Fibromyalgia and the Elderly
Finding Relief with Massage
By Joyce A. Garland, RN, LMBT
Originally published in Massage & Bodywork magazine, October/November 2001.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.
One day after attending a geriatric workshop seminar, I visited a neighborhood boutique. While browsing, I overheard a customer tell the clerk she had fibromyalgia. Trying to explain the disorder to the clerk, the woman sighed and said doctors don't know exactly what fibromyalgia is. Those who have it experience a general muscular aching, pain and stiffness, she explained. "I also have certain points that are so tender at times I can't even get dressed," said the woman. "With me, it began one day when I got the flu. I've felt like this ever since." As the clerk empathized, she asked if there was anything that could be done. "A few months ago I received a few massages, but it was too painful," said the woman.
"Excuse me," I interrupted. "I couldn't help overhearing your conversation. I am a massage therapist, and I've just learned a technique I'm pretty sure could help you."
I explained the concept of geriatric massage, conveying that it's not just a lighter massage, it is massage using modifications of standard techniques especially suited to debilitating physical conditions. Her eyes brightened.
The Link Between Fibromyalgia and the Elderly
For those suffering from fibromyalgia, chronic pain is paired with an intense sense of "aloneness." Sufferers look great on the outside, but inside feel as if they are terminally ill. Fibromyalgia affects marriages, friendships and all interpersonal relationships.
Clients try hard to identify how and when their condition began. Some remember a flu or a severe cold as the onset. Others say an accident -- typically a whiplash or neck injury -- caused it. Still others attribute the disorder to a difficult pregnancy or a fall. Fibromyalgia is a difficult condition to diagnose. There are no lab findings to identify it, and the diagnosis is made primarily from the patient's history of the symptoms. Over the years, though, doctors have recognized some guidelines to aid diagnosis.
Doctors can identify 17 trigger points specifically found on fibromyalgia clients, but pain is the most prominent of symptoms with this disorder. Pain is felt all over the body, and its intensity is reported to be twice that of those suffering from rheumatoid arthritis. Pain is described in various ways -- burning, radiating, gnawing, soreness, stiffness and aching. The severity is often attributed to change in weather, stress or sleep patterns. Pain from the specific trigger points varies from day to day, just as the severity of pain can vary from patient to patient.
Other symptoms, not uncommon, include weight gain, shortness of breath and pelvic pain. Possibly the most important and common complaint is difficulty in sleeping. The person who suffers from fibromyalgia rarely captures the depth of sleep that allows the body to repair itself from the day's use. They experience alpha delta sleep anomaly. This level of sleep is necessary to repair muscles overused during the day, as well as to release growth hormones.
The emotional state of the patient can be affected by depression and anxiety. Whether it is attributed to situational or biological factors is not known. Some clients have neurological symptoms of numbness and tingling of their hands, legs, feet and occasionally, their face. At night, they may suffer from restless leg syndrome.
Fibromyalgia has been with us for years. Sir William Gowers first described it in 1904, but it is only since the 1970s that doctors and scientists confirmed it is not caused by an inflammation or known disease. At that time, I remember medical personnel diagnosing it as a psychological disease. It "must be in your head" was the catch phrase at the time. It took a long time for patients to convince the medical community this truly is a crippling condition. The recent definition of fibromyalgia calls it a widespread muscular aching, pain and stiffness associated with tenderness on palpation of specified trigger points mainly on the neck, back and extremities.
Ironically, the overwhelming majority of Americans afflicted with fibromyalgia syndrome are women. It is the second most common diagnosis made by rheumatologists today. What I have found is that doctors are now diagnosing it in their geriatric patients. Those who thought they had arthritis or rheumatism end up having many of the symptoms of fibromyalgia. According to recent research, 7 percent of the women affected with fibromyalgia are more than 70 years old.
The Work Begins
I made an appointment with the woman from the boutique, named Chris, and we discussed families, husbands and homes. It was superficial conversation until she felt she could trust me. As we discussed what she thought she would like from massage therapy, Chris expressed both a desire not to be hurt, and to find some relief no matter how long it might last.
Chris' disease was progressing rapidly and she was experiencing severe bladder pain and spasms, along with severe muscle pain and near-daily migraine headaches. She eventually told me her husband had to give her an injection of Demerol because nothing else helped. I noticed her skin had a mottled appearance and she said she was extremely sensitive to temperature changes.
