Needing advice from any who have experience working with fibromyalgia clients

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Permalink Reply by Gary W Addis, LMT on July 30, 2013 at 11:47pm

Sorry, I do not palpate the kidneys: I am a massage therapist, I work with the myofascial systems. 

Textbooks tell me that the immune system is "on" all the time, that if it is off, the body will soon fall victim to numerous diseases.  Likewise, overproduction of the immune response can cause numerous problems, such as rheumatoid arthritis and psoriasis.  Textbooks also inform me that the adrenal gland is not in control of the immune system or any other gland other than itself--and not even that.  Hypothalamus controls the pituitary which controls the rest of the endocrine system. BTW, most of the immune system is on autopilot.  White corpuscles form a significant portion of blood; immune system antibodies are always on patrol against invaders-- once active, they are active.

FM is felt in the myofascial system, if it affects internal organs I've never seen research indicating this.  It is diagnosed not with tongue depressors or blood tests or peeing in a bottle: it is diagnosed by palpating 18 specific trigger points; if 11 or more of the 18 are painful for 3 or more months, then it's labeled FM.  Inflamed? well, perhaps, but only in the manner that trigger points are inflamed, which is to say only in the very small area of the trigger point.  Inflammation is measurable with medical diagnostic tests; if doctors have ever diagnosed FM as a causative factor in the formation of inflammation (or vice-versa) they're keeping it a secret.

The description of fibromyalgia as adrenal dysfunction is incompatible with what scads of researchers have concluded and skilled therapists  (including moi) have discovered by palpating FM patients.  In my experience, the quickest way to quieten the pain delivery system is by light, vigorous rubbing before palpating trigger points. In the same way that a TENS unit works, this brisk rubbing will temporarily overload the nerves, and temporarily partially block the pain signal, allowing the therapist to work without the client jumping off the table.  Gordon Wallis uses very specialized, advanced techniques; his trigger point therapy is essentially painless.  Me? I begin with the vigorous rubbing-- not massage, a lighter touch than massage-- and when the client can tolerate light to medium pressure, I begin treating and releasing trigger points.  The therapy goes quicker if the client can grit the teeth and withstand a bit of pain.  I'm careful not to overtax the client during a session...what Gordon can accomplish in 1-2-3 sessions takes me much, much longer, but eventually none of the client's 18 trigger points produce the pain response when pressed for a few consecutive sessions.  At that point, the client may not need to schedule another session for months. 

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Permalink Reply by Wilson Jordan on July 31, 2013 at 12:17am

you cant palpate the pituitary or the hypothalamus; but you are incorrect when you say you are a massage therapist and you don't palpate the adrenals/kidneys but you will affirm that you palpate the intestines; why the over favoritism toward one organ that you know a bit about and one that you claim you don't palpate, even though you do because it is impossible to rub or massage the low back without feeling them; and to not be able to palpate them is an even more dangerous thing.  As a massage therapist you are responsible for knowing the body; not just where endangerments are located but what a healthy endangerment area feels like versus a problematic one. So, first off I couldn't disagree with you more.

Next, the immune system is on auto pilot as long as it is on. When it is off for whatever duration it is also automatically off because something triggers that switch.  What triggers the body into flight auto pilots and triggers the auto immune to off. Why else would something like Aids be so radical.  We can trade sources about this or go on in either direction with another part of my response.

You are making FM the cause; we are not born with FM; it has to develop from somewhere. That somewhere is the cause not FM. Treating the FM is like treating the sore throat when a cold is present. For example with FM there is always a swelling of the tissue, over sensitivity and tightness. Those are the symptoms they all vary in degrees but they don't disappear. Can we agree on that.  Swelling indicates inflammation, sensitivity indicates nerve irritation and tightness along with inflammation indicates cramping. Can we agree so far. I'm going step by step. We must leave the books and tell the truth about what our hands our experiencing. And, when and if we are not absolute certain then we ask.

