Thursday, October 29, 2009

Professional Practice blog 7

What does it mean to be a massage therapist and a multi-disciplinary healthcare provider?
Victoria Walden
Due Date 30th October 2009

What does it mean to be a massage therapist?
As a massage therapist I believe that I have techniques and the qualifications to help improve the present status of clients that come to me with muscle pain or just for pure relaxation. Working within the scope of practice, that Massage New Zealand has produced I believe that I can help improve client’s quality of life.

As a multi-disciplinary practitioner alongside massage therapy is where I believe that I should become accustomed to other healthcare providers scope of practice that could aid in the recovery of any client that may come to me for treatment.

I feel as a multi-disciplinary practitioner you have to have an open mind to other means of treatment to help your client recover from any dysfunction that needs attending too.

McQuillan (2009), states that ‘Dialog is the key to working effectively as a multi-disciplinary practitioner:’

To achieve this is:
- Consensus
- Appreciation of difference
- Cross-fertilisation

- Consensus means a general or widespread agreement among all the members of a group. Between different means of treatment from different healthcare providers is where as a practitioners research has to come into play and showing evidence of treatment plans and how they can help the client. Through research and communication I believe that healthcare providers can produce a quality treatment plan for the client.

- Appreciation of difference means that every healthcare provider will have a different perspective on different treatments for clients therefore each practitioner needs to understand that everyone has different expertise.

- Cross-fertilisation means that each practitioner may have their expertise and through this you can work together and cross-fertilise ideas and treatment plans.

To provide a multi-disciplinary healthcare to each client from a massage therapist viewpoint will be hard and struggle to get other healthcare providers on board. This has a large affect on the C.A.M (Complimentary alternative medicines) as we have so much that we can provide to other healthcare professionals, who see that they are higher and more highly ranked in this department of care for clients. Recent research however has seen that C.A.M are becoming more recognised, World Health Organisation now recognises multi-disciplinary as a way for healthcare operators to work.

I believe as a massage therapist and part of the C.A.M we are slowly but surely making a mark in the healthcare provider’s profession. As a massage therapist, I feel it is our duty to inform clients of their options to request the second opinion of other healthcare providers. It is also our duty to respect and understand that there are other alternatives to treatment for each individual.

As a whole I believe that within any healthcare profession that multi-disciplinary practice should be set in place to provide that best suited care for any client who needs help. Communication is the key alongside consensus, appreciation of difference and also cross-fertilisation, from this I believe that it will take time and money, also the hierarchy within occupations will have to subside. If all is applied, the healthcare profession will reach new heights in applying care for clients.


Class notes

McQuillan, D. Elluminate. Multi Disciplinary Practice. October 28th 2009. Professional Practice.

My own thoughts

Friday, October 23, 2009

How does reflective practice, supervision and the professional development policy, support professional practice?

Professional Practice:

Victoria Walden

Due Date: 23rd October

In a massage business a professional practice is what keeps your business successful and providing a high quality of service to each potential customer. I believe that within each business there should be reflective practice, supervision and a guild and also being involved with the professional development policy, this will show that you as a massage therapist uphold and support professional practice in your business. I believe that these three steps in your business will increase the status of your practice and improve the thinking, focus, and ideas that will continue to enhance you professional practice.

Reflective practice:

Using reflective practice within your business gives you the opportunity to improve not only with the present status of your business but also for yourself, in how you can improve your application within the business, massage, and also with client care. When using a reflective practice you can identify your strengths and weaknesses and how you can tackle them. I believe I could apply this in my business by:
- Writing a journal
- Feed-back forms from clients
- An comment box for clients who would like to remain unknown
- Writing comments to self, after treatment of each client, what worked and what could I have done better.
- Researching and asking about similar differences that others may have in common from other therapists.
From these few ideas I believe that I can obtain vital information and review what I can do to help improve the way that my business is run, from how each client is welcomed including phone calls, all the way to when they have come and gone back out the door. I know that this will improve the professional practice of any business.


