Few chronic diseases or conditions have been more complex and frustrating for massage therapists than fibromyalgia. The variety of complaints a fibromyalgia client presents with can be daunting, but some simple tools in the traditional Chinese medicine (TCM) spectrum—aromatherapy and acupressure—can help you work with this client in a gentle, healing way and still get the results both client and therapist seek.
Defining the Problem
According to the National Fibromyalgia Association, fibromyalgia is an increasingly recognized chronic pain illness that affects an estimated 10 million Americans. It is characterized by widespread musculoskeletal aches, pain, and stiffness; soft tissue tenderness; general fatigue; and sleep disturbances. The most common sites of pain include the neck, back, shoulders, pelvic girdle, and hands, but any part of the body can be involved. Fibromyalgia patients experience a range of symptoms of varying intensities that wax and wane over time.1
The sites of pain for fibromyalgia sufferers are typically defined by 18 tender points, with various levels of intensity. However, more in-depth studies have revealed 75 other tender points to qualify the condition, most of which are situated along the spine and the Urinary Bladder (UB) channel, as dictated by TCM theory.2
Although the symptoms associated with fibromyalgia fluctuate from person to person, there is one common symptom experts all agree on—they ache all over.
In addition, there is a cluster of other seemingly unrelated pathologies, signs, and symptoms that point to systemic involvement in the fibromyalgia client. These include adrenal insufficiency, allergies, brain fog, candida, depression, edema of the extremities, endometriosis, fatigue, food sensitivities, hypertension, hypothyroidism, insomnia, irritable bowel syndrome, migraines, obesity, osteoarthritis, painful menstruation, PMS, Raynaud’s syndrome, sugar cravings, tension headaches, and vaginal infections. The appearance and severity of these signs and symptoms varies from person to person.
When faced with this multitude of pathologies and conditions, the massage therapist might feel overwhelmed with how much a fibromyalgia client presents with, as so much is really outside the scope of practice of massage therapy.
The emphasis in Western medical massage tends to be to address the fibromyalgia client with neuromuscular therapies, coupled with various forms of stretches, hydrotherapy, and myofascial release. When combined together, these modalities are very effective in treating the various signs and symptoms of pain, limited range of motion, and ischemic trigger points. They also can enhance circulation and lymphatic drainage, while decreasing scarring and adhesions.
Looking beyond the Western paradigm, we ask: can these benefits be accelerated by first addressing the mind and spirit of the client in a more holistic approach, utilizing both essential oils and acupressure?
Aromatherapy
Let’s start by looking at how aromatherapy works. Odor molecules affect our brain chemistry by targeting the limbic system. The limbic system is sometimes called the “leopard” part of the brain because it is mainly associated with the sympathetic nervous system and the fight-or-flight response. The limbic system affects emotions, learning, and memories, as well as appetite and sexuality. Once the odor molecule stimuli affects the limbic system, several neurotransmitters are released: endorphins, which reduce pain; enkephalin, which promotes pleasant feelings; and serotonin, which causes a calm, relaxed state that can lift depression. The sense of smell also affects the hypothalamus, which controls the body’s neurochemical and hormonal regulation. This part of the brain also communicates with the frontal lobes, which control attention and memory; the reticular system, which brings together the body and mind; and the sex glands.
Using a Holistic Approach
When addressing the fibromyalgia client from a TCM approach, attention should be first given to treating the mind and spirit. The medical community believes fibromyalgia is largely caused by stress, or a combination of shock and trauma. In keeping with the philosophy of TCM, all ailments are essentially a disturbance of the spirit. Accordingly, it is the spirit that heals the disease.
A major benefit of using essential oils is that they work in a nonconfrontational manner. This is important for fibromyalgia clients, especially on their severe-pain days, when any kind of bodywork seems contraindicated. If this is the case with your client, start by using a combination of lavender and Roman chamomile for their relaxing and sedative effects. Clary sage and cypress can be used for their antispasmodic effects, while rose and ylang ylang can lift the mood of depression.
Again, focusing on the mind without being confrontational, the therapist then includes an acupressure treatment on several strategic channels and acupressure points. Since there are several points that have multiple benefits, you can address just a few to achieve whole-body effects without having to tax your client’s pain threshold.
It makes sense to select the acupressure points that cover multiple benefits in order of importance. In addition, the essential oils themselves can also be applied directly on such points to enhance the effects. (Note: you can also layer several oils on one acupressure point. Apply the first essential oil and rub it in counterclockwise until it is absorbed. Good oils only take seconds to be absorbed through the skin. Repeat with the other oils.)
An Acupressure Protocol
What would then be a good overall protocol that combines acupressure with essential oils? The strategy should be one of moving from the general to the specific. As in aromatherapy, the general focus would refer to the mind and the specific to more somatic points of discomfort.
The therapist should start with the Governor Vessel (GV) points on top of the skull. The GV “governs” qi; stagnation or blockage of qi impedes the flow of blood and lymph, creating pain, lack of energy, chronic emotional toxicity, memory loss, and numerous other things.
A crucial point in this group would be GV 20. According to The Systematic Classic of Acupuncture and Moxibustion,3 a pre-modern classic of contemporary acupuncture, GV 20 is mainly responsible for mental alertness, concentration, memory, and energy, all things the fibromyalgia client has issues with. TCM therapists also use it to alleviate headaches, general pain, and stress, as well as to achieve overall balance of the mind.
The therapist will first apply one drop of an essential oil like ylang ylang, geranium, or lavender and rotate their thumb in a counterclockwise rotation on GV 20 with gentle pressure. Rotating your thumb counterclockwise calms, centers, and grounds the client. The pressure applied should be minimal. On a scale of 1–10, where 10 represents extreme pressure and 1 is minimal pressure (or the weight of a quarter), a pressure of 1–2 is appropriate. (All additional references to “minimal pressure” here shall mean pressure on a scale of 1–2 out of 10.)