So going back to the origins of FB, if you accept that it is just the pitutitary and hypothalmous and not the entire Endocrine system then you have just back yourself out of a job. Because you have no access to truly remedy the situation. The Adreanals are the bodyworker's avenue into the Endocrine system (pituitary & hypothalmus).  When looking at any problem the problem shows up because something else is over doing it or under doing it. There is no other problem that the body can have. Tracing back to source is the challenge. Getting there is one thing then arriving and knowing what to do is another. FM is frustrating when chased like a cold because then it makes no sense. But it is never the condition that makes no sense it is always us practitioners.  FM is still being treated like a disease by therapist and M.D.'s and it is not it is a condition where specific systems have gone haywire.

Trigger Points, from whence do they come. They are not causal either but always symptomatic responses to overload on a path that one or more nerves travel. So to rely upon Trigger Points telling you anything more than that is skeptical at best. That is not to say Trigger Points are not of value but for assessment purposes they are a dime a dozen as with FM and other conditions. But for the sake of conversation lets say yea for TP's as indicator of sometime more than nerve channel and flow being irritated.  

No inflammation can be palpated and I'm will to bet my life that you are already palpating the kind of inflammation found in a Trigger Point but do not realize it, because you may have never been taught how to recognize it with your hands.  Okay, I have kept reading and see where we agree that FM is not the cause.

When inflammation is present friction of any kind can only create more inflammation and more scar tissue.  It doesn't matter if it is brisk, gentle, firm it is still friction against and inflamed state. Go back to inflammation stages one O one.  Three stages of inflammation, acute, subacute, and chronic and what constitutes each.  If something is already inflamed then it has to be contra to anything that might even further inflame it.  Following the Trigger Point pattern is okay for a region but then that means that you are going to TP the entire body.  That's kind of over load.  

The pain delivery system (nervous and endocrine), somehow you landed there. I must admit I don't know how and it is not important what is that you sought to quiet the delivery system. Addressing the nervous (via TP's) is right on. My question is how do you know whether or not you have addressed all of the pain delivery systems.

Until you quiet all the roots of the pain delivery system your clients will have to continue seeing you for that condition, and the same is true for all conditions. I wanted to offer another way of looking even deeper at FM and moreso the body.

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Permalink Reply by Gordon J. Wallis on July 31, 2013 at 1:33am

If the person in pain has trigger points.  And 70% to 85% of the time trigger points are the cause of the pain.  And 93% of the time they are involved in all pain syndromes.  So no matter how you go about getting positive clinical results. Those trigger points have to be gone.  Sometimes when working with a real sensitive fibromyalgia client. I have to calm the hpersensity fight of flight nervous system down. I do that by using a specific pattern of light skin touching around the body for a half hour.  I turn into a tens unit.  Real nociceptive pain travels four times slower to the brain then that of light skin touching and caressing.  They basically go to the same receptors. A lot of the pain is blocked.  Then after calming the nervous system down I'm able to address the trigger points.  And once those things start going away, there is even more calming and a rebalancing of the entire body/mind.    Thats the direction I take.  Not that any one else has too.  lol

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Permalink Reply by Gordon J. Wallis on July 31, 2013 at 2:02am

http://m.youtube.com/watch?v=QR5FYag58Oc&desktop_uri=%2Fwatch%3...

I calm a hyperactive pain delivery system down by utilizing the information in that youtube video.  

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Permalink Reply by Gary W Addis, LMT on July 31, 2013 at 2:04am

I'm posting my response within your posting, offset with bolding

Wilson Jordan said:

you cant palpate the pituitary or the hypothalamus; but you are incorrect when you say you are a massage therapist and you don't palpate the adrenals/kidneys but you will affirm that you palpate the intestines; why the over favoritism toward one organ that you know a bit about and one that you claim you don't palpate, even though you do because it is impossible to rub or massage the low back without feeling them; and to not be able to palpate them is an even more dangerous thing.  As a massage therapist you are responsible for knowing the body; not just where endangerments are located but what a healthy endangerment area feels like versus a problematic one. So, first off I couldn't disagree with you more.

