SHIATSU & FIBROMYALGIA

WHAT IS FIBROMYALGIA?

Fibromyalgia is a chronic condition of widespread pain and profound fatigue. The pain tends to be felt as diffuse aching or burning, often described as head to toe. It may be worse at some times than at others. It may also change location, usually becoming more severe in parts of the body that are used most. The fatigue ranges from feeling tired, to the exhaustion of a flu-like illness. It may come and go and people can suddenly feel drained of all energy – as if someone just “pulled the plug”. Fibromyalgia is a common illness. In fact, it is more common than rheumatoid arthritis and can even be more painful. Prevalence of Fibromyalgia: A Survey in Five European Countries (see www.fmauk.org/prevalence for details) put the prevalence of FM at between 2.9 and 4.7%. People with mild to moderate cases of fibromyalgia are usually able to live a normal life, given the appropriate treatment. If symptoms are severe, however, people may not be able to hold down a paying job or enjoy much of a social life. The name fibromyalgia is made up from “fibro” for fibrous tissues such as tendons and ligaments; “my” indicating muscles; and “algia” meaning pain

Source: Fibromyalgia Association UK, December 2013

RESEARCH

A Study of the Effects of Shiatsu on Pain Management at the Pain Management Clinic of the University Aretaieion Hospital Athens Greece (March 2008 through October 2011)

By Maria Gryllaki, founding member and current Treasurer of the Hellenic Shiatsu Society.1)

Our team included my two Shiatsu practitioner colleagues: Marianna Lazana, founding member and current President of the Hellenic Shiatsu Society (HSS); and HSS member Anna Vazirgiatziki, in conjunction with and supervised by three chief anaesthesiologists, Erfili Argyra, Athina Vadalouka and Ionna Siafaka, who also teach at the University of Athens Medical School.2)

Of the 68 patients ranging in age from 30-85 presented by the doctors (and us) to receive shiatsu, I saw 25 (about 300 sessions), Marianna saw 38 (about 240 sessions), and Anna saw 13 patients (about 257 sessions), for a grand total of 797 sessions, with each patient receiving approximately 12 sessions. Psychotherapy, acupuncture and reflexology are also integrated at the pain clinic but were not measured in this study. All the outpatients we saw were suffering from chronic, non-malignant-related pain in four major categories. About 80% were on medications, for:

Myoskeletal problems (fibromyalgia, athletic injuries, deformities, osteoporosis, etc).

Auto-immune diseases (Multiple Sclerosis, Rheumatoid Arthritis, etc).

Neurological diseases (Migraines, post-herpes neuralgia, trigeminal neuralgia, etc).

Complex Regional Pain Syndrome (CRPS). Patients expressed their appreciation for the advice they received from us about regular exercise (breathing, - walking, yoga, stretching, etc.), and nutrition. Relief from secondary problems (intestinal disorders, stress, hormonal imbalances, allergies, and insomnia) was related mainly to shiatsu. Therefore our holistic approach went beyond merely addressing the

origin of their chronic pain. Our interaction with the patients was aimed at enhancing their understanding of the nature/etiology of their pain. It helped their self-confidence to realize they had some measure of control over ways in which they could mitigate pain. Additional complications compounding their pain included psychosocial issues like addictions, family problems, financial stress, and mental stress. Assessment Parameters Improvement in:

Level, frequency, duration of pain

Quality of life (stress levels, parallel complaints/ illnesses, functioning, mood)

Satisfaction

Outcome Almost every patient expressed feelings of relaxation and relief. All commented on the unique experience of being treated as an individual with a particular health issue, and not just as an impersonal “medical statistic.” Specifics

Myoskeletal syndromes: 61% (of 36 patients) = 21-90% improvement

Neurological syndromes: 67% (of 9 patients) = 21-90% improvement

Complex patients (Myoskeletal syndromes-Neurological syndromes-parallel diseases and complexities in life): 44% (of 23 patients) = 21-90% improvement

Details Myoskeletal syndromes:36 patients

- 2 patients (6%) = temporary improvement - 12 patients (33%) = 5% - 20% improvement - 22 patients (61%) = 21% - 90% improvement

Neurological syndromes: 9 patients - 2 patients (22%) = temporary improvement - 1 patients (11%) = 5% - 20% improvement - 6 patients (67%) = 21 - 90% improvement

Complex patients 23 - 8 patients (34%) = temporary improvement - 5 patients (22%) = 5% - 20% improvement - 10 patients (44%) = 21% - 90% improvement 60% (of 68 patients) = 40%-50% quality of life improvement Conclusions Shiatsu has a considerable and important effect on pain of any etiology/cause, and more specifically:

Age was not a definitive parameter to the pain improvement. Patients of 40 years old and 60 years old experienced improvements equally.

