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Fibromyalgia - Where Should Bodywork Fit Into An Integrated Treatment Picture?

by Leon Chaitow, ND DO(more info)

listed in fibromyalgia, originally published in issue 151 - October 2008

The symptoms of Fibromyalgia Syndrome (FMS) include disabling levels of pain and stiffness, largely associated with the head, neck, spine and pelvis, commonly associated with chronic fatigue, severely disturbed sleep patterns, and gut problems – among many others.

With the primary symptoms involving pain and stiffness, it is not surprising that focus is often given to the musculoskeletal system – despite the fact that there is ample evidence that the major causes lie in massive systemic metabolic imbalances.

This does not mean that there is no benefit to be gained from appropriate bodywork (see below); however, it does mean that manual approaches can never be more than part of an integrated solution.
Causes of FMS vary from person to person, and a number of subsets, or ‘pathways to FMS’, have been identified.[1]
These include:[2]

  • Genetic predisposition;
  • Trauma – particularly whiplash;
  • Endocrine (hypothalamic-pituitary-adrenal) and or thyroid disturbance – most commonly hypothyroidism;
  • Deficiencies – for example of vitamin D;
  • Toxicity – frequently associated with Small Bowel Intestinal Overgrowth (SIBO), but also possibly involving heavy metal (e.g. lead, mercury) accumulation, or haemochromatosis (iron overload) and the increased oxidation that these toxic burdens would entail;
  • Unsurprisingly, as with any chronic pain/fatigue condition, there will be disturbed respiratory function, as well as emotional/psychological repercussions in FMS patients – all of which can aggravate the symptoms.

What Do Doctors Do for FMS?

Medical attention to FMS patients often focuses on use of antidepressants, moderate exercise and Cognitive Behavioural approaches – all of which can offer the potential for modestly enhanced coping abilities and symptom reduction – despite not actually addressing underlying causes or maintaining features.

Which non-bodywork methods may help with FMS?[3]
  • Vitamin D supplementation (4000 IU/d of cholecalciferol for several months);[4]
  • Normalization of thyroid status;
  • Attention to heavy metal levels (possibly involving oral chelation – for example high fibre and/or selenium);
  • Dealing with gut overgrowth and dysbiosis (particularly SIBO) – commonly involving enhancement of transit time; carbohydrate restriction; probiotic supplementation and eradication of bacterial and yeast overgrowth (oregano oil, berberine, etc);
  • A fruit/vegetable/nut/seed vegetarian dietary pattern has been shown to be of value in many instances;
  • Use of natural supplements, including 5-hydroxy-tryptophan (5HTP), Magnesium malate, acetyl-L-carnitine, Co-Q-10, SAMe, may all be helpful.
Which bodywork and other physical medicine methods may help with FMS?
  • In many instances, Myofascial Pain Syndrome (MPS) involving multiple myofascial trigger points, is responsible for much of the musculoskeletal pain experienced in FMS;
  • Deactivation of such triggers, by gentle manual methods (neuromuscular therapy), manual lymphatic drainage, acupuncture, dry needling, laser or use of Frequency Specific Microcurrent (FSM), have all been shown to assist in reducing the pain burden;[5]
  • Chiropractic and osteopathic treatment as been shown to be helpful, particularly where gentle methods such as Positional Release/Strain-counterstrain,[6] are employed;
  • Massage – particularly non-invasive ‘relaxation massage’ – can be extremely helpful;
  • Respiratory retraining is vital to enhance tissue oxygenation, and reduce overuse of already painful structures caused by inappropriate patterns involving the accessory breathing muscles;[7]
  • Various forms of hydrotherapy – including Watsu and balneotherapy – have been shown to be helpful;[8]
  • Acupuncture can also reduce the pain burden.


It is important to re-emphasize that because FMS is not primarily a musculoskeletal problem, despite the manifestation of most of its symptoms in the muscular and joint tissues; manual/physical methods should not form the primary therapeutic focus.

Nevertheless, bodywork and other physical approaches should be at the heart of any integrated approach to this disabling condition.


1.    Chaitow L. Fibromyalgia Syndrome – A Practitioner’s Guide to Treatment. Churchill-Livingstone/Elsevier. Edinburgh. 2003.
2.    Vasquez A. Musculoskeletal Pain: Expanded Clinical Strategies Institute of Functional Medicine. Gig Harbour. WA. 2008.
3.    Chaitow L. Fibromyalgia and Muscle Pain: Your Self-treatment Guide. Thorsons/HarperCollins. London. 2001.
4.    Armstrong D et al. Vitamin D deficiency is associated with anxiety and depression in Fibromyalgia. Clinical Rheumatology. 26: 551-554. 2007.
5.    Rickards L. The Effectiveness of Non-Invasive Treatments for Active Nyofascial Trigger Point Pain: A Systematic Review of the Literature. International Journal of Osteopathic Medicine. 9(4): 120-136. 2006.
6.    Dardzinski JA. Myofascial Pain Unresponsive to Standard Treatment: Successful Use of a Strain and Counterstrain Technique with Physical Therapy. Journal of Clinical Rheumatology. 6(4): 169-174. 2000.
7.    Chaitow L, Bradley D and Gilbert C. Multidisciplinary Approaches to Breathing Pattern Disorders. Churchill-Livingstone/Elsevier. Edinburgh. 2002.
8.    Chaitow L. (ED). Naturopathic Physical Medicine. Churchill-Livingstone/Elsevier. Edinburgh. 2008.


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About Leon Chaitow, ND DO

Leon Chaitow ND DO - December 7, 1937 — September 20, 2018 was a registered Osteopath and Naturopath and an Honorary Fellow at the University of Westminster. He has been author of over 70 books, edited the peer reviewed Journal of Bodywork & Movement Therapies, and practised in a NHS Health Centre and privately. He taught widely to Physiotherapists, Osteopaths, Chiropractors and Massage Therapists. Further information about Leon who sadly died 20 September 2018 is available via his website:

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