In working with Chris, we discussed a plan of care. She and I decided to "reprogram" so that eventually she would see touch as a form of healing.
Chris was unable to lie on the massage table and felt a seated massage chair would be the most comfortable. Working from a chair offered her another advantage -- Chris chilled quite easily and the chair didn't require her to remove any clothing.
In the first session, I began with a gentle rocking of Chris' body to aid in relaxation. I explained this technique would be both gentle and surprisingly effective. As we got underway, Chris mentioned she had severe pain in her right rhomboids medial to the scapula. We discussed the trigger points of fibromyalgia and knew this was one of them.
I began massaging slowly and deliberately, allowing the brain to absorb the strokes. I started with a light effleurage and a slight fluffing of the traps. Fluffing is a term coined by Dietrich Miesler (longtime author of this column) that involves a combination stroke of effleurage and petrissage. Along the way, I often checked in with Chris to evaluate her pain threshold using a scale of 1-10 (10 being the most painful). After the traps, I turned attention to loosening the erectors by administering three long back strokes. Because Chris' body was so sensitive, I could only work on her for 20 minutes at a time, even though she wanted me to continue longer. I did some gentle friction in the area of the rhomboids and finished with a nerve stroke.
Afterward, Chris sat in the chair for a few moments before I helped her up. She expressed some release of the horrible pain. I could see it in her face. She was more relaxed and her eyes were brighter. She was so encouraged, yet guarded that it might not work. We set up a schedule to meet for a 30-minute massage session twice a week. Her homework included journaling how she felt the day after our session.
Before our second session I planned on ways to help Chris relax. I brought my tape recorder with calming music. I dimmed the lights and made sure the temperature of the room was comfortable for her. We chatted a few minutes about the first session. Chris said she had felt very little pain afterward and had slept better that night. She was anxious to begin again.
This time Chris felt more comfortable on the massage chair. I could feel her relax with the first effleurage stroke. I worked on the lower back to relieve sciatic pain and I worked around her trigger points with gentle friction strokes. Chris was so grateful to be feeling some relief that she tended to be a "chatty Cathie" during our sessions. I gently reminded her this was her time to relax and enjoy. Again I checked in regarding her pain threshold. She said it was in "8" on the left buttock. At the end of the session it was a "5."
By the third session Chris took less time to relax and began to trust me more. I was able to friction massage the traps and the paraspinals. When starting the massage or when I could feel her tightening up, I would use effleurage, the most sedating of strokes. Gentle cross-fiber friction created a calming and beneficial effect.
On the fourth session, Chris complained her feet and legs were in pain and burning. She sat on the couch with her legs elevated and I began with a gentle nerve stroke/effleurage to become familiar with the extremities and to allow the extremities to know that my touch would not hurt. We progressed slowly and, like the first session, it took time for Chris to relax with this new technique.
Whenever I work with Chris or any other fibromyalgia client, I need to be totally focused. This is one reason why geriatric massage is only 30 minutes. It is intense for both client and therapist. I need to be constantly aware of my stroke and level of touch. A good rule of thumb is "less is best."
Offering Support and Resources
In treating fibromyalgia over the years, I've come to realize how important it is for clients, their family and their friends to learn as much as possible about the disorder and how to live with it. Many fibromyalgia patients have been shunned by doctors, friends and family, leading to feelings of isolation, guilt and anger.
Besides educating themselves, fibromyalgia sufferers need to take a pro-active look at their lives. In seeking quality of life, these clients most likely will need to make a change in their present living patterns, putting themselves first, if they want to feel better. Clients must take an active role in their treatment. I merely remind them of some things that have been shown to help: better eating habits, including the avoidance of alcohol, caffeine, sweets, and sometimes wheat and dairy products; and proper breathing techniques, forgoing the shallow, oxygen-depriving breathing most of us unconsciously practice.
And the most important bit of advice I can offer is continuing with their 30-minute massage twice a week. With proper therapy, most fibromyalgia survivors improve and are able to deal with their complaints and lead a productive and wholesome life.
Joyce Garland is a Registered Nurse, an LMT in three states, and an instructor with the Day-Break Geriatric Massage Project. She resides with her husband in Charlotte, N.C., where she also has her own practice. To find out more about geriatric massage, contact the Day-Break Geriatric Massage Project at 317/772-9896.