I believe having a supervisor is a vital aspect to the massage practice, within its professional practice. The position that the supervisor would take is to be a channel for your thoughts and also someone to bounce ideas off. The supervisor would also be there as a guild and someone to talk to if problems or issues come about within the practice that you cannot seem to find a solution. As a new massage therapist to the business I feel that I would need a supervisor within my first year as I no longer have the security of the lecturers or fellow students and have to deal with issues on my own. With a supervisor I can channel my thoughts and categories them into priorities to what is necessary at the time. My business therefore would not be cluttered with my thoughts and be scattered, instead it would be organised as my thinking process and also my worries would be out of my head, keeping it clear for the high quality of professional service that I would want to provide.
To establish a professional business you need to have someone to channel your thinking process and to keep your mind clear and concise.

To develop and improve your massage business you need to keep up with the latest things and the keep furthering and increasing your knowledge of the massage industry. With the professional development policy that is run through Massage New Zealand I believe as a massage therapist that it would be a great time to join and keep up to date. With joining MNZ you can further your education as a therapist and also be informed of workshops, gaining formal education. Massage New Zealand can offer so much to a young therapist in the industry: Latest knowledge, creditability, also giving your clients the comfort knowing that you are a trustworthy and professional practitioner. To have a professional practice being involved with a business, MNZ, is a step forward to becoming a successful therapist in the industry.

From what I have stated above I believe that it all relates and supports professional practice, they can improve the quality of the business at present and can maintain a high quality of service to each individual. These steps can enhance the ability to understand the industry and also your business in that industry. It can improve relations, ideas, quality, and the success of your practice in pleasing the potential customer and also you as a business owner.


My own thoughts

Saturday, October 17, 2009

Massage Industry and Government Policy in NZ

Massage Industry and Government Policy in NZ
Victoria Walden
Due 16th Oct (with week extention).

How can I as an individual massage therapist influence the development of government policy & laws that are supportive of the profession?

Within New Zealand our Government has certain policies and laws that are put in place to ensure the protection and safety of both parties involved. Massage therapy does not have laws specific to the profession and therefore there are massage therapists that are not qualified under NZQA or other education outlet. Through this anyone can massage and set up a business.
The laws that relate to massage therapy are as follows:

Privacy Act 1993
Health and Safety in Employment Regulations 1995
Consumer Guarantees Act 1993
Medicines Act 1981
Health and Disability Commissioner Act 1994
Health Practitioners Competency Assurance Act 2003
Injury Prevention, Rehabilitation and Compensation Act 2001
Local Body Requirements
Occupational Health and Safety requirements

From these laws they are a base outline as to what a massage therapist should abide by. These laws are unfortunately not specific to a massage therapist allowing a lot of variation to each therapist. Within New Zealand anyone can set up a business and apply massage to any customer that walks through their door. I believe that this approach to massage has to be rectified as there are different levels of experience and variation as to the extent of the education to some therapists.

I feel that the massage industry should be regulated. Yes there are therapists out there who have made their living as a professional massage therapist, without any educational certificates and have the same knowledge. I believe that there should be an allowance for people such as them, even a test that is national wide. From my perspective I see that some therapists can diminish the massage industry by their professionalism and through their practice, therefore regulation should be put into practice.

However as a new massage therapist to the industry I believe that there should be a one year integration into the business where I have read that you only really start learning when you being to apply your massage to the public.

With the dispute “massage regulation” I believe as a massage therapist myself there needs to be more information provided and also giving the opportunity to educate massage therapists without the correct knowledge if they agree.

There will always be public who dispute the regulation of therapists: Massage therapists without education, massage therapists who, not only supply massage, and also the public. From this the massage industry will always be split until there is more information provided to the public and also to other massage therapists, as in this industry the practice is evolving and improving in its techniques and application to the potential cliental.

I believe that the ways in which I could influence the minds of the public and try and convince, is that the education to a massage therapist is beneficial and essential to your help and safety of each client.