Acupressure is all about connecting energetically and not trying to force away any pain by being confrontational. This is especially true for the fibromyalgia client. The duration of the treatment on each acupressure point should be a minute or more, or until the pain is reduced substantially. Care should be taken not to spend too much time with a stubborn pain area but move on, as all areas are interlinked by channels. Removing stagnation of qi in any part of the channel will allow the qi to flow along the whole channel much easier. It’s like removing a dam of debris on a stream.
A good follow-up is to perform acupressure down the midsagittal line on the head of the client where the pathway of the GV is located. Pressure should be minimal and the therapist can linger on points for 3–4 seconds. The therapist starts on the hairline in front and finishes just below the position of GV 20, or just below the apex of the head. This procedure should be repeated 10 times. Treating these points on the head is also a good way to address insomnia successfully.4
Next, the therapist should treat Liver (LV) 3 on top of the foot. A calming essential oil like lavender, or any of the aforementioned oils, could be used.
This is an extremely important point, especially with myofascial pain issues, and is always used in treating migraine headaches as well. On an emotional level, it disperses anger and lifts up depression. The therapist first holds these points for 5 seconds with minimal pressure. Then, they rotate each finger counterclockwise for 19 seconds each. (Those who do chakra balancing and polarity therapy will notice how we have moved from one opposite pole to the next.)
Only now should the therapist do specific acupressure on painful sites. The UB channel now comes to mind, as most tender points are situated on or near it in fibromyalgia clients. Acupressure is performed down the entire UB channel, with both thumbs next to one another, at least 10 times (see image on page 56). Initial pressure on the first sweep down is minimal; each subsequent sweep down increases to 4–5 pressure out of 10. The therapist should linger on specific tender points for up to 10 seconds or more with minimal pressure, rotating in a counterclockwise rotation, and then move on.
Finally, areas of the body that are hurting most at the time of the client’s visit can be targeted sequentially. In addition to being sore all over, fibromyalgia clients always have specific areas that hurt more than others. Speculation is rife about the reasons for this phenomenon: muscle strain, weather, psychological or physical trauma, depression, anger, and so on. A practical reason for focusing primarily on a client’s particularly problematic areas, as opposed to doing a general overall treatment, is time and endurance. A massage therapy client suffering from fibromyalgia may not have the stamina to endure a full hour of general massage or acupressure.
The therapist locates the area, which may or may not be near a classic acupressure point. The TCM text The Yellow Emperor’s Classic of Medicine states that “… wherever there is pain, there is an acupuncture point.”5 The therapist applies a calming oil and follows up with acupressure. The protocol is exactly like the one performed on the head and spine, with the exception that it is done once and only repeated two times as a follow-up, after first moving on to other sites and then only returning to the first sites to check back in.
After dealing with myofascial pain and mental stress, what remains are the issues of constant fatigue and depression. In TCM, lack of motivational energy and depression are caused by insufficient qi not moving the blood and lymph. The insufficient qi could have been caused partially by pain and trigger points that are the result of blocked or congested qi. Now the therapist has to proceed from the narrow focus of treating the client specifically for pain syndromes to the more general emphasis of boosting overall qi and blood and lymph flow. For this, acupressure points and channels that tonify and strengthen organs need to be treated.
A good formula would be a combination of Kidney 1 and 3 with Spleen 6 and Stomach 36 bilaterally. This is followed by Large Intestine (LI) 4. Finally, GV 20 should be treated by rotating the thumb clockwise now for more energy, focus, and strengthening of all organs. The duration of treatment should be 1 minute each on these points.
Essential oils for energy include black pepper, lemon, and peppermint. Cinnamon and ginger are options, but together can be too warming for fibromyalgia clients. The therapist should use one drop each per point and rub them in clockwise. This treatment should only follow after the initial use of calming oils.
Because acupressure taps into the endocrine system, allowing for the release of dopamine, endorphins, enkephalins, serotonin, and other hormones that act as natural opiates, as well as its ability to help stabilize mood, lift depression, and increase focus and overall well-being, acupressure can be a natural adjunct to Swedish massage for the fibromyalgia sufferer. Because acupressure repeats the effects of aromatherapy, it augments the overall treatment effect, all in a somatically nonconfrontational way, helping restablish the holistic body-mind-spirit connection in the fibromyalgia client.
Notes
1. National Fibromyalgia Association, “About Fibromyalgia,” accessed November 2016, www.fmaware.org/about-fibromyalgia.
2. R. W. Simms et al., “Tenderness in 75 Anatomic Sites: Distinguishing Fibromyalgia Patients from Controls,” Arthritis and Rheumatism 31, no. 2 (February 1988): 182–7.
3. Mi Huang-Fu, The Systematic Classic of Acupuncture and Moxibustion (Boulder, CO: Blue Poppy Press, 2004); George Soulie de Mourant, Chinese Medicine (Brookline, MA: Paradigm Publications, 2004).
4. Sun Chengnan, ed., Chinese Bodywork: A Complete Manual of Chinese Therapeutic Massage (Berkeley: Pacific View Press, 2000).
5. The Yellow Emperor’s Classic of Medicine, trans. Maoshing Ni (Boulder, CO: Shambhala Publications, 1995).
Wolfgang Luckmann, AP, LMT, is an acupuncture physician and massage therapist who teaches workshops across the country—most are based in traditional Chinese medicine and ayurvedic philosophy. In 2015, he was inducted into the Massage Therapy Hall of Fame. For more information, visit www.wolfgangluckmann.com.