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Use of Massage Therapy in the Treatment of Fibromyalgia1

Nancy Crippen, Jennifer Sovine & Samuel Wong

Introduction

The American College of Rheumatology defines fibromyalgia (FM) as a condition of

widespread pain in both sides of the body, above and below the waist, in the axial

skeleton, and pain in 11 of 18 tender points on digital palpation.2 Starlanyl and Copeland

(2001) describe FM as real, a source of substantial disability, and a complex syndrome

characterized by pain amplification, musculoskeletal discomfort, and systemic symptoms.

In the poster presentation on “Using Massage to Treat Fibromyalgia,”3 a partial report of

an exploratory study with a medically confirmed FM client, 43-year old, Asian female,

Sovine and Wong postulate that entanglement of free nerve endings on fascia is a

probable cause of fibromyalgia (FM) and the de-entanglement of free nerve endings is a

viable and effective treatment for FM.4

To detangle free nerve endings, they converted ground substance from gel to sol using

the NOVA-S Method. The Method is made up of sustained gliding and rhythmic

compression applied with Yin-Yang Touch5 and synchronized with abdominal breathing.

Skin-on-skin sustained gliding and rhythm compression were selected as the massage

techniques to detangle the entanglement of free nerve endings because these movements

do not excite the nervous system into the “fight or flight” mode. Instead, they engage the

parasympathetic division of the autonomic nervous system to relax the tonicity of the

tissues. The tempo of gliding and compression entrain pulsation of the body fluid to

create micro rhythms to permeate the entanglement. Abdominal breathing adds fuel to

the micro rhythms to sustain the pulsation. When free nerve endings are pulsated in the

micro rhythms of body fluid, they eventually detangle.

Midway through the treatment progress, Sovine and Wong introduced a compress made

up of raw ginger root and sea salt to keep the tender points warm and to hasten flushing

of toxins in the tender points. The client kept ground substance in sol form through self-

care routine adapted from NOVA-S Method and daily exercise.

By the end of the treatment segment, the client felt her widespread chronic pain had

localized and fewer than 11 of the 18 tender points were still sensitive to touch. While

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she still had pains, the pain configuration was not that of FM. The exploratory study

seems to indicate massage is effective in treating FM.

To validate the outcome of the exploratory study, NVCC Professional Development

Committee provided a grant for a professional development project on using massage to

treat FM. Results of the project are presented in this report.

Preparing for the Project To have uniformity and comparability in the project, an objective measurement of

success is needed. We decided to use the Revised Fibromyalgia Impact Questionnaire, a

standardized instrument with 21 questions.6

In the exploratory study, NOVA-S Method was complemented with a variety of

treatment modalities. The goal was, without doing harm, to try whatever might work to

relieve chronic pain. Sovine and Wong found raw ginger root and sea salt seemed to

produce more lasting benefits, and decided to use these organic products in the project to

test further their effects on treating FM.

In the exploratory study, the client had adapted some of the techniques she experienced in

treatment sessions to her self-care routines. She found abdominal breathing, abdominal

massage, and joint movements especially beneficial in helping her to fall asleep and stay

asleep, to let go of stress held up in the body, and to regulate sluggish bowel movement.

As these conditions -- sleep problem, stress, and problems with bowel movement -- are

often associated with FM, their relief is indirectly addressing FM. Thus, in the project

student therapists were told to encourage clients to consider adapting these exercises for

self-care as preemptive measures.

To streamline the case study, Sovine and Wong developed a set of protocol.7 However,

the steps outlined in the protocol were NOT to be followed rigidly, but adjusted

according to client’s condition. Student therapists were to document variation or

deviation so that results of the treatment could be assessed with due regards to emergent

needs. Health History and Consent/Release forms and SOAP note chart were also

redesigned specifically for data collection.8 Eight students from Massage III class in the

summer and fall semesters 2013 participated in the project.

