Fascia: a hidden piece of the fibromyalgia pain puzzle

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

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

In my experience, both as someone who suffers from the disease personally and as a doctor who treats fibromyalgia, using these medications is only inappropriate. For me, I found no relief from that deep and burning pain in my neck and upper back muscles until I found a treatment that treated my pain in a different way. It turns out that there is another big 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 generating the 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 fibromyalgia pain and use this information to address treatment.

Now you can feel your own fascia by gently tilting your head to the side, as if trying to rest your ear on your shoulder. You will feel a sense of stretching or stretching 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 that goes 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 fascia is a continuous network of connective tissue type network that surrounds 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 from the brain.

The fascia is the “armor” of the connective tissue of the body, which tenses immediately in response to the signals of the many nerves that cross it. This provides strength in emergency situations and can save lives in the short term. The 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 defeats a cougar who is attacking her child, as happened recently in Colorado.

In fibromyalgia we know that the brain is triggering the “fight or flight” alarm bells by mistake all the time, instead of just in cases of emergency. This does not occur in our thinking brain, but in those areas that control basic cleaning functions, such as breathing and digestion. Sustained danger signals from the brain to the muscles produce chronically tight muscles.

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

Several studies have demonstrated the effectiveness of treatments that reduce tension and that can “take off” 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 gentle and prolonged fascia stretching, and it is by far the most effective treatment I have found to detach the fascia and reduce fibromyalgia pain.

Two large European studies found that after 20 sessions of myofascial release, subjects with fibromyalgia reported a significant reduction in pain. What is really cool, however, 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, 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 rashes. Most therapists will also teach you techniques using balls or other tools you can do at home to extend the benefit of each treatment.

In addition to myofascial release, there are some other manual therapies that can treat tense and painful fascia. Rolfing Structural Integration, or Rolfing ™, is a manual therapy that addresses fascial treatment a little differently but can also be quite effective. A form of practical manipulation developed over 50 years ago, Rolfing focuses on the fascia around the joints, with treatment that emphasizes posture correction 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. Healthcare 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 I 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 muscular area. Allow it to sink on the ball for a few minutes to provide the right amount of sustained pressure that allows the fascia to release.

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

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