I could:

- Have my qualifications displayed on the wall where the clients will see it.
- Be registered under Massage New Zealand
- Provide clients with information that I have qualifications
- Provide clients with the information that some therapists do not have to qualifications as a massage therapist
- Communicate with Polytechnic where I studied, including teachers, students etc...
- Communicate with town district
- Get as many people behind the bill, this also involves the potential clients that will need massage for example: high advanced sporting athletes, doctors, hospitals, high profile businesses etc...

In conclusion I feel that the regulation of therapists should come into play and that everyone should back it. Myself as a therapist, I feel that each therapist should be allowed a year in the industry to learn and to get the experience of how the business is run and how to polish of techniques to provide the highest quality of service to each client. I feel that I need to understand and read more about how this industry is evolving and how we as a nation can improve the status at this present point where there are a lot of questions still unanswered.


Class notes. (2008).

McQuillan, D. Elluminate. Understanding Legal Process .September the 23rd 2009. Professional Practice. Polytechnic Massage Therapy Diploma Course.

My own thoughts

New Zealand Legislation. (2009). Retrieved October, 17th, 2009 from

Wednesday, September 23, 2009

Sustainable Practice:

Sustainability: Blog 4
Victoria Walden
Due Date: 25th September 2009

Sustainable development is described by the Otago University Press as “Development that meets the needs of the present without compromising the ability of future generations to meet their own needs” (1987).

Sustainable massage practice involves three specific points:
- Environmental sustainability
- Social sustainability
- Economic sustainability
All three of these points interlink and relate to the theory and practical side of massage therapy.

Environmental sustainability:

Environmental sustainability is to do with the environment and how we are as a community, taking it for granted. Within the massage practice here are examples of how we are sometimes unsustainable: Example of this would be the amount of paper that is used, the amount of electricity used in the things such as laundry and the use of a motor car each day to get to and from work. As a massage therapist in my massage practice I believe that my business should try and improve our environmental sustainability, we can do this by:

- Biking to work
- Having adequate equipment (sheets)
- Using sheets as they dry more quickly
- Also using recycled paper or computer files for clients
- Timer on heating device in the business premises

I believe that as a practitioner it is also my occupation to spread the word about environmental sustainability and information to clients is another step in their recovery from injury or from something else. Information on 30mins and day “push play” can make a difference in a client’s daily routine.

Social sustainability:

Social sustainability relates to the quality of interaction between people, different parties, religions, trust. Within massage therapy social sustainability is a vital aspect to the communication, information and expansion of the business. Social sustainability is between clients ad their therapists and also other therapist’s interaction with each other and the interaction between the therapist, client and other health professionals.
Within my massage business I feel that social sustainability is a major aspect that should be addressed. Social sustainability has to do with communication and trust between all parties that relate to my massage practice. I feel that my business can do this by:

- Working with other therapists and healthcare professionals
- Looking after yourself
- Educating clients about improving their wellbeing
- Being aware of issues of environmental sustainability.

All of these points will improve my massage business as I feel that communication is the key to a successful business and consistent cliental. I can learn from other business and also learn from the clients in what they are looking for in a massage business, as they are my main target market.

Economic sustainability:

Economic sustainability basically means the financial performance of the operation of the business. For the massage therapist to build a credible reputation and to maintain the trust to exist between the therapist, client, and other health professionals the business needs to be economically viable. Economic sustainability is typically considered as actions which maintain economic capital for example financial performance, also taking environmental and social sustainability into consideration.
Within my massage business economic sustainability is another major point that must be addressed. Ways in which my massage practice can meet economic sustainability include:

- Setting fees and managing money
- Trigger point identifying target market to attract new clients and maintain existing clients
- Form relationships with interacting organisations: e.g. sports clubs, businesses, other health professionals and tourist orientated businesses.