The Case Studies

Students. The eight students were in the 20-59 age group. They included 6 female and 2

male and all of them were college graduates. They came from Annandale, Arlington,

Chesapeake, Fairfax, Front Royal, Manassas, Mount Vernon, and Stafford. Each of them

spent 60-90 minutes on each session of massage. The total hands-on time was 118 hours.9

Profile of Clients. All the clients were female. Their ages ranged from 37 to 75: One

under 40, four in 40-49 age group, and three were over 50. Their FM history varied from

1.5 years to 20 years: 1 had FM for less than 10 years, 6 had it between10-19 years, and 1

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for 20 years. Seven of the clients have prior surgery and other medical conditions in

addition to FM. Seven of them are non-smokers and six of them do not use alcohol.

Only three exercise regularly.

Table 1 Sleep Improvement Case No. 1_1 1_2 1_3 1_4 2_1 2_2 2_3 2_4

First Session 4 5 2 2 9 5 3 8

Final Session 7 7 7 5 10 2 5 10

Difference +3 +2 +5 +3 +1 -3 +2 +2

Table 1 shows that between the first and final sessions, all but one client showed sleep

improvement. On a scale of 1-10, 1 being extremely poor sleep and 10 being sleeping

extremely well, the sleep scores in the first session for the seven who had improvement

varied from 2 to 9, with an average of 4.71 (33/7). The scores in the final session for the

same group varied from 5 to 10, with an average of 7.29 (51/7), an improvement of 2.58

points. Individual improvements ranged between 1 and 5 points.

Client 2_2 had deteriorated in her sleep condition between the first and final sessions,

from 5 to 2 points. The score of 2 was the worst in the 12-session period. In previous

sessions, her scores were 9 for 1 session, 8 for 4 sessions, 7 for 2 sessions, 6 for 1 session,

5 for 1 session, and 4 for 1 session, for a total of 70 points, yielding an average of 7.0

points. Thus, issues extraneous to FM condition before the final session probably

accounted for the worsening sleep condition.

Table 2 Stress Improvement Case No. 1_1 1_2 1_3 1_4 2_1 2_2 2_3 2_4 First Session 5 6 4 6 10 3 8 4

Final Session 7 2 2 3 3 5 7 5

Difference -2 4 2 3 7 -2 1 -1

Table 2 shows that five clients reported lower stress level between the first and final

sessions of massage. On a scale of 1-10, 1 being extremely low level of stress and 10

being extremely high level of stress, the stress level in the first session for the five who

had stress improvement was between 10 and 4, with an average of 6.80 (34/5). The stress

level in the final session for the same group was between 7 and 2, with an average of

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3.40, a difference of 3.40 (17/5) points. Individual improvements varied from 1 to 7

points.

The three clients who showed higher stress level between in the first and final sessions

had other life issues that were not directly related to FM. One was dealing with the effect

of a car accident; the other was dealing with issues that kept her from sleeping well and

the third one stressed herself with over activity. Those issues could account for the

increase of stress.

Table 3 Pain Improvement Case No. 1_1 1_2 1_3 1_4 2_1 2_2 2_3 2_4 First Session – Before 5 5 2 7 6 5 6 4

First Session -- After 8 3 1 5 1 5 5 3

Difference -3 2 1 2 5 0 1 1

Final Session – Before 8 1 1 5 2 7 4 3

Final Session – After 6 0 0 2 1 1 2 2

Difference 2 1 1 3 1 6 2 1

Table 3 shows that six clients reported improvement in their pain condition after the first

treatment. On a scale of 1-10, 1 being extremely low level of pain and 10 being

extremely high level of pain, the individual scores at the beginning of the first session for

the six who had pain improvement were between 2 and 7, with an average of 5.0 (30/6).

The scores at the end of the first session for the same group were between 1 and 5, with

an average of 3.0 (18/6), an improvement of 2.0 points. Individual improvements varied

from 1 to 5.

