Ltd 2011 fibromyalgie

What about Fibromyalgia?What about Fibromyalgia?byby

Johnny Carlsson, LMTJohnny Carlsson, LMT

• Johnny Carlsson

• Trager practitioner/Massage Therapist

• Owner SWEHAB Företagsmassage AB

Who am I?Who am I?

FibromyalgiaFibromyalgia

Fibromyalgia (FM) is a chronic pain syndrome whose primary symptoms are widespread chronic pain and fatigue.

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CausesCauses

There are several theories

•Mental illness•Abnormal processing of the signals/hyper sensitivity to the brain•Miss interpretation of the signals to the brain•Neuro-immune-hormonal disease•Neuro transmitor cascades 

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Triggers to the first onsetTriggers to the first onset

•Crisis•Pain•Trauma•Infection 

FM that starts with local pain or mental crisis usually a slow progress  FM that started with an infection usually occurs suddenly.  

International statistics: About 2-4 % of the adult population. Women: 80-85%

About 10% are children or adolescents.

Who is affected?Who is affected?

DiagnosisDiagnosis The diagnosis of FM is a so called criteria diagnosis.

A certain number of set criteria must be met.

Impossible to diagnose by laboratory tests or other medical examination.

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• At least three months of general pain in all four quadrants of the body

• Pain on palpation (pressure) in at least eleven of eighteen tender points. (pressure should be relatively light. Max 4 kg)

• Weakness of muscles• Stiff muscles

Recent research suggests 75 more tenderpoints…

FM or MTrP?

Main criteria for determining FMMain criteria for determining FM

• Constant pain at rest.

• Abnormal fatigue.  • Muscle pain affects motor skills.  • The pain affects sleep.

• Healthy persons show a multitude of FM symptoms after only a few days of disrupted sleep!

Are there more symptoms?

SymptomsSymptoms

•Pain (100%)•Disturbed sleep (80%)•Headaches/migraine (50%)•Numbness/tingling (70%)•Anxiety (50%)•Balance problems/dizziness (50%)•Decreased muscle strength•Lower leg cramps•Stiffness•Nausea•Cold fingers and toes•Tics•Disturbed heart rhythm•Voice is changing or is hoarse

More symptoms! More symptoms!

• Irritable bowel (30%)• Sensitivity to light sound

and smell• Growing pains as a child• Fatigue• Loss of short term

memory• Hard to concentrate• Irritability/mood swings• Swelling• Symptoms from the eyes

nose and groin• Feeling of fever, hot and

cold sensations

Even more symptoms! Even more symptoms!

• Frequent urination• Itching• Depression • Blurred vision• Diffuse skin reactions• Sensitivity to

infections especially herpes zoster

• Abnormal sweat• Bruises easily• Fragile hair and nails,

hair loss• Dry skin• Cravings for sugar and

carbohydrates

• Lack of sleep• A bad bed and or bad

pillow• Static work (computer)• Repetitive work • Over work• Hard physical activity• Depression• Anxiety and worries• Stress• Mental illness• Snoring• Psychological trauma• Physical trauma• Body asymmetry• Poor posture

Perpetuating factors Perpetuating factors • Morton’s foot or flatfoot• Infection• Allergy• Asthma• Diabetes• Poor breathing patterns • KOL• Malnutrition• Dehydration• Caffeine• Smoking• Cigarettes• Drugs• Medicines• Whether changes• Heavy handbags and

backpacks

2 hours of watching television+

8 hours in a bad bed+

8 hours at a computer =

18 hours/day!

The joy of television!The joy of television!

• Trigger points (of course)• Depression• Arthritis• Carpal tunnel syndrome/thoracic outlet syndrome• Hyper mobile joints• Migraine• MS• Restless legs• SAD (seasonal affective disorder)• IBS (Irritable bowel syndrome)• Esophageal reflux• Chronic fatigue syndrome• Yeast infections• HIV

Co existing diagnoses Co existing diagnoses

TreatmentTreatment

Within the EU : NO approved drug

In the U.S. three drugs are approved: • Lyrica• Cymbalta• Savella.

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Causes of FM unknown, hence: no cure!

BUT

 We CAN relieve it!

Get the client motivated!Get the client motivated!

Make a list of the worst culprits:

• television, • bed, • computer • work.

 Make necessary changes Not too many at once!

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• A good bed and pillow • bedroom not to warm. 18°C is

good for a healthy person but with FM it can be to cold.

• Sleep is hormonally induced. Catch the sleep train!

• 6 hours after a cup of coffee half of the caffeine is still in the body. Black tea and coca cola have the same effect.

• Avoid computer work and TV an hour before bedtime. No TV or computer in the bed room!

• Dim the lights an hour before bedtime.

Sleep !!!!!!!!!Sleep !!!!!!!!! • Dont go to bed with your to-do-list. Make a list and forget about it!

• Some may sleep better after eating or drinking. Some may not. Experiment

• If you can´t fall asleep get up, read a book. The sleep train will return

• Make sure it is quiet! Do not accept to be called “easily disturbed” If nothing else works get good earplugs.

• Alcohol=big no-no!• Nicotine= withdrawal after 2

hours• Exercise, but not within two

hours before bedtime• Meditate• Avoid arguing

Use a Trigger Mat to induce sleep.

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Why Zebras do not get ulcers…Why Zebras do not get ulcers…

The fight or flight system is the reason.

Sympathetic nervous system+

Para sympathetic nervous system=

Autonomic nervous system

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Zebra meets lionZebra meets lion

Sympathetic system: Fight or flight response activated

Heart rate is upMuscles are ready to goBlood pressure increasesDigestion shuts down.The pupils are constricted

TRY TO SLEEP NOW!!!

Hormones released:•Adrenaline

•Cortisol•Noradrenalin

•Glucagon•Insulin

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The zebra runs for its life and if it The zebra runs for its life and if it is lucky it can have a bite to eat…is lucky it can have a bite to eat…

The para sympathetic nervous system is activated.

1.Acetylcholine is released2.Adrenaline goes down3.Heart rate goes down4.Blood pressure is reduced5.Insulin level drops6.Digestion starts up again

We are surrounded by attacking “lions” all the time:

• Alarm rings• Wake up the kids• Make breakfast• Off to school and work• Avoid all cars on the way• Stress-stress-stress at work• Avoid traffic on the way home• Buy some food • Pick up the kids• Cook dinner• Clean the house• Pay the bills• Fulfill your dreams• Exercise (?)• Check the email• Watch TV• Try to sleep…

Are people stupid zebras without stripes?Are people stupid zebras without stripes?

• Releases oxytocin• Releases endorfine• Activates the

parasympathetic nervous system

• Promotes relaxation• Reduces pain• Promotes sleep• Breaks first

defense!

The Trigger Mat The Trigger Mat

Using the inflatable TriggermatUsing the inflatable Triggermat

• Inflate to max 2/3• Start with 5 min.• Increase to max 30 min.• Use a cloth if needed• Check client• Use for one month • Take a break for a few weeks

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Before going to workBefore going to work

1. Anamnesis

2. Postural evaluation

3. Palpating the 18 tender points

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AnamnesisAnamnesis

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Fill out this form

Postural EvaluationPostural Evaluation

• Ear to heel• Shoulders• Head forward• Rounded shoulders• Hunched back• Scoliosis• Fallout test• Mortons foot/flatfoot• Leg length

18 points

Max. 4 kg of pressure

Palpating TenderpointsPalpating Tenderpoints

Go play!

Questions?

QuestionsQuestions

Triggermats for your practise?Triggermats for your practise?

Ze zijn te koop Ze zijn te koop tegen de tegen de volgende volgende aanbiedingsprijzeaanbiedingsprijzen:n: Tegenover de Tegenover de receptie, bij receptie, bij NellekeNelleke