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Massage doesn't have to hurt for it to work! In fact, for clients with fibromyalgia, meeting their nervous system at a place of comfort and ease can be vital.
0:00 Introduction
1:23 The flareup/remission cycle
2:13 Central sensitization in fibromyalgia
2:46 Sample interview with a client
3:00 "When do you hurt and where?"
3:31 "Have you had any recent flareups?"
3:55 "What kind of massage is helpful for you?"
4:10 "Have you ever had a massage that made things worse?"
Massage demonstration
4:51 Adjusting bolstering for that client (avoiding positional discomfort)
5:55 Tracking your client
6:45 Sensitivity to smells, sounds, etc
7:10 Starting where the pain isn't
8:00 Using a mother hand
8:30 Working with tender points using myofascial release
10:18 Slow and light pressure massage for clients with extreme sensitivity
11:35 Being patient with change across multiple sessions
12:21 Alternate strategies for clients who can't receive direct work
13:05 Tracking results and negative outcomes across sessions
13:35 Avoiding inflammation
14:10 Massage as a gateway to wellness

Relevant research:
https://www.ncbi.nlm.nih.gov/pmc/arti... Review of studies on massage for fibromyalgia prior to 2014
https://www.ncbi.nlm.nih.gov/pmc/arti... Cupping no more effective than placebo (needs replication)
https://www.ncbi.nlm.nih.gov/pmc/arti... A study focused on a weekly myofascial release protocol
https://www.ncbi.nlm.nih.gov/pmc/arti... Myofascial vs Swedish for fibromyalgia symptoms
https://www.sciencedirect.com/science... The role of central sensitization in fibromyalgia pain

The main thing I'd like you to take away from this video is that each client with fibromyalgia will be different, which can mean making no alterations to your usual routine, all the way to working more lightly and slowly than you ever have before. If you do end up needing to deliver a uniquely lightpressure massage, just keep in mind that this isn't so much about the tissue itself. This isn't a problem that needs to be broken down or stretched; this is largely a matter of nervous system programming and endocrine function. As long as you're delivering contact that sends a message of safety and comfort, you'll be making progress.

As you work on and around your client's tender points and sensitive areas, consider using an approach informed by myofascial release. Instead of confronting the points directly as with trigger point therapy, use oblique pressure and long slow "ironing out" techniques. This can allow you to work with these areas more directly, and without provoking a pain response.

Let me know what you think in the comments, and if you have any questions! I'd love to hear some experiences you've had working with massage clients with fibromyalgia, and the strategies that have worked for you!

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