At the end of the final session, all the clients reported improvement in their pain

condition. Individual scores at the beginning of the final session were between 1 and 8,

with an average of 3.9 (31/8). The scores at the end of the final session were between 0

and 6, with an average of 1.75 (14/8), an improvement of 2.15 points. Individual

improvements varied from 1 to 6. Massage seems to be effective in lowering pain both

within a session and over a period of time.

In the first session, there was one client each in extreme and severe FM conditions, two in

moderate condition and four in mild condition. In the final session, the client who was in

extreme FM condition (Case 1_1) had improved to the severe condition, with a drop of

16.5 points. The client in severe condition (Case 2_2) had improved to moderate

condition, with a drop of 10.2 points. The clients in moderate condition (Cases 1_4 and

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2_4) had improved to mild condition, with a drop of 16.7 and 16.5 points, respectively.

Three of the four clients in mild FM conditions in the first session had shown

improvement, with a drop of 8.3 Points (Case 1_2), 9.4 points (Case 1_3) and 23.5 points

(Case 2_1). Only one client (Case 2_3) had no significant improvement (Table 6).

Table 4 FIQR Scores First Session Case No 1_1 1_2 1_3 1_4 2_1 2_2 2_3 2_4 Class Range

Extreme 75-100 81.0

Severe 60-74 60.2

Moderate 43-59 50.5 45.0

Mild 0-42 14.6 41.2 36.1 36.0

Final Session Case No 1_1 1_2 1_3 1_4 2_1 2_2 2_3 2_4 Class Range

Extreme 75-100

Severe 60-74 64.5

Moderate 43-59 50.0

Mild 0-42 6.3 31.8 33.8 12.6 35.0 28.5

Difference 16.5 8.3 9.4 16.7 23.5 10.2 1.0 16.5

The summary report of Deborah Wedemeyer, one of the student therapists, captures the

dynamics of the treatment process.10

In the first session, the client was in distress, therefore, we focused the session on decreasing stress. From self-reporting and manual palpation, client felt tenderness in six points in the lower cervical, occiput, and trapezius regions. In the second session, the client’s hands and feet were cold and she felt great

relief upon receiving hand and foot massage to increase circulation. Abdominal and back massage brought heat to mid region of the client’s body. The client’s

breathing grew increasingly slower throughout the massage.

During sessions two, three and twelve, the client fell asleep. When ginger and sea salt compress was included in sessions three, four and five, the client felt some

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tingling, but it did not increase heat on the skin. In session five, the client received the ginger-sea salt formula for use outside the massage sessions.

In sessions five and six, client reported feeling much more grounded and was able to incorporate more strenuous art projects and activities into her life. In session eight, the client received deep tissue massage and reacted well to moderate pressure. By session 12, the client was going to yoga classes three times a week and working with a personal trainer to increase muscle tone. No tenderness was found in any of the 18 points in the final session.

All but one client were positive about their massage treatment.

Case 1_1 states: “[Student therapist] is great. I really feel like the massage therapy is

helpful, especially since you suggested she try side massage. Now it doesn’t hurt my

back. The therapy that is done with the breathing is working out painful areas that don’t

get much attention usually…. I was very glad to be a part of this study.”

Case 1_2 states: “[Student therapist] is always very professional and explains the

techniques he is using. I found this specific protocol… to be very effective…. I was

diagnosed with FM 12 years ago and had it at a very manageable level. However, I continued to struggle with the lack of restorative sleep. This treatment really seemed to help with that, which is why [student therapist] and I plan to continue with it on a regular basis. In addition, the ginger root and sea salt compress really seemed to enhance the pain/sensitivity reduction and kept the discomfort from returning. In fact at our last session, we recorded the lowest tender point assessment I’ve had in 12 years.” Case 1_3 states: “[Student therapist] is very professional…. She found many trigger

points all over my body and worked to eliminate each one every session…. My pain level

has dropped from 80-90% to 15-20%.... My largest pain areas are the sides of my body, making it difficult to sleep for very long on either side. With the messages, I’m finding I

don’t go from one side to the other as often so I’m getting more optimum sleep.” Since

the end of the treatment, Case 1_3, had in fact become a paying client of the then student

therapist (now certified massage practitioner).