For my massage business to maintain an economic sustainable business requires customers. The relationship between the therapist and client maintains both social and economically sustainable businesses. Basic economics relies on income (fees). Fees have to be set at acceptable levels... this also maintains the social sustainability of the business. Fees set too high are both economically and socially unacceptable therefore my business would research the other supplying business around the area to maintain a average price that is acceptable. Referrals from other associated businesses are also necessary in maintaining economic sustainability. This can be taken as broadly in include other health professionals, bank manager, accountant. My business will identify who my clients are and who is my target market; this will assist in the planning of the purchase of equipment. Equipment leads to environmental sustainability and the equipment needed is a direct outcome of which the target market will be, relating to social sustainability. Only the equipment necessary to meet the demands of my business needs to be purchased. Equipment that is not being used to its full application does not make economical sense.
In all I believe that my massage practice will do its best to keep a sustainable business, unfortunately this is not a perfect world and that the business will still rely on certain power sources, for example dryers, especially during the winter months. Also the fact that transport is necessary for me to get to work unless it is a fine day or public transport is available. Within my practice I do feel that that the three aspects of sustainability will be put into action and that it is a major topic in the community today.

Class Notes 2008
McQuillan, D. Elluminate. Sustainable Practice. September the 23rd 2009. Professional Practice.
My own thoughts
The World Commission on Environmental and Development. (1987). Our Common Future, Oxford, New York: Oxford University Press.

Saturday, September 12, 2009


Pathology: Pyelonephritis
Victoria Walden
Due Date: 14th of September


Acute pyelonephritis (also known as acute infective tubulointerstitial nephritis) is a sudden inflammation caused by bacteria that primarily affects the interstitial area and the renal pelvis or, less often, the renal tubules. It’s one of the most common renal diseases. With treatment and continued follow-up care, the prognosis is good, and extensive permanent damage is rare.
(Springhouse, 2005)

Pyelonephritis is more common in females and can occur more when the immune system is down in any human body. This infection of the kidneys needs antibiotics as therapy, and treatment of any underlying causes to prevent recurrence.


The main cause of Pyelonephritis is when a kidney produces an infection that usually is caused by bacteria that has travelled to the kidney from an infection in the bladder, when the defences are broken down increasing bacteria flow.
- Women have more bladder infections than men because the distance to the bladder from skin, where bacteria normally live, is quite short and direct. Usually, however, the infection remains in the bladder.
- A women is more likely to develop pyelonephritis when she is pregnant. Peylonephtritis and other forms of urinary tract infection increase the risk of premature delivery.
- A man is more likely to develop the problem if his prostate is enlarged, a common condition after age 50. Both men and women are more likely to develop pyelonephtritis if they have any of the following conditions:

· An untreated urinary tract infection
· Diabetes
· Nerve problems that affect the bladder
· Kidney stones
· A bladder tumor
· Abnormal backflow of urine from the bladder to the kidneys, called vesicoureteral reflux
· An obstruction related to an abnormal development of the urinary tract

- Tests or procedures that involve the insertion of an instrument into the bladder also increase the risk of urinary tract infections and pyelonephtritis.
- Children sometimes develop pyelonephritis because of an abnormality in the bladder that allows urine there to flow backward (reflux) into the ureter, the connection between the kidney and bladder. This can lead to scarring of the kidney.

Through all of these the chances of this infection occurring are very high and can cause pain and further damage, also increasing reoccurrence.
Infections can also come from another part of the body, not just the bladder. Infections can come from the bloodstream. For example: A staphylococcal skin infection can spread to the kidneys through the bloodstream.
Also risk of producing this infection is increased in people with diabetes or with a weak immune system; this reduces their fight against infection.
Pyelonephritis is usually caused by bacteria, but it is rarely caused by tuberculosis, fungal infections, and viruses.
(Shankel, 2007)


Pyelonephritis occurs more commonly in females, probably because of a shorter urethra and the proximity of the urinary meatus to the vagina and the rectum — both conditions allow bacteria to reach the bladder more easily — and a lack of the antibacterial prostatic secretions produced in the male. Incidence increases with age and is higher in the following groups:
- Sexually active females: Intercourse increases the risk of bacterial contamination.
- Pregnant

females: About 5% develop asymptomatic bacteriuria; if untreated, about 40% develop pyelonephritis.
- Diabetics: Neurogenic bladder causes incomplete emptying and urinary stasis; glycosuria may support bacterial growth in the urine.
- Persons with other renal diseases: Compromised renal function aggravates susceptibility.
(Professional Guide to Diseases (Eighth Edition), 2005)