However, age was a factor in compliance issues! Younger patients were more positive and optimistic about dealing with their health issues. Older patients tended to be more pessimistic and linked their health problems to their limited prospects in life. They tended to get disappointed and to give up more easily.

PTSD, grief, and psychological factors played a frequent role in their pain profiles.

Compliant patients experienced faster and better long term results.

Final Observations Shiatsu offered pain relief and improved the quality of life of those involved in the study. Patients praised the feeling of support from us after their doctors had run out of many other

options in pain management. And finally, according to the personnel of the Pain Management department of the Athens Aretaieion Hospital, shiatsu has enhanced the status of onsite services there.

_____________________________________ [1] Maria and her colleagues presented the details of this study at the 12th National Congress of Regional Anaesthesia, Pain Treatment and Palliative Care held at Elounda, Crete on October 13-16, 2011. [2] Shiatsu therapists in this study volunteered their time. Patients showed their gratitude by bringing bottles of homemade olive oil and cakes and pies. Sources: A Study of the Effects of Shiatsu on Pain Management. In: AOBTA-Pulse Winter 2011 picture: Gerd Altmann (www.pixelio.de)

Shiatsu Massage Soothes Fibromyalgia

Blog by Dr. Shad. Foster Chiropractic News, fibromyalgia, Massage September 25 2013

Complementary and alternative medicine is drawing more attention in the treatment of fibromyalgia. The increased popularity of CAM therapies among fibromyalgia patients is likely related to dissatisfaction with traditional medicine, a desire for a more holistic treatment approach, and the positive patient-doctor relationships frequently developed in CAM practices. While studies have demonstrated the effectiveness of massage, chiropractic, and acupuncture for alleviating fibromyalgia symptoms, no studies have examined a specific massage therapy called Shiatsu in the treatment of fibromyalgia syndrome (FMS).

Developed in Japan, Shiatsu therapy combines elements of acupuncture/acupressure with Western massage techniques. Former studies have shown that Shiatsu can benefit patients with pain and sleep problems, two symptoms that are hallmarks of fibromyalgia, and researchers sought to conduct the first-ever pilot study of Shiatsu for FMS.

The study included 34 patients with FMS, between the ages of 33-62 years old, who were divided into a control group or a Shiatsu group. The treatment group received Shiatsu twice weekly for eight weeks. Researchers evaluated pain intensity on a visual analog scale, along with pain sensitivity with pressure pain tests. Patients also completed questionnaires assessing anxiety, sleep quality, and the overall impact of fibromyalgia symptoms.

After treatment, patients receiving Shiatsu had significant improvements in all variables except anxiety. Patients experienced a 40.6% decrease in pain intensity, a 76% improvement in pressure pain thresholds, 34% improvement in sleep quality, and a 22% improvement in scores of the Fibromyalgia Impact Questionnaire. These results meant that 94% of patients reported being satisfied with Shiatsu treatment.

Like other forms of massage therapy, the pain-alleviating effects of Shiatsu are believed to be caused by muscle tension release, increased blood circulation promoting oxygenation of cells and tissue as well the removal of waste products, and the release of serotonin.

Although future studies are needed to confirm these results, the study suggests that Shiatsu presents a promising treatment option for patients with FMS searching for natural solutions. Even if you do not have access to Shiatsu in your hometown, you can still experience similar benefits by visiting your local massage therapist, acupuncturist, and chiropractor. Recent guidelines from the Canadian Medical Association recommend patients with fibromyalgia pursue natural treatments as part of multimodal strategy.

Ref: Yuan S, et al. Effects of Shiatsu in the management of fibromyalgia symptoms: a controlled pilot study. Journal of Manipulative and Physiological Therapeutics 2013; 36(7):436-443.

TESTIMONIALS

Elaine Dormon, London

“I work at a community day service in London I have had a massage from the Shiatsu practitioner who visits us. She cannot see me privately. I have quite a serious problem with my neck which has resulted in a disturbance throughout the body. I have a formal diagnosis of fibromyalgia. One treatment from this practitioner released this pattern and I was pain free.”

PRACTITIONERS’ TIPS

I had a client who had FM and I also did a number of demos at the FMS support group sessions. My overall impression was of an SI issue, including the fact that many of the “pain points” on the FMS diagnosis sheet were on the SI meridian.

Also I remember being told that developing FMS was often preceded by shock (child birth, car crash etc). This again ties in well with SI jitsu and the inability to absorb and process emotions.

Mike Draper

ARTICLES

Sasha Howard found her life turned upside down by debilitating pain and fatigue. The 29-year-old Durango woman was waking up tired and un-refreshed, surprised that caffeine had no effect. Pain varied from dull aches all over her body to specific pain in her ankles, wrists, neck and shoulders. She often felt as if she was in a fog, her ability to concentrate diminished. Always a "people person," Howard found herself withdrawing from social activities, not able to commit to a simple lunch with friends. "There are times I can't even get out of bed," Howard says. After three years of tests, she was diagnosed with Fibromyalgia Syndrome. Forced to quit her position as vice president of sales for a large California firm, Howard returned to the Durango area to live with her mother. Fibromyalgia Syndrome causes long-term fatigue and widespread aches and pains in the muscles, ligaments and tendons. Experts estimate it affects anywhere from 3 million to 8 million adults in the United States 3 percent to 6 percent of the adult population. Eighty percent to 90 percent of those afflicted are women. Research into the syndrome continues, but many questions remains as to its cause and methods of treatment. Sufferers can find it to be anything from a minor inconvenience to life-debilitating. Some symptoms are common, while others vary from patient to patient and can change because of weather, stress, physical activity and even the time of day. In 1990, the American College of Rheumatology defined the criteria for diagnosing fibromyalgia as experiencing pain upon gentle pressure in 11 of 18 possible body points, and having had widespread pain for at least three months. Many physicians believe the criteria are too narrow. Karen Zink, a certified nurse practitioner in Durango, estimates she has 20 to 30 patients who have been diagnosed with fibromyalgia. She agrees that the official criteria are too rigid and that all symptoms should be considered as a whole. She further believes that "the medical community can fail sufferers of fibromyalgia by focusing only on the individual symptoms rather than the cluster of symptoms that can result in the proper diagnosis." Fibromyalgia's cause in unknown, but a number of triggers are consistent among patients. According to the Mayo Clinic Web site, a common trigger is brain chemical imbalance, particularly in the chemical that regulates depression and migraines, and another associated with pain, anxiety and stress. The Fibromyalgia Network Web site says the same problem is seen with two hormones, one

that is essential to the body rebuilding itself and another that influences nerve activity. Other possible triggers are an injury or trauma to the upper spinal region or central nervous system; a viral or bacterial infection; an abnormality in the autonomic, or involuntary, nervous system; changes in muscle metabolism; and psychological stress. Doctors know of no medication to treat fibromyalgia, although aspirin, ibuprofen or acetaminophen can help control aches and pains as can prescription muscle relaxants. Zink believes that treatment must be approached as a "package" based on diet and exercise. Sufferers should limit the intake of starches, simple carbohydrates and sugar while eating more vegetables, particularly green. Also important are regular cardiovascular and stretching exercises and a regimen of premium vitamin and mineral supplements. Zink says additional treatments could include antidepressants or sleep aids. Dr. Jennifer Heinicke, a local doctor of internal medicine, agrees with the importance of rest. "Sleep regulation has a profound (positive) effect on the body," and is Heinicke's first priority when treating fibromyalgia. Howard has "tried it all" when it comes to fibromyalgia therapy. Those that have proven most successful for her are acupuncture, Shiatsu massage, Reiki (energy work) and craniosacral therapy. Other alternative therapies that have proven successful for fibromyalgia sufferers include yoga, biofeedback and acupressure. Experts agree, however, that the most important factor in successfully treating fibromyalgia is the patient's willingness to accept the diagnosis and take control of their own treatment process. Living with a disease that waxes and wanes daily lends itself to living on an emotional roller coaster. The Mayo Clinic Web site refers to this as a "cyclic pattern" during which emotions such as fear, frustration, guilt, depression and hope continually recur. The National Fibromyalgia Partnership says, "It takes enormous energy as well as courage to adjust to fibromyalgia and find treatments that work well without wasting precious energy on guilt, self-deprecation and doubt." Stephanie Neidermyer, a Durango-based family and marriage therapist, coaches her fibromyalgia patients to deal with the diagnosis by replacing negative views and behaviours with positive ones. Durango has a support group, which Howard attended regularly, dedicated to Chronic Fatigue Immune Dysfunction Syndrome and Fibromyalgia Syndrome which now meets as needed. Howard says she is still struggling with the thought that fibromyalgia will affect the rest of her life. Though she is currently on disability and living on her own, she fervently hopes that she will someday be able to re-enter the workforce and "receive re-enforcement that her life has purpose." Reach News Staff Assistant Julie Marble-White at julie@durangoherald.com. Marble-White has been diagnosed with Fibromyalgia Syndrome. Source: The Durango Herald. Online at http://durangoherald.com. Contents copyright © the Durango Herald. All rights reserved. Reprinted with permission.