Case 1_4 states: “My experience with [student therapist] and the pilot project was a very

good one…. She did explain what she was doing and why each session… I can’t really

pinpoint what techniques helped more. I felt like the ginger that she put on my tender points definitely helped. There were days when my knees were actually pain free…. I do

think overall my pain level has decreased… I was experiencing some problems with my

sleep before the study; however, I am sleeping better now…. I have already discussed

continuing the treatment with her in the future….” Case 2_1 states: “Can massage help fibromyalgia pain? Based on my 12-massage session treatment, I can say yes. Many factors about this therapy were helpful. I believe some pain is rooted in the tension we carry in our muscles. These sessions were a

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conscious effort to not only make time for stress relief, but brought awareness to which parts of the body the stress was manifesting in. The session times were not only a physical relief, but also a mental relief. The assessment of muscle groups that may be out of alignment, overused, or underused by a massage therapist can also help give ideas about reducing pain. The ginger application was also very helpful. The heat produced by the organic compound gave a relief option that did not include adding pharmaceuticals to the care plan of pain. This would be important to many pain sufferers who are trying to reduce or eliminate the cost of or physical damage brought on by prescription medications. The introduction to self-care brought an opportunity to assess stressful areas of my life, come up with strategies to resolve those problems, and give accountability to following through with the plan. Thank you very much for allowing me to be involved in this study.”

Case 2_2 states: “[Student therapist] explained everything very thoroughly. She

explained every session with detail and what she would be working on. I found the compress somewhat helpful in the sense that sometimes it would feel like an icy-hot feeling and other times it felt like a cold cream. The self-care deep breathing helped me relax better during the massage. I will definitely continue with the treatment and [student therapist] as she is very caring to my needs. My body is very sensitive so of course I was sore after the massage. It would last a couple of hours. The day after the massage I had no aches and pains. I am very happy I participated in this study. Before this study I would avoid massages of any kind. Now I look forward to massage. I’ve

enjoyed working with [student therapist] very much. I have found lots of relief for my aches and pains.” Case 2_4 states: “The first massage I experienced during this study felt wonderful. I left feeling relaxed and refreshed…. However, within 24 hours I was having spasms in my

back. Within 48 hours my entire body hurt in extreme pain. It was as if the massage woke up every myofascial trigger point in my body and they were all mad. Over the next few weeks, pressure was adjusted and my body seemed to react more positively, I was able to experience longer periods of relief before my body reacted with some type of pain and what pain I did have was less severe. By week six I noticed more flexibility without pain. As long as I was able to keep my daily routine at a slow pace, I felt less stressed and more relaxed…. [My] fibromyalgia flare up of pain, spasms, and extreme fatigue…

did not last as long as they normally did prior to the massages…. Overtime, I felt that

the massages helped my body be able to return to its normal state of low pain levels more quickly…. What seems to have improved is the duration of my body’s reaction.” Case 2_3 did not make an assessment of the treatment. She was the one client who

showed no significant improvement in her FM condition. She is a smoker, using 5-10

cigarettes a day, and she does not exercise. When I visited her for on-site supervision,

she told me she had monthly acupuncture treatments in addition to trying massage for

treating fibromyalgia. She also did not use the ginger-sea salt compress regularly.

Whether these factors had impact on her condition is uncertain.

Seven of the eight clients participating in the project showed improvement in their FM

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condition, according to the FIQR scores. Most of them appeared to have more energy

after the 8-session or 12-session treatments. Evidently, massage therapy can be a viable

treatment option for patients with fibromyalgia.

