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Fibromyalgia and massage

    What is fibromyalgia?

    A skilled orthopedic massage therapist at Tranquil Therapy Wellness providing manual therapy to a tattooed client in a calming treatment space. The therapist uses a hands-on technique to improve mobility and reduce pain, complementing the client's physical therapy program for optimal recovery.

    Fibromyalgia and massage  Fibromyalgia (FM) is a complex chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, cognitive difficulties, and even mood issues such as anxiety and depression. FM involves central and peripheral mechanism of pain, neuroinflammation, and altered nervous system processing.  It is estimated that about 2% to 4% of the population suffers from fibromyalgia, and it is more common in women than men.

    The exact cause of fibromyalgia is not yet known, but it is believed to be a result of a combination of genetic, environmental, and psychological factors. A study by McGill University Healthcare Centre (MUHC) has highlighted a connection between fibromyalgia and gut health. Researchers have discovered alterations in gut bacteria and blood bile acids may be correlated to the severity of symptoms in those with fibromyalgia. Suggesting gut dysbiosis and low-grade intestinal inflammation may contribute to the development and persistence of FM symptoms.  Fibromyalgia can be challenging to diagnose because it does not show up on conventional medical tests such as X-rays or blood tests. Diagnosis is usually based on a physical examination and a patient’s symptoms. Emerging evidence talks about elevated levels of autoantibodies and neuroinflammation in fibromyalgia patients. They think this could mean immune system dysfunction could contribute to symptom development. 

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    Massage and Fibromyalgia

    Massage therapy can be a helpful treatment for fibromyalgia. By not only reducing pain and muscle tension but also its ability to calm the nervous system. A study done by Filipovic in 2025  found levels of neurotransmitters such as serotonin and norepinephrine (which normally help regulate pain and mood) are lower in those with FM, while excitatory chemicals like glutamate and Substance P are elevated, amplifying pain sensations. Changes in the central nervous system that cause heightened sensitivity to pain is referred to as Central Sensitization. It’s like having your brain’s “pain volume control” turned up too high due to altered neurotransmitter levels. This imbalance makes normal sensations feel abnormally painful.

    It doesn’t stop there, the Peripheral Sensitization where the nerves outside the brain and spinal cord become more sensitive. That causes the nerves to react more easily but especially so when there is Small Fiber Neuropathy. SFN are those tiny fibers that sense pain, temperature, and touch. In Fibromyalgia these small fibers are damaged, inflamed, or dysfunctional. Sending  signal to the patient that are unbearable and feel out of nowhere. 

    This all comes to ahead and creates a “loop” between the Brain (CNS) and the Body (PNS).  The Peripheral nerves become damaged or hyper sensitive due to the SFN, sending too many pain signals. The Central Nervous System becomes overwhelmed by these signals, adjusts neurotransmitter levels “incorrectly” and amplifies these signals creating even more intense pain.

    Massage is great for Fibromyalgia because there are so many variations to choose from. Most of them target the PNS and assist in relaxing the surrounding tissues. Modalities like Myofascial Release, DNM, and Swedish techniques all get great results in calming the nervous system.  Ashley uses a slow yet firm pressure to address tight soft tissues and switches to DNM when in a flair up. 

    Do white blood cells play a role in fibromyalgia?

    There is ongoing research into the role of white blood cells in fibromyalgia, but the exact relationship between the two is not yet fully understood. White blood cells are an essential part of the immune system, and they play a crucial role in fighting infection and disease.

    In fibromyalgia, it is believed that the immune system may play a role in the development and progression of the condition. Studies have shown that people with fibromyalgia may have an overactive immune system, which can lead to increased inflammation and pain.

    One study published in the journal Rheumatology International found that people with fibromyalgia had higher levels of certain types of white blood cells called neutrophils and monocytes, compared to healthy controls. These white blood cells are involved in the inflammatory response and can contribute to pain and tissue damage.

    However, the exact relationship between white blood cells and fibromyalgia is complex, and more research is needed to fully understand it. It is also important to note that fibromyalgia is a multifaceted condition, and its development and progression likely involve a combination of genetic, environmental, and psychological factors.

    Why do you work with FM clients?

    I started my orthopedic massage career by working with clients who had Fibromyalgia. I was fresh out of school and had my Delaware license. After looking for work I found a position at Dr. Lipton’s office in Narberth PA, just outside of Philadelphia. I learned a lot about how to talk to clients, how to listen, and best of all how to write treatment notes. I later found those notes were very helpful in identifying patterns my autoimmune clients had. When I started FM was “made up” and nothing was known about what it could be or how to treat it. I was convinced I could feel things changing under my hands and with a trusted client we started to try new things. Around this same time I was taking myofascial classes and used a lot of those techniques on this client. We got great results and worked together every week for almost 2 years. 

    Although I have referred to FM as an autoimmune condition there has not been significant evidence that this is the case. Until some recent studies indicated that it may have an autoimmune component. Patients with FM frequently exhibit elevated levels of autoantibodies, that mistakenly target the body’s own tissues, as well as increased signs of neuroinflammation. These findings suggest that dysregulated immune responses contribute significantly to Fibromyalgia symptoms. There have been some electrodiagnostic studies that detected nerve abnormalities, that also occur with autoimmune damage or irritation. (Filipovic et al., 2025; Hulens et al., 2020; Mangnus et al., 2023). This means that it can have autoimmune related components but we aren’t sure if it is autoimmune or not. 

    Over the years I continued to work with people that have various autoimmune conditions ranging from Fibromylagia to Lyme Disease. I am committed to helping those with autoimmune conditions find pain relief and ways to manage that pain. Working with your physicians for a holistic view, getting you the best possible care.

    There are also studies that have shown the work of CBT (Cognitive Behavioral Therapy) to improve the lives of those with Fibromyalgia. There is an app called Stanza, a digital behavioral therapy indicated for the treatment of fibromyalgia symptoms in adult patients. If you have FM and use this app please reach out and let me know how it worked for you!

     

    If you have any questions on how Ashley can help you please send us a message or book your appointment today. 

    info@tranquiltherapywellness.com

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    • Filipovic, T., Filipović, A., Nikolic, D., Gimigliano, F., Stevanov, J., Hrkovic, M., & Bosanac, I. (2025). Fibromyalgia: Understanding, diagnosis and modern approaches to treatment. Journal of Clinical Medicine, 14, 955.
    • Hulens, M., Bruyninckx, F., Rasschaert, R., Vansant, G., De Mulder, P., Stalmans, I., … & Dankaerts, W. (2020). Electrodiagnostic abnormalities associated with fibromyalgia. Journal of Pain Research, 13, 737–744.
    • Mangnus, T. J., Dirckx, M., & Huygen, F. J. (2023). Different types of pain in complex regional pain syndrome require a personalized treatment strategy. Journal of Pain Research, 16, 4379–4391.
    • Ottawa Panel. (2008). Ottawa panel evidence-based clinical practice guidelines for strengthening exercises in the management of fibromyalgia. Physical Therapy, 88(7).
    • McGill University Health Centre (MUHC). (n.d.). Another secret of fibromyalgia discovered in the microbiome. Retrieved from: https://muhc.ca/news-and-patient-stories/research/another-secret-fibromyalgia-discovered-microbiome
    • Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., … & Sheon, R. P. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis & Rheumatism, 33(2), 160–172.
    • Li YH, Wang FY, Feng CQ, Yang XF, Sun YH. Massage therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014 Feb 20;9(2):e89304. doi: 10.1371/journal.pone.0089304. PMID: 24586677; PMCID: PMC3930706.