This document summarizes a presentation on myofascial web and fibromyalgia. It discusses how fibromyalgia pain is generated from hypersensitive central nervous system processing and muscle tissue. Fascia, the connective tissue surrounding muscles, plays an important role as it becomes inflamed, tense and prone to "knotting up" in the form of myofascial trigger points in fibromyalgia patients. Treatments discussed include myofascial release therapy, trigger point injections, and self-care. A study found myofascial release therapy significantly improved fibromyalgia pain and tender points and the effects persisted over time compared to sham ultrasound. Another study found patients receiving myofascial release therapy experienced greater improvements in a fibromyalgia impact questionnaire than those receiving massage.

1. Myofascial Web and
Fibromyalgia
Fibromyalgia Information Foundation
2014 Annual Conference
Ginevra Liptan, MD

2. Fibromyalgia (FM) pain
Hyper-reactive spinal cord and brain called
“central sensitization”
Pain generated from muscle tissue

3. 18 tender points used to
diagnose FM

4. Fibromyalgia muscle pain sources
-Fascia –connective tissue around muscle
-Myofascial trigger points

5. What is fascia?
 Connective tissue network
 Surrounds both individual and groups
of muscles
 Highly sensitive to pain
 Contracts to give muscles extra
strength

6. Myofascial “web”

7. Connective tissue that
envelopes muscles

8. Connective tissue that’s left after
muscle cells dissolved

9. Fascia in FM
 Increased tension
 Inflammation
 Prone to “ knotting up”( myofascial trigger
points)

10. Myofascial trigger points
 Hyper-irritable or taut band of muscle
 Painful on compression
 Refers pain
 Can occur in any muscle under strain

11. Myofascial trigger point

12. Treatments for fascia/trigger
points
 Myofascial release (MFR)
 Trigger point injections
 Self-care

13. Myofascial release therapy
 Manual traction and prolonged assisted
stretching
 Breaks up painful adhesions in the
connective tissue surrounding muscle

14. MFR is not massage

15. Myofascial release for FM

16. Castro-Sanchez et al . 2011
 20 weeks myofascial release therapy
 Compared to sham ultrasound
 Significant improvement in pain and tender
points
 Pain reduction persisted at 1 and 6 months post-
intervention

17. Our study- MFR vs. massage
Women between the ages of 21 and 50 with a
confirmed FM diagnosis
Randomized to myofascial release or Swedish
massage
Therapists had advanced training using the
John F. Barnes MFR approach
90 minutes weekly for 4 weeks

18. FIQ-R Percentage Change in
Myofascial Release SubjectsPercentagechangeinFIQ-R
Myofascial release subjects 1–8
A change of 14% or more is considered significant

19. FIQ-R Percentage Change in
Massage SubjectsPercentagechangeinFIQ-R
Massage subjects 1–4
A change of 14% or more is considered significant

20. Trigger point injections
 Injection of lidocaine
 “Dry needling”

21. Trigger point self-treatment

22. Resources
www.theracane.com
www.myofascialrelease.com
Book:
The Trigger Point Therapy Workbook:Your Self-
Treatment Guide for Pain Relief by Clair Davies
Web sites: