What is happening in the

FMS
p a t i e n t ’s m u s c l e s ?
(Goldenberg 1989, 1994, Henriksson 1994,
Moldofsky 1993)
localized sympathetic predominance,
associated with changes in the hydrogen
ion concentration and the calcium and
sodium balance in the tissue fluids.
These changes are associated with
vasoconstriction and hypoxia/ischaemia
(Petersen 1934).
Defective pain sensors and proprioceptors
Muscle

Spasm and hard, nodular l

localized tetanic contractions of muscle

bundles together with vasomotor and
musculomotor stimulation, intensify each
other, creating a vicious cycle of self-
perpetuating impulses
(Bayer 1950).
Altered sleep reduced growth hormone
production
poor repair of minor muscle damage

low levels of serotonin

Reduced natural pain-

killing effects of
disturbed sympathetic endorphins
nervous system
increased pain sensitivity.
(Duna & Wilke 1993)
American College of Rheumatology criteria
for the diagnosis of Fibromyalgia

History of widespread pain

– pain in the left side of the body
– pain in the right side of the body
– pain above the waist
– pain below the waist
 American College of Rheumatology criteria
for the diagnosis of Fibromyalgia
Pain in 11 of 18 palpated sites
1. Base of the skull
2. Between The 5th And 7th Cervical Vertebrae
3. Upper Trapezius
4. Supraspinatus Muscle
5. Second Rib Meets The Breast Bone
6. Outer Aspect Of Either Elbow (Epicondyle)
7. Gluteus Medius
8. Insertion Of Piriformis Muscle
9. Either knee in the fatty pad just above the inner aspect of the
joint
 chummmmmma
• Janet
• Travell, defines trigger points as: hyper-
irritable
• foci, lying within taut bands of muscle, which
• are painful on compression and which refer
• pain or other symptoms at a distant site’.
 Trigger point characteristics

• Hyper-irritable foci, lying within taut

bands of muscle, which are painful on
compression and which refer pain or
other symptoms at a distant site’.
• Embryonic trigger points will develop as
‘satellites’
• Painful points which do not refer
symptoms to a distant site are often latent
triggers
 Trigger point characteristics
• The taut band in which triggers lie will twitch
if a finger is run across it.
• Muscles which contain trigger points will hurt
when they are contracted or stretched
• Trigger points are areas of increased energy
consumption and lowered oxygen supply
• Muscle Cannot reach its normal resting length
• Trigger points lie in parts of muscles most
prone to mechanical stress, often close to
origins and insertions
Different types of Trigger
points
(Simons & Travell 1998)
Central triggers