During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and  well thought out information and  decision-making outcomes. I am happy to share some of their assignments for you to enjoy.

Condition: Fibromyalgia                                                                                           

Why did you choose this client/condition? The client states that she receives a weekly massage at the school because massage is one of the only treatments that gives her relief from fibromyalgia-related pain (the client states that swimming is helpful too). Before working with this client, I had heard of fibromyalgia; however, I did not know much about the condition. I chose this client and this condition because I massaged the client weekly for nine weeks during my internship. I want to be better informed about fibromyalgia because I know many people use massage to help deal with the symptoms of fibromyalgia. I want to be confident that my techniques are (research-based) effective for this client and others with the condition.

Briefly summarize the condition for this client–what led to the condition, how long has it existed, has it changed, etc.  The client is a high school art teacher and is attending graduate school in psychology. The client reports being in multiple serious car accidents, beginning in her teens. When she was 32, the client was in a car accident that left her unable to walk for six months. The client states that she developed fibromyalgia after being in these car accidents. The client is now in her mid-50's, so she has lived with fibromyalgia for approximately 20+ years. The client reports having post-traumatic stress disorder. The client reports being exposed to toxic mold in the workplace. She believes that the PTSD and mold exposure also contributed to her developing fibromyalgia. The client states that she has trigger points all over her body. She reports chronic soreness in her neck, shoulder, and hips. She states that she has frequent migraine headaches. The client states that her pain increases when she overexerts herself physically or is under a lot of stress.

Discuss your understanding of the condition (causes, symptoms, pathology, treatments, etc.) Fibromyalgia is a chronic syndrome characterized by generalized pain, joint rigidity, intense fatigue, sleep alterations, headache, spastic colon, craniomandibular dysfunction, anxiety, and depression.
Fibromyalgia is considered to be a disorder of pain regulation. People with fibromyalgia may experience pain at a lower threshold because of an imbalance in the way the autonomic nervous system responds to physical, chemical and psychologic stress.
While the cause of fibromyalgia is unknown, it most likely involves several factors working together including:

• Genetics. Because fibromyalgia tends to run in families, certain genetic mutations may make a person more susceptible to developing the disorder.
• Infections. Some illnesses appear to trigger or aggravate fibromyalgia.
• Physical or emotional trauma. Post-traumatic stress disorder has been linked to fibromyalgia.

Symptoms

• Widespread pain. The pain associated with fibromyalgia often is described as a constant dull ache that has lasted for at least three months. To be considered widespread, the pain must occur on both sides of the body and above and below the waist.
• Fatigue. People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea.
• Cognitive difficulties. A symptom commonly referred to as "fibro fog" impairs the ability to focus, pay attention, and concentrate on mental tasks.
• Other problems. Many people who have fibromyalgia also may experience depression, headaches, and pain or cramping in the lower abdomen.

Treatments

Treatments for fibromyalgia include both medication and self-care. The emphasis is on minimizing symptoms and improving general health. No one treatment works for all symptoms.

Medications. Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:

• Pain relievers (over-the-counter and prescription);
• Antidepressants;
• Anti-seizure drugs; and
• Pregabalin (Lyrica) was the first drug approved by the FDA to treat fibromyalgia.

Therapy. Talking with a counselor can help strengthen a person's belief in her abilities and teach strategies for dealing with stressful situations.

Self-Care. Self-care is critical in the management of fibromyalgia. The person should try to:

• Reduce stress;
• Get enough sleep;
• Exercise regularly;
• Pace herself; and
• Maintain a healthy lifestyle.

Complementary and Alternative Therapies. These complementary and alternative therapies have been shown to help control fibromyalgia symptoms:

• Acupuncture;
• Yoga and tai chi; and
• Massage therapy. Massage therapy is one of the best treatments for fibromyalgia. Research shows that massage improved sleep patterns and decreased pain, fatigue, anxiety, depression, and cortisol levels in adults with fibromyalgia.

Identify your treatment plan and explain why you chose that treatment plan. My treatment plan was to incorporate some myofascial release techniques for the back, legs, and glutes into the client's weekly massage. I chose to add these techniques for several reasons: 1) because the client requested these techniques. The client stated that she had had myofascial release therapy in the past and it helped relieve her symptoms; 2) because I had read the below research article and other resources that endorse myofascial release techniques in the treatment of fibromyalgia symptoms; and 3) because I had learned a few myofascial release techniques in class and was interested in putting them into practice.

Find a research article that includes massage for that condition and summarize the information in the article. Cite the referenced article. The researchers conducted a randomized controlled trial to examine whether myofascial release therapy improved pain, anxiety, quality of sleep, depression, and quality of life in people with fibromyalgia. Subjects in the experimental group received massage (myofascial release therapy) and subjects in the control group received a placebo treatment with a disconnected magnotherapy device.
The experimental group underwent a protocol of myofascial release therapy during a weekly 90-minute session for 20 weeks. A massage therapist specializing in myofascial release therapy aimed to release myofascial restrictions at the sites of the 18 painful points reported by the American College of Rheumatology.
The researchers measured the subjects' pain, anxiety, quality of sleep, depression, and quality of life at four points; before (baseline) and immediately after the 20-week intervention and again at one month and six months post-intervention.
Immediately after treatment and at one month post-intervention, anxiety levels, quality of sleep, pain, and quality of life were improved in the experimental group over the control group. At six months post-intervention, the only significant difference between the experimental and control groups was in the quality of sleep index.
The study demonstrated that myofascial release therapy helped people with fibromyalgia achieve temporary improvement in their symptoms. The treatment reduced the study participants' sensitivity to pain at tender points and their pain perception. The participants also reported reduced anxiety levels and improved sleep quality and physical function. The study results suggest that ongoing treatment is needed since the benefits tapered off after six months.

Citation: Adelaida Maria Castro-Sánchez, Guillermo A. Matarán-Peñarrocha, José Granero-Molina, Gabriel Aguilera-Manrique, José Manuel Quesada-Rubio, and Carmen Moreno-Lorenzo, "Benefits of Massage-Myofascial Release Therapy on Pain, Anxiety, quality of Sleep, Depression, and Quality of Life in Patients with Fibromyalgia," Evidence-Based Complementary and Alternative Medicine, vol. 2011 (2011). Web. 22 Sept2015 <http://dx.doi.org/10.1155/2011/561753>

What was your expected outcome from your treatment plan? Because of the client's previous experience, I expected the client to report decreased pain after receiving the myofascial release techniques.

Actual outcome and new plan. The client reported decreased pain after receiving the myofascial release techniques. While the client reported a positive outcome, I am unsure if I would continue to use these techniques. For one, I have heard opposing views on the benefits of myofascial release techniques. Secondly, I am not confident in my skills. My new plan is to continue to research myofascial release techniques and alternative massage techniques (for example, are Swedish techniques equally effective?) that benefit people with fibromyalgia. If I decide after further research that myofascial release techniques are beneficial, I will practice to improve my skills.