Lessons Learned

The purpose of the professional development project was to replicate the

exploratory study on using massage to treat fibromyalgia. We have accomplished our

goal. We have involved eight students in the project, guided them in the case study

process, and summarized their findings in this report. While the number of cases is still

too small for claiming success, the results do show a success rate of 88 percent (7 out of

8). We plan to incorporate the training of students in doing research on fibromyalgia in

the massage-specific courses in the Massage Therapy Program, NOVA. With

accumulation of more case studies, we will have the critical mass to build a case for using

massage to treat fibromyalgia.

Wong had taught his unique NOVA-S Method and Yin Yang Touch to the

students, met with them at critical points to review their progress, and maintained open

access for them throughout their study. Through their arrangement, Wong observed a

couple of students doing actual treatment in the home of their clients.

Due to the pioneering nature of this project, we had to adapt what we wanted to

do to fit with what we were able to do. Thus, to measure of progress, we used an

objective instrument to measure progress instead of relying on subjective palpation of

tender points. We had to forego verification of the progress by a physician as clients

were unwilling to incur expenses for a consultation with their physician after the 8 or 12

sessions of treatment. Besides, working within a college calendar had no time for follow

up activities.

The benefits that students get from involving in the study might perhaps be

glanced from the report of Rebecca Mayfield, one of the student therapists:11 On a personal level, the experience of working with my client in the FMS study was very humbling. To date, it has been my experience that after a client gets off the table she or he is elated with the results: pain is reduced, relaxation is increased, and overall well-being is restored. Such was not the case with my FMS client. I was routinely frustrated by my ability to increase her pain level after a massage even after being conscious of the pressure I was applying. I was frustrated by the inability to provide pain relief in an area before another area caused her pain. There was no linear pattern to the increase or decrease of pain. The “aha” moments I had did not come until I started to look at the

data as a whole, following the 12 sessions. She would probably not gain these insights if

she were simply doing routine massages.

A probable outcome of this professional development grant is the introduction of

massage research in the Massage Therapy Program, an option Crippen and Sovine are

exploring. We recognize the importance of research in helping massage therapy to

advance as healthcare modality and helping the NOVA training program to stand out

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among the plethora of training programs in the academic marketplace. We have already

introduced the use of NOVA-S Method to massage therapists in a highly successful

NOVA-sponsored workshop on treating veterans with PTSD in November 2013, and we

are planning a cooperative research project with a group of therapists on using massage to

treat PTSD. In the exploratory study and the case studies, ginger and sea salt were used to

complement manual work, and we have made no attempt to assess the impact of these

organic products on healing. We feel that in the course of actual treatment, so long as

practitioners are mindful of doing no harm, the cross contamination or cross fertilization

of different modalities is not a serious drawback. At this stage of developing a treatment

module for FM, our primary interest is in using whatever may work to restore the

wholeness of the client, not in the merits of each individual modality. It would be

unethical to delay restoration of wholeness just to satisfy experimental purity. After we

have more successes, we can afford to do clinical tests to ascertain the contribution of

different modalities. Now is not the time.

In the mix of different modalities for treating FM, what then is the role of

massage therapy? The exploratory study has shown that massage therapy was in fact the

primary route through which other modalities made their contributions. Without massage

as the focus, the potential and real contribution of each modality is unlikely to find

expression. Thus, massage has a dual role in treating FM.

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APPENDIX 1: DISTRIBUTION OF TENDER POINTS OF FIBROMYALGIA

Source: Clinical Massage Therapy, p. 982

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APPENDIX 2: POSTER PRESENTATION

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APPENDIX 3:

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APPENDIX 4: RESEARCH PROTOCOL

(1) Location of Tender Points of Fibromyalgia

Points 1&2 of the posterior tender points are located inferior to the occiput, at

the suboccipital muscle insertions; Points 3&4 in upper trapezius, at midpoint of

the upper border of the muscle; Points 5&6 at supraspinatus origin, above the scapula

spine near the medial border; Points 7&8 in gluteus medius, at the anterior portion of the

muscle; and Points 9&10 in the greater trochanter, at the trochanteric prominence. Points

11&12 of the anterior tender points are located in low cervical, at the anterior aspects of

the TVPs of C5 to C7; Points 13&14 in second rib, at the costochondral junction; Points

15&16 in extensor digitorum, at a point 2 cm distal to the lateral epicondyle; and Points

17&18 in the knee, at the medial collateral ligament proximal to the joint line (Wolfe et

al. 1990, Rattray & Ludwig. 2007).