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Gary replies...

///   Sigh.  I assure you that I know all I am required to know about the human anatomy, including the internal organs.  The intestines are movable within their cavity, and by the way, they are contain muscle.  The adrenals and the kidneys they adhere to are not mobile, they are not protected by abdominals and obliques.  A punch to the kidneys can kill, even a light bump can cause you to bleed into your urine for a week.  FYI, I say once again: I am a massage therapist, one certified in neuromuscular therapy and MFR.  I don't administer drugs, I don't conduct laboratory exams, I do not palpate internal organs, not even remotely using Chinese energy fields. Please don't assume that you are the teacher here and I your student.///
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Wilson again:

Next, the immune system is on auto pilot as long as it is on. When it is off for whatever duration it is also automatically off because something triggers that switch.  What triggers the body into flight auto pilots and triggers the auto immune to off. Why else would something like Aids be so radical.  We can trade sources about this or go on in either direction with another part of my response.

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// The immune system does not switch off-- it cannot.  Antibodies are formed as a result of the immune system's defeat of an invader, so that the next time that particular invader gets in, it will be destroyed immediately.  A short lesson in AIDS: the immune system is NOT switched off by it, it is attacked by the AIDS virus, rendering it ineffective, but if it were switched off the patient would die within the first day without treatment, instead of months or years.  In order to "switch off" the immune system billions of white corpuscles in the blood system and organs and macrophages in the lymphatic system would have to receive a simultaneous order to shut down (and they are living cells that act independently under the parameters of their DNA).  But that is beside the point.  You claimed that the adrenal system somehow orders the immune system to shut down. And, frankly, I find that statement to be  asinine.
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You are making FM the cause; we are not born with FM; it has to develop from somewhere. That somewhere is the cause not FM. Treating the FM is like treating the sore throat when a cold is present. For example with FM there is always a swelling of the tissue, over sensitivity and tightness. Those are the symptoms they all vary in degrees but they don't disappear. Can we agree on that.  Swelling indicates inflammation, sensitivity indicates nerve irritation and tightness along with inflammation indicates cramping. Can we agree so far. I'm going step by step. We must leave the books and tell the truth about what our hands our experiencing. And, when and if we are not absolute certain then we ask.

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I said "TPs inflamed" as a sop to your ego.  According to all the sources I've found, TPs are not accompanied by inflammation.  TPs may form as an after effect of the inflammation that accompanies the healing process, but TPs do not create inflammation. 

By the way, your "Can we agree so far" statements I find to be condescending, as if you are instructing an imbecilic student.  Which I most assuredly am not.  And, frankly, I haven't read anything you've written so far to indicate that you are qualified to teach.

So going back to the origins of FB, if you accept that it is just the pitutitary and hypothalmous and not the entire Endocrine system then you have just back yourself out of a job. Because you have no access to truly remedy the situation. The Adreanals are the bodyworker's avenue into the Endocrine system (pituitary & hypothalmus).  When looking at any problem the problem shows up because something else is over doing it or under doing it. There is no other problem that the body can have. Tracing back to source is the challenge. Getting there is one thing then arriving and knowing what to do is another. FM is frustrating when chased like a cold because then it makes no sense. But it is never the condition that makes no sense it is always us practitioners.  FM is still being treated like a disease by therapist and M.D.'s and it is not it is a condition where specific systems have gone haywire.