Treating people with Fibromyalgia: "Lots of gain without

the pain"

By Helena O’Loughlin

Over the past number of years I have put a lot of energy into bringing awareness of the benefits of Shiatsu to different support organisations, such as Multiple Sclerosis and Fibromyalgia, etc. I suppose it all really started when I was on the Shiatsu Society of Ireland committee about 10 years ago, and the committee realised the need to bring awareness of Shiatsu to the general public, and to many of the different support organisations that help people with various difficulties. I was elected for the job of contacting the support organisations. Having done some research and gathered phone numbers and email addresses, I started my task of calling each group, about thirty in all. It was a slow and tedious process. While talking to these people, I was shocked at the total lack of awareness and knowledge of Shiatsu within these organisations. My next aim was to educate them. Many phone calls and emails followed; sending out all the information that I could find on the benefits of Shiatsu. I was hoping that the information would at least ignite a little interest about Shiatsu. Unfortunately this was not the case. Having opened Shiatsu College Dublin some years later, I again took up my quest to get Shiatsu out there. I was really looking for somewhere that our students could work and gain experience under a placement programme. I myself developed Fibromyalgia shortly after opening the college. When searching for information about Fibromyalgia and contacting the various societies, it became very clear that there was little or no knowledge of Shiatsu in the Fibromyalgia world. Having sent numerous emails and made many phone calls over that past couple of years, I finally got in touch with Rachel, a lady who runs the Fibromyalgia group on the north side of Dublin. She was, at least, willing to meet up and listen. When I went out to meet Rachel, I was pleasantly surprised by how lovely and open she was. We spoke for quite a while about the pros and cons of having Shiatsu in their organisation. Many of their members had had massages and Shiatsu before (just like I had myself) and found it just too painful. She was, therefore, very reluctant to bring in or recommend any treatments. I explained to her that I was a sufferer myself, was familiar with the pain caused by massage / Shiatsu and, therefore, I had designed a treatment that would not cause pain or discomfort. Rachel wanted to receive my treatment so she could experience Shiatsu for herself. I gave her a treatment that evening. She told me that she would be in touch within the next couple of days. To my surprise, I received an email the very next day to say that she had slept really well and that her neck and shoulders, etc. were a lot easier. Her body felt much lighter. The big plus was she had no pain the next day. She was then in agreement that she would give the Fibromyalgia members a trial Shiatsu clinic day and let them decide for themselves what they thought of it. There was one condition: that the practitioner would do exactly what I did. I trained a number of the college practitioners to give this specific treatment. We agreed that the practitioners would go out to the Northside Fibromyalgia facility and give half-hour treatments to clients, using the plinths. The members would then decide if Shiatsu was for them or not.