(2) The Protocol

The protocol for “Using Massage to Treat Fibromyalgia” is designed for 8 treatment

sessions, but it can be expanded to 12 or more sessions. Activities to be included in each

session are outlined below.

First session. Review with client the model of entanglement of free nerve endings and

the proposed treatment plan. Demonstrate the self-care routine of abdominal breathing,

abdominal massage and joint movements. Locate and palpate the 18 tender points. Use

Yin Yang Touch to do full body relaxation massage for client, begin with client in supine

position and end with client in prone position. Ensure client drinks at least half-a-pint of

water before and after massage.

Second session. Re-demonstrate the self-care routine. Use Yin Yang Touch to do

full body relaxation massage, begin with client in supine position and end with client in

prone position. After full body massage, apply gentle rhythmic compression and

sustained gliding over posterior points 1-6 for 15-20 minutes. Client is to synchronize

her breathing with the compression and gliding. Alert client that she might feel sorer in

her muscles after the treatment and some of the tender points might feel cold.

Third & Fourth sessions. Work through self-care routine with client. Do full body

relaxation massage, begin with client in supine position and end with client in prone

position. After full body massage, apply ground raw ginger roots and sea salt compress

to points 3-6 (to address coldness in tender points). While compress is on points 3-6,

apply gentle rhythmic compression and sustained gliding over points 7-10 for 15-20

minutes. Remove compress. Apply rhythmic compression and sustained gliding over

points 1-6 for 10 minutes. Wipe tender points with dry or warm cloth.

Fifth & Sixth sessions. Work through self-care routine with client. Do anterior full body

relaxation massage. After anterior body massage, wrap ginger roots and sea salt

compress on points 15-18. Apply gentle rhythmic compression and sustained gliding

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over points 11-14 for 15 to 20 minutes. After the anterior treatment, place client in prone

position, apply ginger roots and sea salt compress on points 3-6. Do posterior full body

relaxation massage. Apply rhythmic compression and sustained gliding over points 7-10

for 10 minutes. Remove compress from points 3-6 and unwrap points 15-18. Apply

rhythmic compression and sustained gliding to points 1-6 and apply gentle friction to

points 15-18. Wipe tender points with dry or warm cloth.

Seventh session. Apply raw ginger roots and sea salt to points 11-14 and points 15-18.

Do anterior full body relaxation massage, with emphasis on abdominal massage. After

anterior body massage, remove compress from points 11-14, massage points 11-14 for 10

minutes. Place client in prone position. Apply compress to points 3-6, do posterior full

body massage, with emphasis on the lumbar region. After posterior body massage,

remove compress from points 3-6 and 15-18, apply rhythmic compression and sustained

gliding to points 1-6 and apply gentle friction to points 15-18 for 15-20 minutes. Wipe

tender points with dry or warm cloth.

Eighth session. Work with client on self-care routine. Do full body massage with normal

pressure. Review progress. Plan for follow up treatment.

Expand sessions 5-7, as needed.

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APPENDIX 5: HEALTH HISTORY & CONSENT/RELEASE FORM FOR PROFESSIONAL DEVELOPMENT PROJECT ON USING MASSAGE TO TREAT FIBROMYALGIA (FM) All information is confidential, released only with your written permission.

Please complete form in full.