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Wilson, surely you are not claiming knowledge superior to the entire medical community, are you?  Hundreds of research papers costing hundreds of thousands of dollars have been, are being, conducted to establish the etiology of FM and establish a cure.  In my previous posting I detailed all that is scientifically known about FM-- everything else is mere speculation-- guesswork. 
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Trigger Points, from whence do they come. They are not causal either but always symptomatic responses to overload on a path that one or more nerves travel. So to rely upon Trigger Points telling you anything more than that is skeptical at best. That is not to say Trigger Points are not of value but for assessment purposes they are a dime a dozen as with FM and other conditions. But for the sake of conversation lets say yea for TP's as indicator of sometime more than nerve channel and flow being irritated.  

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You should refrain from thinking that you are anything more than you are.  It is not within your scope of practice to determine cause of illness.  But that's on you.  As for me, I treat trigger points as exactly what they are to a massage therapist: a source of pain and muscle dysfunction and limited ROM that the massage therapist attempts to relieve using various methods, usually employing ischemic compression.  Please absorb this: I don't give a diddly squat what a trigger point has to say about the condition of its nerve channels and the endocrine system that serves the body-- in relation to trigger points, the only job of a massage therapist is this: if it is causing the client to feel pain it is the therapist's job to make the TP dissolve and thereby stop the pain.
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No inflammation can be palpated and I'm will to bet my life that you are already palpating the kind of inflammation found in a Trigger Point but do not realize it, because you may have never been taught how to recognize it with your hands.  Okay, I have kept reading and see where we agree that FM is not the cause.

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Wilson, don't presume to teach me how to recognize inflammation and trigger points with my hands.  Hell, I can often locate trigger points in a client when the client is sound asleep merely by the reaction of the tissue when I press into it.
====================

When inflammation is present friction of any kind can only create more inflammation and more scar tissue.  It doesn't matter if it is brisk, gentle, firm it is still friction against and inflamed state. Go back to inflammation stages one O one.  Three stages of inflammation, acute, subacute, and chronic and what constitutes each.  If something is already inflamed then it has to be contra to anything that might even further inflame it.  Following the Trigger Point pattern is okay for a region but then that means that you are going to TP the entire body.  That's kind of over load.  

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Wilson, I wonder whether you have ever palpated a trigger point.  Not one source I've read claims that inflammation is a byproduct of trigger point formation.  While it is true that inflammation may occasionally be found near the location of a trigger point, no knowledgeable therapist ever presses into inflamed tissue--in fact, most of us refuse to treat injuries during the acute stage, when the tissue is suppurating or inflamed.   

When a client presents with a pain and directs me to the area I scan for trigger points in that area. When one is located, I treat it, a process that usually takes only a few seconds. When all the tps in the area are resolved, I begin the massage.  During the massage, however, I continue to check for trigger points, because quite often, I discover TPs the client didn't know he had.  Most of my clients come to me due to pain they can no longer stand, so they might have half a dozen spread throughout the body.  Usually the one session, and one follow-up are all that's needed.   

The pain delivery system (nervous and endocrine), somehow you landed there. I must admit I don't know how and it is not important what is that you sought to quiet the delivery system. Addressing the nervous (via TP's) is right on. My question is how do you know whether or not you have addressed all of the pain delivery systems.

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I don't worry about things I cannot change.  I treat what I can.  I test to determine whether the pain and restriction originates from sprain or strain.  If muscle strain, odds are nearly 100% that the cause will be trigger points, which I can usually take out with just one session.  Depending on the severity of a sprain (micro-tears) within tendon or ligaments, treatment can take months of inactivity combined with physical therapy.  If the pain is not found within the myofascial system, I refer them to the proper specialist--an MD neurologist or endocrinologist who can employ MRI and Xray and laboratory tests to determine the etiology.  Not within my scope of practice, or yours either as a massage therapist. 

Until you quiet all the roots of the pain delivery system your clients will have to continue seeing you for that condition, and the same is true for all conditions. I wanted to offer another way of looking even deeper at FM and moreso the body.

Once again, I reiterate my scope of practice: I am a massage therapist certified in neuromuscular therapy and myofascial release.  I am not an endocrinologist.  If the pain is caused by nerve compression caused by trigger points or fascial adhesions, I am very good at relieving the pain and restoring freedom of movement.