Acute pyelonephritis can occur at any age. In neonates it is 1.5 times more common in boys and tends to be associated with abnormalities of the renal tract. Uncircumcised boys tend to have a higher incidence than circumcised boys. Beyond that age girls have a 10-fold higher incidence. In adult life it reflects the incidence of urinary tract infection (UTI) in that it is much more common in young women. Over 65 the incidence in men rises to match that of women.
(Dr. Knott, 2009)

Signs & symptoms:

The two primary symptoms of pyelonephritis are pain in one flank, the area just beneath the lower ribs in the back, and fever. The pain can travel around the side toward the lower abdomen.
There can also be:
- Shaking chills
- Nausea & vomiting
- Urine maybe cloudly
- Urine can be tinged with blood
- Urine maybe unusually strong or foul-smelling
- Urinate more often
- Urinating maybe painful or uncomfortable.

Shankel says that one or both kidneys may be enlarged and painful, and doctors may find tenderness in the small of the back on the affected side. Sometimes also the muscles of the abdomen are tightly contracted. Spasms can occur when passing urine or kidney stones. If the ureters goes into spasms, people may experience intense pain.

In children, symptoms of a kidney infection often are difficult to recognise. In older generation, pyelonephritis may not cause any symptoms that seem to indicate a problem in the urinary tract. Instead the older generation may have delirium or an infection of the bloodstream (sepsis).
(Shankel, 2007).

Pyelonephritis can be sudden (acute) or long-term (chronic).
- Acute uncomplicated pyelonephritis is the sudden development of kidney inflammation.
- Chronic pyelonephritis is a long-standing infection that does not go away.

Indications and contraindications for massage therapy:

- Do not massage during acute phase
- Encourage the client to take the full course of antibiotics
- Avoid massaging the abdominal area until pain had subsided.
(Dr. Premkumar, 2000)

Risk factors:
- More common in women due to shortness of urethra
- Any kind of obstruction in the urinary tract predisposes to this infection
- Catheterization, pregnancy, loss of bladder control as in spinal, cord injuries, renal stones, birth defects of the urinary tract make a person more susceptible to infection.
(Dr. Premkumar, 2000)

Homecare exercises:

- Drink several glasses of water each day.
- If you are a women, wipe from front to back.
- Decrease the speed of bacteria during sex (urinate after sexual intercourse).

References: Health topics A – Z. Retrieved September 13th, 2009 from

Dr. Knott, L. (2009). Patient UK: Pyelonephritis. Retrieved September 13th, 2009 from

Dr. Premkumar, K. (2000). Pathology A to Z: A handbook for massage therapists, (2nd ed.). Canada: VanPub Books.

Schwartz, M, W. (2008). The 5-Mintue Pediatric Consult. Retrieved September 12th, 2009 from

Shankel, S. (2007). Kidney Infection (Pyelonephritis). Retrieved September, 12th, 2009 from

Springhouse. (2005). Professional Guide to Diseases, (Eighth Edition). Retrieved September 12th, 2009 from

Springhouse. (2005). Professional Guide to Diseases, (Eighth Edition): Prevalence and incidence of Pyelonephritis. Retrieved September 13th, 2009 from

Wikipedia. (2009). Pyelonephritis. Retrieved September 12th, 2009 from

Wednesday, August 12, 2009

Professional Practice

Professional Practice: Ethics
Victoria Walden
Due date 14th of August

Reflect on ethical principles relevant to massage practice:

Within a Massage Practice ethical principles are put in place to ensure the emotional and mental safety of client and practitioner.

The core ethical concepts are:
- The therapeutic relationship
- Client-centred care
- Power differentials
- Transference
- Counter-transference

The therapeutic relationship:

Benjamin states that in a therapeutic relationship there is a power differential, also that each person in the relationship has a clear role, the environment is safe and that the time spent together between therapist and client is structured.

I feel this, sums up the difference between personal and therapeutic/professional relationship.