Name: ________________________________________________________________Age: ___________

Address:

_____________________________________________________________________________________

Phone: home _______________mobile _______________Emai__________________________________

Occupation:

_____________________________________________________________________________________

Emergency Contact:_______________________ Physician for FM:_______________________________

How is your general health?_______________________________________________________________

How many years have you had FM?__________ When were you diagnosed as having FM?_____________

What medications are you taking to treat FM?___________________ Since when?___________________

What is your current stress level?

Circle: 1 2 3 4 5 6 7 8 9 10 (1 extremely low; 10 extremely high) How well do you sleep usually?

Circle: 1 2 3 4 5 6 7 8 9 10 (1 extremely poor; 10 extremely well)

Do you have headache? _____ How often?____ What type?___________ Medication? ___________

Are there other medical conditions? _______________________________________________________

Which parts of your body have the most persistent pain?________________________________________

Please describe the pain sensation:_________________________________________________________

Previous Surgery (date & nature)

_____________________________________________________________________________________

Previous Injury (date & nature)____________________________________________________________

(e.g. dislocation/fracture/car accident)

Special Alert(s) for massage:

_____________________________________________________________________________________

(Hearing aids, contact lenses, dentures, hairpieces, special equipment…)

Do you smoke? ______ Elaborate:____________ Do you drink?_____ Elaborate:____________________

Do you exercise at least 3 times a week? Yes ____ No ____ If yes, what do you do___________________

Have you received massage before? Yes ____ No ____ If yes, date of last visit_____________________

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How was your previous massage experience?_________________________________________________

What is your expectation of your involvement in the pilot project of using massage to treat fibromyalgia?

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APPENDIX 6: CLIENT’S CONSENT/RELEASE FOR MASSAGE THERAPY (PILOT RESEARCH PROJECT)

I understand that

--the practitioner is a trainee in therapeutic massage and massages performed by her/him are for her/his

training and clinical practices. She/He does not receive any financial compensation for the services

rendered.

--massage therapy involves the manipulation of the soft tissues of the body, skin, muscle, ligaments and

connective tissues, using touch, stretch, joint mobilization and other techniques to produce therapeutic

results.

--in massage therapy, I will disrobe to my comfort level. However, only the areas of the body being

directly treated are uncovered at one time. If at any time I am uncomfortable with the pressure or technique

being used, I can ask the practitioner to make necessary adjustment or stop the treatment at any time.

--massage therapy is for the purpose of stress reduction, relief from muscular tension or spasm, or for

increasing circulation and energy flow.

--information exchanged during any massage session is educational in nature and is intended to help me

become more familiar with and conscious of my own health status and is to be used at my own discretion.

--the practitioner does not diagnose illness, disease, or any other physical or mental disorder, or prescribe

medical treatment or pharmaceuticals, or perform any spinal manipulations.

--massage therapy is not a substitute for medical examinations and/or diagnoses and that I will seek

medical treatment for any physical ailment(s) that I might have.

I will keep the practitioner informed of any changes in my health, and any medications that I may begin to

take while in therapeutic treatment.

I consent that clinical information relating to my case can be submitted as part of a research report, that

even though my identity will be concealed, anonymity cannot be guaranteed.

I absolve the practitioner from any and all liabilities that might incur in massage therapy. I have read the above and give consent for massage therapy. Client Name (please print)__________________________________________________________

Client Signature_________________________________________________Date_____________

Practitioner Signature_____________________________________________Date_____________

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APPENDIX 7:

NVCC PROFESSIONAL DEVELOPMENT PROJECT: USING MASSAGE TO TREAT FIBROMYALGIA

SO(A)P NOTE CHART

Client’s Name ________________________________________Date______________________

S: [At beginning of session, ask…]

What is your current stress level?

Circle: 1 2 3 4 5 6 7 8 9 10 (1 extremely low; 10 extremely high) How well did you sleep last week?

Circle: 1 2 3 4 5 6 7 8 9 10 (1 extremely poor; 10 extremely well)

Did you have headache last week? Y/N Medication? Y/N Headache now? Y/N

What other symptoms do you have?

