The following is an overview about Fibromyalgia presented by Gary Maguire, PT a physical therapist .
Fibromyalgia Syndrome (FMS) refers to a complexity of symptoms involving diffuse musculoskeletal pain. There are also other problems associated with Fibromyalgia such as cognitive impairment, fatigue, sleep disturbance and morning stiffness.
Unfortunately there is currently no diagnostic test for this condition. Currently health care providers use a standard developed by the American College of Rheumatology (ACR). Following a patient history about their onset of pain, trauma and emotional state the criteria for a diagnosis is as follows:
There needs to be an unexplained or spontaneous pain present for over 3 months along the spine and in all 4 quadrants of the body. A quadrant of the body consists of dividing the body in half from head to your feet and across at the naval or waistline.
A clinician then assesses if pain is present by palpation or moderate pressure over 18 designated tender point areas. To qualify a patient as having Fibromyalgia they have to test positive for 11 out of 18 tender points.
· The tender points are on both sides in muscles at the base of you skull or what is referred to as the occiput.
· The next group is at the lower base of our neck area on both sides at the neck and shoulder line or the cervical vertebras of the 5th to 7th of the neck.
· At the level of our upper shoulders over the middle of the trapezius muscles at the middle are the next two points on each side.
· The shoulder blades or scapula each has a point. This is located at the middle on the inside edge closest to the spine. Half way from the top of the scapula to the lower tip.
· On our front chest on each side are the next two points. These are located where the collar bone meets the sternum at what is called the costochondral junction.
· Over our elbows where the end of the humerus or upper arm bones are the next points on each side. The point is 2 cm away from the outside tip of the bone or what is called the epicondyle.
· The buttock muscles or gluteals each have a point located in the middle and towards the outside.
· Each thigh bone (femur) at the top closest to the hip or greater trochanter has a point located on the back side.
· The last points on each side are in the back of the knee joint at the area referred to as the medial fat pads or the half way point where the knee bends.
When examining these tender points to assess Fibromyalgia there are limitations. This has lead to controversy amongst the medical community surrounding the identification of FMS. The positive outcome is the recent research into what is referred to as Central Sensitization (CS) and further understanding of pain mechanisms.
Further research is also providing a clearer understanding of connective tissue or fascia tissue and its relationship to the autonomic nervous system. As musculoskeletal physiology evolves, our clinical ability to accurately identify and diagnose Fibromyalgia will greatly improve. Recent research studies have lead to the identification of what are called myofascial trigger points or MTrPs. These trigger points or painful tissue points play a specific role in Fibromyalgia.
These myofascial trigger points have been identified in Fibromyalgia patients in recent clinical studies. A myofascial trigger point is a taut band of skeletal muscle fibers that create a characteristic pain and referral pattern of symptoms when they are palpated or stimulated.
These trigger points can be active and painful. They also can be quiet and do not cause any discomfort. When active they can cause spontaneous pain locally and can also refer pain to other areas exhibiting a muscle twitch. Then they are quiet they only become active and painful when pressure is applied to them causing pain or a tender bruising symptom.
One common characteristic of myofascial trigger points is the presence of spontaneous electrical activity (SEA). This activity can be measured using medical equipment referred as an electromyography (EMG) while the muscle is at rest.
As a physical therapist who has successfully treated and resolved patient with Fibromyalgia one important component is to engage the patient in a progressive swimming approach.
Due to over arousal of the sympathetic nervous system and its direct influence on the connective tissue and trigger point mechanisms, this approach is aimed at quieting and shutting off this over arousal or derailment of the sympathetic nervous system.
The sympathetic nervous system is part of our central nervous system (CNS) involved involving the autonomic nervous system. With progressive swimming a patient can reduce the overall symptoms and with specific treatment techniques applied by a physical therapist this condition can be resolved permanently.
Gary Maguire, PT is a physical therapist who specializes in treating patients with chronic pain. As a physical therapist for over 20 years I have successfully resolved chronic pain related problems utilizing neurophysiology treatment approaches.
Gary Maguire, PT
Physical Therapist
Gary J. Maguire, PT Physical Therapist
Vancouver, WA
PT
