot, and press and hold for a release (you can release a dozen satellites but if you don't take out the primary the satellites will reawaken.
Releasing trigger points doesn't have to be killer painful, Gordon knows some advanced techniques that require only very light, virtually pain free pressure. But he lives in Alaska. You'll have to rely on ischemic compression of 6-7 on the 10 pain scale.
I
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also available through kindle, and only $13.72:
http://www.amazon.com/Healing-through-Trigger-Therapy-ebook/dp/B00B...
It's about treating FM through trigger point therapy. An excerpt from it didn't impress me though.
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What I do, as far as a client thats seeing me because they hurt, is palpate their entire body, front, back, and sides for tender spots. Too many therapists are hung up on pain patterns. I have those charts, but I dont use them or refer to them while working. I just use them to show the client why they hurt. That its not in their head and they dont have to live with it. Despite all the other therapy they have had from other health care practioners that says otherwise. Reguardles of where the client hurts Im going to eliminate of down grade every tender area I find. I don't think or worry about pain patterns because where ever I find a tender area, thats what I want to eliminate or down grade. Because when Im able to do that, I often get positive clinical results. The client feels much better. And its unrealistic to think you can eliminate all the painful spots in one session, although that can happen. I take note of all the painful points and do my best to eliminate them. Thats how I judge if Im imporving their situation. I will have them come back withing two or three days for a follow up session.. Usually all the points will be down graded in intensity compared to the first visit, or some of them will be completely gone with only a few remaining. Usually within a few (three to seven) half hour sessions their pain problem is over if you have eliminated those tender spots. I have found that pretty much every other kind of health care practioner knows nothing about trigger point pain. Oh they all know the word, but they doint know.. If I palpate a client thats hurting at some level and I cant find painful or tender spots. Or Im not able to eliminate those tender spots within a few sessions. I probubly cant help them. After doing this for nearly thirty years I help a lot( 80%). I'm talking cure. I know there have been clients in the past that I could not help. But I bet I can help them now.. The more you do anything the better you get. I never want to come in here and tell people what to do. I just tell what I do. Thats all. But if you, with whatever techniques you have within your massage tool kit, are able to clean out those tender spots. You will get positive results for your client. I know that. Thats truth.
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Why don't Massage therapists claim it?
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Im just reposting an attachment that i think is important as far as our profession goes. We have within our license the abilities and leaglities , to eliminate 70% to 85% of all pain, period. The pain industry is now a 600 Billion dollar a year industry. Whats 70% of that? And everyone is complaining about Massage Envy? I think we need REAL organization?
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of course you're right, we do need the collective strength of the AMA and ABA. But we don't have their money, and money is their power. Have you noticed that almost all powerful groups are known by short, easily pronounced, easily recognized acronyms (AMA, ABA, ATA, USMC)? For us there's NCBTMB --who the hell can remember that mouthful!
Just as chiropractors, physical therapists, osteopaths are all separate organizations, I personally think that the energy modalities belong in a separate organization. But the flip side of that coin is that we should have just one certification bureau-- CST, NMT, MFR, Thai Massage, Russian Massage, Orthopedic Massage, Medical Massage, Ortho-Bionomy, AIS, PRRT, STR and a couple dozen others all have their own little certifications. I don't think clients should be expected to know the difference in all those techniques when they need pain relief. It's by accident that they stumble onto someone who can do what you do, Gordon. What I'm saying is that our profession does need an advanced certification.
But not one based on book knowledge. We are manual therapists; our license ought to be based on demonstrated palpatory skills and not on the ability to label the chambers of the heart. Almost all massage schools these days have a class in NMT and MFR, but how many can actually locate a trigger point and make it go away? Maybe one in 10? And I'm talking about only basic skill...the ability to use ischemic compression to dissolve trigger points. One in a thousand, if that, has the advanced skill set of a Gordon Wallis. The advanced certification ought to be based on abilities demonstrated in practical exams (hands' on exams of real people). All the little fiefdoms ought to be melded into a strong national organization. No state massage bureaus, no separately controlled certifications of this and that. All that should matter is the ability to relieve pain and stress and provide relaxation-- but I think a practicing professional ought to be able to provide all three.
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I called into work today asking about my schedule. I had only one 25 minute appointment at the end of my day. But thats a good one. She had some sort of spinal fusion done do to scoliosis several years ago. Anyway a year ago the right side of her back began to hurt very bad. So bad that she had to go to the emergency room. She had and MRI done, and they found nothing. Her medical doctors gave her pain meds, and later sent her to physical therapy because the pain would not go away. She went through twelve weeks of physical therapy that gave her no help what so ever. I think somebody refered her to me. She hurt in the mid to lower right quadrent of her back. I palpated her hips and back, well all her body eventually. I found one really painful spot at T12 on the right side spinal errectors and later after I had down graded that really bad T12 point another very tender spot just past the L5 sacrum junction on the sacrum. A total of two very nocioceptive spots. She flinched when I touched the T12 one. It was a bit of a process finding the sacrum one. It went unnoticed because of the intensity of the T12 trigger point. After I had substancially down graded the T12 trigger point I had her roll over on her back so I could do some neck work and release any kind of emotional stress tension there along with massaging her head and scalp...After a few minutes of me working on her neck and scalp she said that her low back is now aching. So I knew something else was wrong.. Hopefully a trigger point that I had missed. And thats when I found the sacrum one. She had this pain for a year. So I said come back tomorrow for 15 minutes and we will work those two trigger points again.. She came in the next day with a Big Smile.. 90% of her pain was gone.. Ive never seen a happier women. The two trigger points were still there, but I had to really search and press firmly to find them. I released them again.. I told her to come in again for 15 minutes a couple days from now.. And thats today. I just want to make sure those two tender areas heal and go away. But its over for her. I mean all that money on MRIs , medical doctors, three moths of physical therapy. How many thousands of dollars is that? I think Im going to make a total of mybe $80 bucks out of the whole thing. Im not complaining I got a very big smile from that women, and she knows the truth. Most pain is from trigger points.
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Another attachment.
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Permalink Reply by Therese Schwartz on
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Gordon, thanks to all your posts with attachments, I've been getting even more successful at helping my clients.
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