The relationship between client and therapist is also stated by Massage New Zealand in their “Code of Ethics”:

• A practitioner shall endeavour to serve the best interests of their clients at all times and
to provide the highest quality service possible.
• A practitioner shall at all times respect the confidence of their client, and diagnostic
finding acquired during consultation and/or treatment shall not be divulged to anyone
without the client’s consent, except when required by law or where failure to do so
would constitute a menace or danger to the client or another member of the community.
• A practitioner shall not enter into an intimate or sexual relationship with a patient whilst
the patient is under their care.

(Massage New Zealand, 2009).

This ethical principle/boundaries put in place for massage therapists gives an outline of the expectations that the massage therapist needs to obey by to conform with; Massage New Zealand’s standards and also to ensure the safety of the client and practitioner.

Client-centred care:

“Client-centred means that every action that the practitioner takes is in the service of the clients needs and not the practitioners needs” (Benjamin & Sohnen-Moe, 2003).

Client-centred care also means that the client must consent to any treatment before massage can begin. Through this step it gives the client a voice and the power to say ‘no’. This is an ethical principle that all practitioner take on board as the client at this stage is vulnerable and exposed when client as consented to massage the power changes from client to practitioner.

Power differential:

Within the massage practice there will be in most cases a power differential where the therapist holds the most power. This is because of the client allowing the practitioner into their space when sitting, lying down also not fully clothed. The client giving permission to the practitioner to massage shifts the power literally putting the safety and wellbeing of the client in their hands.

“To maintain an ethical practice, the person in power must regulary say “no” to something she could easily get and must instead choose to pay attention to the needs of the person with less power” (Benjamin & Sohnen-Moe, 2003).

The practitioner must maintain the respect and integrity of all clients’ boundaries when they are in a vulnerable state during massage practice.


“Transference is the personalization of the professional relationship by the client” (Fritz, 2004).

Transference in a massage practice is where the client may demand more of the therapist’s time, bring them gifts, attempt to engage the professional in personal conversation, propose friendship or sexual activity or an expression of anger and blame towards the practitioner.

“Transference occurs when the client sees the therapist in a personal light instead of a professional manner” (Fritz, 2004).

The ethical principles have been put in place to stop this situation from occurring therefore in this case the practitioner needs to clearly state the professional relationship to reinforce the ethical boundaries. Also to refer client to the appropriate professional to help them.

Counter-transference is the opposite of transference where the practitioner has attached their personal feelings into the professional environment of their practice.

Ethical principles are put in place to limit this sort of inappropriate behaviour from client or practitioner.

Massage New Zealand has in place “Code of Ethics”, Established above and also sates professionalism, scope of practice/ appropriate techniques and image/advertising claims.

Each massage practice should take pride in their service, honesty, treatment, professionalism; respect for others and also for the practitioner themselves.

Obeying the ethical boundaries that have been enforced will improve the practice of a massage therapy business.


Benjamin, B & Sohnen-Moe, C. (2003). The Ethics of Touch. (SMA Inc., Tucson, Ariz., 2003.)

Massage New Zealand. (2009). Code of Ethics. Retrieved, August, 13th, 2009, from

McQuillan ,D. Elluminate August 12th,13th 2009. Professional Practice 2.

My Own Thoughts

Fritz, S. (2004). Mosby’s fundamentals of therapeutic massage, (3rd ed.). Missouri: Mosby.

Sunday, July 26, 2009


Pathology 2: Fibromyalgia
Victoria Walden
Due Date: 27/07/09


Fibromyalgia is a syndrome, with chronic pain disorder that affects the client physically, mentally and socially. The syndrome is characterised by chronic widespread pain, multiple tender points, abnormal pain processing, sleep disturbances, fatigue and often psychological distress (National Fibromyalgia Association 2009).

Tender points:
Tender point pain occurs in local sites, usually in the neck and shoulders. The pain then spreads out from these areas. The actual pain starts at the muscles. The joints are not affected. There are no lumps or nodes associated with these points of pain, and no signs of inflammation (swelling). People diagnosed with fibromyalgia feel pain in at least 11 to 18 specific tender points.

