Fascia and Its Role In Fibromyalgia Pain

Dr. Ginevra Liptan, founder of The Frida Center for Fibromyalgia and author of “Figuring Out Fibromyalgia,” spoke to our support group (The Portland Area Fibromyalgia – ME/CFS Group) on Saturday.

The topic of the talk was “Fascia and Its Role in Fibromyalgia Pain.”  However, Dr. Liptan was kind enough to take questions from the group throughout the talk so the scope of her presentation became larger than the initial topic.

She began by saying that “seen scientifically, there is something going haywire in the nerves in FMS.”  Scientists agree that there is a component of enhanced pain processing called central sensitization that happens.  In this process, pain signals become amplified and altered from the time they move from the site of the pain to the brain.

In 2003, a study validated that FMS is a true illness with a component of pain amplification.  Using a functional MRI, researchers took subjects with fibromyalgia and perfectly healthy subjects and watched their brains as enough pressure was applied to their thumb to make them say, “ouch.”  What they saw was that with fibromyalgia, the whole brain lit up while with the healthy subjects this did not happen.  This proved that fibromyalgia patients are feeling pain much more intensely than normal people.  It was this study that interested the pharmaceutical industry in fibromyalgia because finally they had something they could begin creating drugs to treat.

According to Dr. Liptan, since 1904 scientists have been looking at the muscles functionally, under a microscope and chemically trying to understand why muscles hurt in fibromyalgia patients (called fibrositis in 1904).  They cannot find anything wrong with our muscles.

So, why do our muscles ache if there is nothing wrong with them?  Dr. Liptan believes, and studies have confirmed, that the fascia, the connective tissue around the muscles, is very pain sensitive.  This is something that M.D.s do not study.  However, it was widely discussed in naturopathic and chiropractic colleges.

It turns out that in fibromyalgia, the fascia is where the abnormalities in the tissue lie.  Dr. Liptan said, “Fascia surrounds each muscle cell, which is wrapped by another bundle of fascia, which is wrapped by another bundle of fascia.”  This fascia is as sensitive to pain as skin.  Interestingly, nerve receptors in muscles don’t even register pain.  Instead, they sense balance and where the muscle is in space.

As it turns out, the 18 tender points used to diagnose fibromyalgia are very rich with fascia and are also the points where muscles have the most strain put on them from every day movements.

Another fact is that when you exercise, sports medicine has found that the muscles themselves stay unchanged, yet there is a lot of immune activity going on in the fascia showing that the repair that is being done in the body is to the fascia.

In FMS, something goes wrong in this repair process and the damage caused to the fascia by exercise or even daily activity can’t be repaired properly by the immune system.  In a research setting, the cytokines that are activated in an immune response can be measured and they are consistently high in the fascia tissue of fibromites.  These tests show that something is dysfunctional in the immune response and how the fascia gets repaired.

Dr. Liptan went on to talk about how in fibromyalgia, the fight or flight response becomes triggered and then never shuts off.  She compares it to a fire alarm being turned on yet there is no fire.  Then the alarm just keeps going and going.

As you can imagine, when you are in constant fight or flight mode, sleep would be difficult to achieve and would be unrefreshing at best.  Because of this inability to achieve deep, restorative sleep, hormones that should be secreted to repair the fascia are not released.  Instead, the hypothalamus is constantly being told to secrete more and more adrenaline.

She also notes that when your body is basically in this state of life-threatening danger (fight or flight) at all times, the stress can rundown the immune system.

In response to a question about exercise, Dr. Liptan said that exercise can be helpful, but must be done right.  Because of this constant fight or flight response, the fascia around the muscles stays in a state of contraction.  She compared it to taffy that is very stiff like it has been in the freezer.  It would easily break.  The trick is to warm up very gently before exercise so that the fascia is not so stiff and contracted.  In her book, “Figuring Out Fibromyalgia,” she goes through a set of warm-up exercises that take about ten minutes.  She then explains her exercise and cool-down regimens.

Finally she explained that standard massage could sometimes cause more pain than it cures in fibromites.  The type of massage that she finds most helpful is called myofascial release.  It is a slow, very slow, gentle stretching of the fascia that breaks up adhesions and lessens pain.

The talk was a mere appetizer compared to the wealth of information found in her book.  I highly recommend that you read “Figuring Out Fibromyalgia” as it goes into much more depth about the fascia, sleep, myofascial release massage and other fascinating topics about FMS.