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Permalink Reply by Gary W Addis, LMT on July 31, 2013 at 2:24am

Very well said, Gordon.  Far better than I did with a lot less words.

Gordon J. Wallis said:

If the person in pain has trigger points.  And 70% to 85% of the time trigger points are the cause of the pain.  And 93% of the time they are involved in all pain syndromes.  So no matter how you go about getting positive clinical results. Those trigger points have to be gone.  Sometimes when working with a real sensitive fibromyalgia client. I have to calm the hpersensity fight of flight nervous system down. I do that by using a specific pattern of light skin touching around the body for a half hour.  I turn into a tens unit.  Real nociceptive pain travels four times slower to the brain then that of light skin touching and caressing.  They basically go to the same receptors. A lot of the pain is blocked.  Then after calming the nervous system down I'm able to address the trigger points.  And once those things start going away, there is even more calming and a rebalancing of the entire body/mind.    Thats the direction I take.  Not that any one else has too.  lol

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Permalink Reply by Gary W Addis, LMT on July 31, 2013 at 2:27am

pre-synaptic inhibition. I'll have to remember that term.

Gordon J. Wallis said:

http://m.youtube.com/watch?v=QR5FYag58Oc&desktop_uri=%2Fwatch%3...

I calm a hyperactive pain delivery system down by utilizing the information in that youtube video.  

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Permalink Reply by Gordon J. Wallis on July 31, 2013 at 4:15am

Yea besides the nocioceptive pain traveling slower then mechanoreceptor sensations to the brain.  Im also using Pre-synaptic inhibition in order to block pain.  The body/mind calms down enough for me to start eliminating trigger points.  And when the trigger points are gone after a few sessions. Well you have one happy client.  Not telling anyone what to do.  Im just talking what I do.  Now can I help everybody?  Well no.  And a few times in my career clients have even wanted their money back.  But I am able to help a suprising number of people now,  like the lady that wrote a review( attachment)a few days ago. It does not always go that good but gosh it made me feel good too help her.

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Permalink Reply by Gordon J. Wallis on July 31, 2013 at 4:21am

Somehow I screwed up when uploading the attachment.  So here is.  She was in a great deal of pain.  Basically two or three trigger points is what I eliminated.  And look at the results.  For 19 months they  where never eliminated, looked for or thought about.  Sadly, very typical.

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• Screenshot_2013-07-27-02-28-06.png, 231 KB

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Permalink Reply by Wilson Jordan on July 31, 2013 at 11:15am

Gary condescending was not my intention nor was arrogance or trying to teach, just offering additional information that has not been welcomed here in the West; like much other sustainable information that the rest of the world has that we ignore. Like our medical field which we are apart of its no different. Given our ability and our ranking in the world this is evident when it comes to health care and nutrition. So when you refer to medical data it is always reasonable to take it with a grain of salt and at least take the time to look for some pepper. Bodywork did not originate here, in this country, but where others had been doing the same thing long before us but our Western arrogance have chosen to ignore there knowledge even in the field of bodywork as well as common sense. That is the way of the Wild Wild West. However what we are addressing is clearly two different things. Your emphasis is upon the symptom. FM is a symptom and nothing else. When it is treated like the cause (meaning the chasing of TP's) it submerges and resurfaces.  JFK and Janice Travell proved this for years and she was applying his injections for said TP's and low back discomort, and she is the mother of TP's.  James Cyriax the father of Orthopedic manipulation and injection of TP's say the same thing.  Both recognized they were chasing a symptom. So the question remains if FM is only a symptom what is it a symptom of not what comprises it symptoms. The two are very different.  We as bodyworkers and massage therapist are not taught how to think outside of the boxes of information we are constantly fed.