Widespread pain described as stiffness, burning, and aching. The pain also “radiates,” or spread, to nearby areas. Most patients report feeling some pain all the time. Many describe it as “exhausting.” The pain can vary depending on the time of day, weather changes, physical activity, and the presence of stressful situations. The pain is often more intense after disturbed sleep” ( Health Topics A- Z).

Clients who suffer from this syndrome severely can be enormously debilitating and interfere with basic daily activities.
Females are more likely to be diagnosed with the syndrome than males.

“Fibromyositis (Fibro = Fiber; itis = inflammation) Also known as fibromyalgia, a group of conditions involving chronic inflammation of a muscle, its connective tissue coverings and tendons, and capsules of nearby joints. Symptoms are nonspecific and involve varying degrees of tenderness associated with specific trigger points, as well as fatigue and frequent awakening from sleep” (Marieb, Hoehn, 2007, p. 320).


“People with – experience pain from stimuli not normally perceived as painful, which is partially because of lowered pain thresholds and partially the result of central sensation involving an unbalanced autonomic nervous system response to physical, chemical and psychological stressors” (Salvo, 2008, p.139-40).

A notable imbalance in this syndrome is related to higher levels in the substance of P (neuroreceptor and neuromodulator associated with transmission of pain impulses to the central nervous system).
Fibromyalgia condition usually develops after phychologic trauma, local or general infections, medications, and excessive use of aspartame, as well as to physical trauma such as whiplash.

McCance and Huether talk about this in their book Pathophysiology – The Biologic Basis For Disease In Adults & Children 4th ed. They state that: "The etiology of Fibromyalgia has been debated for more than a century and that this syndrome cannot be caused by one single factor. There are different factors involved, for example: Flu like viral illness, chronic fatigue syndrome, HIV, Lyme disease, physical trauma, emotional trauma, also medications, especially steroid withdrawal. Fibromyalgia may overlap with myofascial pain syndromes; also rheumatic disease may coexist if not manifest with Fibromyalgia" (McCance & Huether, 2002. p.1399).

There are some clients that show signs of a genetic predisposition, with other family members also affected.


“A total of 2595 incident cases of fibromyalgia were identified between 1997 and 2002. Age-adjusted incidence rates were 6.88 cases per 1000 person-years for males and 11.8 cases per 1000 person-years for females. Females were 1.64 times (95% confidence interval=1.59 – 1.69) more likely than males to have fibromyalgia. Patients with fibromyalgia were 2.14 to 7.05 times more likely to have one or more of the following comorbid conditions: depression, anxiety, headache, irritable bowel syndrome, chronic fatigue syndrome, systemic lupus erythematosus, and rheumatoid arthritis” (National Fibromyalgia Association 2009).

“The disorder has an increased frequency among women 20 to 50 years old. The prevalence of the disease has been estimated between 0.7% and 13% for women, and between 0.2% and 3.9% for men” (Fibromyalgia Support, 2009).

Signs & Symptoms:

· Chronic, widespread pain
· Fatigue
· Heightened pain in response to pressure
· Tingling of the skin
· Prolonged muscle spasms
· Weakness in the limbs
· Nerve pain
· Functional bowel disturbances
· Chronic sleep disturbances
· Impaired concentration
· Problems with short and long term memory
· Impaired speed of performance
· Inability to multi-task
· Cognitive (relating to thought processes) overload
· Diminished attention span
· Anxiety
· Depression
· Myofascial pain syndrome
· Headaches
· Localised pain (shoulders, neck, low back, hips, etc..)
· Diarrhea
· Constipation
· Bloating
· Gas
· Urinary problems (burning while passing urine)
· According to the American College of Rheumatology, diagnosis is made if there is diffuse muscular pain along with 11 to 18 tender points described. (Dr. Premkumar, 2000, p.137)

“Other underlying ailments, such as chronic fatigue syndrome, irritable bowel syndrome, and rheumatoid arthritis, can also be present. New patients should be checked for these underlying conditions as well as fibromyalgia” (Fibromyalgia Support, 2009).