_______________________________________________________________________________

Which parts of your body have the most persistent pain? _________________________________

What is the pain level?

Circle: 1 2 3 4 5 6 7 8 9 10 (1 extremely low; 10 extremely high) Did you have difficulties doing the self-care routine? _____ How often did you do it?___________

[At end of session, ask…} What is your pain level now?

Circle: 1 2 3 4 5 6 7 8 9 10 (1 extremely low; 10 extremely high)

O: [What did the practitioner observe before and during the massage, especially about the 18 tender points

and other areas of hypertonicity and sensitivity? How was the client after the treatment?]

Measurement:

Blood Pressure Pulse

Beginning

Ending

P: [What did the practitioner do? Was compress used? Other modalities? Focused on which parts of the

body? Did the techniques work? Questions for Instructors/Reviewers?]

Practitioner Signature _______________________________________________Session #_____

Reviewer’s Comments ___________________________________________________________

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References

Juhan, D. Job’s Body. New York: Station Hill Press, 2003

Schleip R.a Fascial plasticity – a new neurobiological explanation: Part 1. Journal of Bodywork and Movement Therapies. 2003 Jan; 7(1): 11-19.

Schleip R.b Fascial plasticity – a new neurobiological explanation: Part 2. in Journal of Bodywork and Movement Therapies. 2003 Apr; 7(2): 104-116.

Starlanyl D, Copeland ME. Fibromyalgia & Chronic Myofascial Pain. 2nd ed.

California: New Harbinger Publications; 2001.

Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombadier C, Goldenberg DL. et al.

1990. The American College of Rheumatology 1990 Criteria for the Classification of

Fibromyalgia. Report of the Multicenter Criteria Committee. Arth Rheum. 1990 Feb; 33

(2): 160-172.

Wong, S, Sovine, J. 2013. “Using Massage to Treat Fibromyalgia: Report of a Case

Study,” poster presentation at the International Massage Therapy Research Conference,

2013.

Wong, S. “East Meets West: Yin Yang Touch,” in massage and bodywork,

March/April 2014, pp. 90-7.

1 Report of a professional development project partially funded by the VCCS Paul Lee Professional

Development Fall 2013 Grant. The report incorporates case reports on fibromyalgia from Richard Greer,

Esi House, Rebecca Mayfield, Amanda Newberry, Tansy de Roos, Nicole-Sophie Salifou, Deborah

Wedemeyer, and Steve Zeswitz. 2 See Appendix 1: Picture of Distribution of Tender Points of Fibromyalgia. 3 See Appendix 2: “Using Massage to Treat Fibromyalgia,” presented tat the International Massage

Therapy Research Conference (IMTRD), Boston, MA, 2013. 4 Schleip R. Fascial plasticity – a new neurobiological explanation: Part 1. Journal of Bodywork and Movement Therapies. 2003 Jan; 7(1): 11-19; Schleip R. Fascial plasticity – a new neurobiological

explanation: Part 2. in Journal of Bodywork and Movement Therapies. 2003 Apr; 7(2): 104-116; and Juhan,

D. Job’s Body, 2003. 5 In both the exploratory study and the pilot research project, Yin Yang Touch was applied to enhance the

effectiveness of western massage. The principle and application of Yin Yang Touch is described in “East

Meets West: Yin Yang Touch,” massage & bodywork, March/April 2014, pp. 90-7. 6 See Appendix 3, Revised Fibromyalgia Impact Questionnaire (FIQR). 7 See Appendix 4, Research Protocol. 8 See Appendices 5-7, Health History and Consent/Release Forms and SOAP Note Chart. 9 Four students invested eight sessions of 90 minutes each and three students invested 12 sessions of 90

minutes each, One student invested 11 sessions of 90 minutes each for a total of 118 hours. 10 Edited from the report of Deborah Wedemeyer. Used with permission. 11 Used with permission.