The body is what it is. It never works in isolation because it can't. It is a self contained unit. There is no way for one part to have a problem without something else happening also.  My previous post was directed solely at that end what else is happening because to say we are bodyworkers and neglect what else is happening is a bit of a contradiction. I'm not pointing at you. It is not what we know that causes us to maintain the same way of thinking but what we don't know.

As far as what I have say, I don't expect you or many others to take the time, which I thank for responding too in sections, to take apart what I'm saying.

Back to palpation. I said there is no way possible to massage the low back without palpating the kidneys and adrenals. Obviously you don't pick them up out of their cavity and squeeze them.  All of the organs radiate, as you know. There is an energy to them when they are healthy, struggling and sick.  The kidneys and adrenals are no exception. We here in the West took ages to acknowledge the efficacy of acupuncture and finally it is happening and yet still with reservation. The focus they have on meridians and organs I have found immensely enhances what is already known here in the West.  The pervasive problem is and has been "how to integrate it" into what the West is already doing? Hence this discussion has gone in the direction it has. 

The only thing a bodyworker cannot change is what we don't know how to change. Our focus is the body not just isolated parts and regions, given that the body is a connected unit. Most understanding about that is minimal. Here is the West we compartmentalize everything. Massage is no different. In some ways it has compartmentalize itself right out of the Bodywork by limiting itself. This is primarily done by ignoring what knowledge was already present before our practice of massage, then furthermore we turn around and deny the benefits and efficacy of this old time knowledge because we don't know how to integrate it with limited scope we are provided as massage therapist. 

You say you don't inflammation with TP's than I suggest you look a harder and take the tissue the stages of inflammation test to prove that there is no inflammation. Because you can't have a dehydrated tissue without having inflammation locked inside of it. How can there be damage without inflammation. Unless it shirvels and rots away and even with that there will be inflammation. Even sensitivity to touch will have inflammation present even though there is nerve irritation. To be an irritant there has to be inflammation. So yes I am saying with FB there is inflammation, there is also adrenal overload, and kidney retardation although this retardation will not interfere with bladder.  With FM it is about looking beyond what the eye can see because that is never causing the problem. At least not in most cases. 

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Permalink Reply by Wilson Jordan on July 31, 2013 at 11:27am

you may find the statement, "But that is beside the point.  You claimed that the adrenal system somehow orders the immune system to shut down. And, frankly, I find that statement to be  asinine." Asinine as you say but then that would make Oriental medicine asinine. I find that to be typical of Western arrogance.  There is much that we don't know but we hold that we know it all but this country is low in the ranking of "medical intelligence" great for triage and trauma but lousy for ongoing and preventive care. Well massage grew up inside of that model; what it taught as well as didn't teach. I find you to be a thorough example of that, which by all means makes sense. Hence someone like me would not make sense to you but I do understand what you are saying as well as how to do it. But the same is not reciprocated but you have comment without experiencing what I am say. So, the context is theoretical. And we both know theory heals nothing.

Regardless I enjoy the dialogue and am looking for a starting that we can meet and go either deeper or outward we mutual learning, sharing and experimenting. My foundation is the same as yours from "88". I have no idea when you began your experience into massage. 

The bottom line is as you stated, "relieving the pain" regardless, I think, how it is done without "causing harm" always works. You may not agree with what I am saying but a book will not prove me wrong because I too can find a book that will prove me right. Now which book is right and which book is wrong. Or is it more about the content of the each book.  The Western content is very rigid and rules out a lot that it does not understand. Massage as I said grew up inside of such a frame.  Herein I believe lies the appearing challenge we are having in connecting.

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Permalink Reply by Gordon J. Wallis on July 31, 2013 at 11:34am

This is a good diagram of pain.  There are a lot of input factors involved.  I influence what I can,  given the situation,  in order to produce a positive clinical output.  I think we all do.  Accidently or on purrpose.

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• Screenshot_2013-07-31-09-26-39.png, 618 KB

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