“Symptoms in Children. In general, children with fibromyalgia most often have sleep disorders and widespread pain” ( Health Topics A –Z).

Fritz states: “Fibromyalgia is a condition characterized by aching and pain in the muscles, tendons, and joints all over the body but especially along the spine. Measurable changes in body chemistry and function occur in some people who have fibromyalgia, and these changes may be responsible for certain symptoms. However, fibromyalgia is not associated with muscle, nerve, or joint injury; inadequate muscle repair; or any serious bodily damage or disease. Also, people who have fibromyalgia are not at greater risk for any other musculoskeletal disease” (Fritz, 2004. p.610).

Indications and contraindications for massage therapy:

· Stress – reduction
· Regular physical activity such as walking, biking, swimming, or water aerobics (clients who are physically fit will experience less symptoms).
· Medication maybe used to reduce pain, improve sleep and combat depression (watch as a massage therapist as pain scale may change with client on pain killers).
· Application of moist heat and massage are proven beneficial in the management of pain and discomfort for this syndrome.

· Massage should be tailored to each client, depending on how they are feeling at the time, as symptoms vary from day to day, also client maybe on pain killers.
· The pain of Fibromyalgia usually seems worse when a person is trying to relax and is less noticeable during busy activities or exercise (Fritz, 2004).
· Clients may request deep – pressure massage, this commonly provokes strong reactions for several days after treatment.
· Massage for stress reduction, removal of toxins, tenderpoint relief, break up adhesions (, 1999-2009).
· Very slow increase in depth of massage strokes, from session to session, and carefully deactivation of trigger-points, are recommended.
· Address any other medical condition. (Salvo, 2008, p.141)

Yes: Detailed history from client every time as symptoms vary.
Yes: enquire about medications and be informed about the side effects of these medications.
Yes: full body relaxation massage of short duration.
Yes: gentle cross fiber friction over entire muscles, stretching and strokes such as effeurage are beneficial.
Yes: Hot packs on painful areas.
No: Massage may not be beneficial to all clients.
Do not use anything that will add to inflammation such as heat; Often over sensitive to touch. Refer to Naturopath and Acupuncturist for treatment if it is not working. Diet and Lifestyle changes are necessary (, 1999-2009).

“Massage has been shown to increase relaxation of muscles, decrease fatigue, decrease pain, produce sleep, decrease edema and increase mobility. It has been shown to increase communication, decrease depression and anxiety and produce a general increase in sense of well being. All these effects directly address the symptoms of fibromyalgia” (Dr. Premkumar, 2000, P.138).

Clients with Fibromyalgia are going to vary with pain, symptoms and tolerances. Therefore the therapist needs to adapt to each individual client with this syndrome to help improve their lifestyle.

References: Health Topics A – Z. Retrieved July, 22nd, 2009, from

Buraun, M., & Simonson, S. (2007). Introducation to Massage Therapy 2nd ed. Lippincott: Williams & Wilkins.

Don L. Goldenberg, M., Carol Burckhardt, P., & Leslie Crofford, M. (2004). Management of Fibromyalgia Syndrome . Jama , 292:2388-2395.

Dr. Premkumar, K. (1959). Pathology A to Z: A handbook for massage therapists (2nd Ed.). Canada: VanPub Books.

Fibromyalgia Support. (2009). Causes, Symptoms and Signs of Fibromyalgia. Retrieved July, 22nd, 2009, from

Frtiz, S. (2004). Mosby’s Fundamentals of Therapeutic massage (3rd Ed.). Missouri: Mosby

Huether, S., & McCance, K. (2002). Pathophysiology: The Biologic Basis For Disease In Adults & Children (4th ed.).St. Louis, Missouri: Mosby, Inc.

National Fibromyalgia Association. (2009). Retrieved July, 20th, 2009, from

Pathology for Massage Therapists. (1999-2009). Retrieved August, 6th, 2009, from

Salvo, S, G. (2008). Mosby’s Pathology for Massage Therapists (2nd Ed.). Elsevier Health Science.

Wikipedia. Fibromyalgia. Retrieved July, 22nd, 2009, from