Fascia: a hidden piece of the pain puzzle of fibromyalgia

Your doctor or a television ad may have told you that fibromyalgia is caused by overactivity of the nerves that detect pain. Admittedly, this is a major source of fibromyalgia pain, but there are other, even more important, pain triggers that must be addressed to achieve significant pain reduction. And, unfortunately, your doctor may not be aware of them.

Many studies have shown that the nervous system of fibromyalgia has been sensitized and, therefore, has hyperactive responses that cause pain. This is the goal of the three drugs approved by the FDA for this disease, and these drugs may be useful, which generally results in a reduction in pain of about 30 percent.

In my experience, as much as someone who suffers from the disease personally and as a doctor treating fibromyalgia, using these medications is only inappropriate. For me, I found no relief from that deep, burning pain in my neck and upper back muscles until I found a treatment that addressed my pain in a different way. It turns out that there is another great factor that may be the missing piece in the pain puzzle.

The massive network of connective tissue that surrounds all of our muscles – think of the shiny outer layer on a raw chicken breast – plays a key role in the generation of pain and muscle sensitivity of fibromyalgia. To obtain more effective pain relief, both patients and providers must understand exactly how this connective tissue (also called fascia) contributes to the pain of fibromyalgia and use this information to address the treatment.

Now you can feel your own fascia if you gently tilt your head to the side, as if trying to rest your ear on your shoulder. You will feel a stretch or stretch feeling on the opposite side of your neck, from the shoulder to the jaw. What you are feeling is not stretching the muscle (there is no muscle going from your shoulder to your ear), but stretching the fascia that surrounds and joins all the muscles between those two points.

Medical understanding has been delayed in this vital component of the body, but it is finally catching up. The first Fascia Research Congress was held at Harvard in 2007 and a wave of research began. We know that the fascia is a continuous network of network-like connective tissue that envelops all our muscles. This network of connective tissue contains many nerves that detect pain and is as sensitive to pain as our skin. The fascia can also contract or tighten, in response to the “danger” signals of the brain.

The fascia is the “armor” of the connective tissue of the body, which is immediately tensed in response to the signals of the many nerves that pass through it. This provides strength in emergency situations and can save lives in the short term. Researchers believe that a rapid contraction of the fascia is what creates the enormous extra force that humans can produce in emergencies; for example, when a mother beats a cougar who is attacking her son, as happened recently in Colorado.

In fibromyalgia we know that the brain is unintentionally triggering the alarm bells to “fight or flee” by mistake all the time, instead of just in emergencies. This does not happen in our thinking brain, but in those areas that control basic cleansing functions, such as breathing and digestion. The danger signals sustained from the brain to the muscles produce chronically tight muscles.

As the research progresses, we learn that stiffness lies not only in the muscles themselves but also in the fascia, that sheath of connective tissue that surrounds the muscles (think of the wrap around a sausage that surrounds and contains the flesh inside) . And this sustained rigidity of the fascia not only causes pain, but also generates inflammation and contorts the muscles in painful knots called trigger points. If you want to delve deeper into the science that supports the role of fascia in the pain of fibromyalgia, you can read more in my article for Journal of Bodywork and Movement Therapy.

Several studies have shown the effectiveness of treatments that reduce tension and that can “take off” the painful knots in the muscles and the surrounding fascia. The treatment that has helped me most personally is a form of manual therapy called myofascial release (MFR), specifically the myofascial release approach of John F. Barnes. This technique involves a combination of sustained manual traction and prolonged gentle stretching of the fascia, and is by far the most effective treatment I have found to detach the fascia and reduce the pain of fibromyalgia.

Two large European studies found that after 20 sessions of myofascial release, subjects with fibromyalgia reported a significant reduction in pain. What’s really cool, though, is that it provides more lasting pain relief, and most of them still report reduced pain levels a month after their last session.

I recommend that my patients try at least two or three MFR sessions to determine if this will help them. It can temporarily cause increased muscle pain, similar to what you feel after intense exercise. But after a day or two, the muscle pain should be much better than it was before the session. If you find it helpful, I recommend going once or twice a week for about eight weeks, similar to a typical physiotherapy program. After that, it can be done as needed for pain eruptions. Most therapists will also teach you techniques using balls or other tools that you can do at home to extend the benefit of each treatment.

In addition to the myofascial release, there are some other manual therapies that can treat the tense and painful fascia. Rolfing Structural Integration, or Rolfing ™, is a manual therapy that addresses fascial treatment in a slightly different way but can also be quite effective. A form of practical manipulation developed more than 50 years ago, Rolfing focuses on the fascia around the joints, with treatment that emphasizes the correction of posture and joint alignment in a series of 10-12 sessions.

A related therapy is osteopathic manipulative treatment (BMT), a combination of gentle stretching and pressure on the muscles and joints. Since this treatment is performed by doctors (usually osteopathic doctors) it is often covered by insurance. Health care providers can also perform trigger point injections to break painful muscle knots.

There are also several ways in which you can treat your own fascia. Learning these personal care tricks may be the most important step you take to control your pain, and it is a great emphasis on my clinic’s treatment program. One way is to place a small soft ball under any tight and painful muscle area. Allow it to sink over the ball for a few minutes to provide the proper amount of sustained pressure that allows the fascia to be released.

Finally, Yin yoga (also called restorative yoga) is a slow and gentle form of yoga that includes stretches with props such as pillows and reinforcements to accommodate in a comfortable position for several minutes, allowing the fascia to melt and soften. Take a look at the yin yoga classes or videos to learn and practice the postures.

Understanding the contribution of fascia to the pain of fibromyalgia expands our treatment options. Certainly, the pain of the fascia is not the whole pain story of fibromyalgia, a hypersensitive nervous system that overreacts to the signals and must also be addressed. But in my experience, the rigidity in the fascia is the spark that ignites the pain and must be treated for a truly effective pain relief ..

Some resources

To learn more about myofascial release and find a therapist in your area, visit myofascialrelease.com or mfrtherapists.com. You can also check the video of my clinic that shows MFR in action ..


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