The members loved it! It has been a great success. Four to five practitioners visit the centre once a month and treat three to four clients each night. We are hoping that the word will spread to each Fibromyalgia group around the country. Perhaps Shiatsu will at last get the recognition it deserves. How I designed the treatment: There were two teachers that influenced this treatment. I knew Gary Carter (www.naturalbodies.co.uk/), having had him facilitate a couple of workshops with the Shiatsu college students. Gary has a wide knowledge of Fascia and Anatomy and Physiology. He demonstrated how to release and work with fascia quite effortlessly. Having taken many workshops with Carola Beresford-Cooke, MRSS(T), I learned how to work the body effortlessly and that less was more. She taught me grace in the body. (http://www.shiatsu-wales.co.uk/). Gathering what I learned from Gary, Carola, my own Shiatsu experience, and my experience of Fibromyalgia and what worked for me, I developed this treatment; a treatment for Fibromyalgia that will cause no pain to the client. It is easy to learn and simple to apply. Just a little history: • Most Fibromyalgia cases are a real case of cause and effect; stress being the cause, leading to pain & discomfort. • Most Fibromyalgia will have started possibly 3 to 5 years before any symptoms have appeared. • Usually a traumatic event can be a trigger. This may be mental, emotional or physical, e.g. a car crash, relationship break-up, nervous breakdown, or simply doing too much. Most people who have Fibromyalgia will have: • Soreness • Stiffness • Tingling • Burning pain, which is hot and stinging In my experience, the following are common symptoms:

Fuzzy head and loss of memory

Poor sleep, resulting in chronic fatigue, due to lack of rejuvenation

Upper thigh and knee pain

Pain in upper arms and across the shoulders, elbows and neck

Feet can be stiff and very sore, especially in the morning TESTIMONIALS FROM NORTHSIDE FIBROMYALGIA GROUP: Shiatsu College Dublin has facilitated a Shiatsu evening once a month for the last six months at FibroIreland. The results have been very positive. Members are reporting a reduction in stress and pain, as well as an improvement in quality of sleep. The Shiatsu practitioners have been courteous, punctual, empathetic and professional. They have been very proactive with feedback, which means each treatment is individually tailored with better results each time. Fibromyalgia is a very complex illness and requires not only a thorough knowledge of anatomy, but also of the human spirit. Practitioners trained at Shiatsu College Dublin seem to know just what the body and soul need.

We cannot recommend them highly enough and have found them to be excellent partners in our wellness maintenance program. Rachel Lynch, Group Facilitator, FibroIreland. www.fibroireland.com. Member quotes:

‘I felt relaxed and calm. Had a lovely sleep too’.

‘’Really enjoyed my massage last night, so relaxing, slept well last night. Many thanks.

‘Thanks so much for my massage, it was great. I can't remember the last time I felt that relaxed’.

‘It was so relaxing, had a relaxing evening after and slept well. Still chilling the next morning let me know if there is a space free for the next sessions’.

FURTHER READING

The Fibromyalgia Association UK http://www.fmauk.org

STUDENT PROJECTS

Shiatsu College Norwich – 3rd Year Project. Treating Fibromyalgia with

Shiatsu

by Valerie Chater. May 12th 2007.

CONTENTS

Introduction

What is Fibromyalgia (FM)?

How do patients describe FM?

Western Pathology & Symptoms associated with FM

Official Diagnostic Criteria (Western Pathology)

Possible causes of FM

Allopathic medicine (Western Pathology)

My client’s medication

Observations, Shiatsu diagnoses & TCM

Relevance to Shiatsu Practice & How Shiatsu helps my client

Useful Pressure Points (Shiatsu Practice)

Recommendations (Shiatsu Practice)

Bach Flower Remedies

Clients’ Feedback

Self-Healing and Self Tolerance

Conclusion

Bibliography and References

INTRODUCTION

My research into FM began while treating a client with this condition. Her case and story illustrates a typical picture of the symptoms and ways of coping.

WHAT IS FIBROMYALGIA?

The name fibromyalgia (FM) comes from “fibro” meaning fibrous tissues (such as tendons and ligaments), “my” meaning muscles, and “algia” meaning pain.

It is a complex, chronic condition which causes widespread pain and fatigue as well as other symptoms. There is a substantial symptom overlap with chronic fatigue or M.E. Because FM has few symptoms that are outwardly visible and is not caused by inflammation, it has the nick name “invisible disability” or the “irritable everything” syndrome.

Unlike arthritis, FM does not cause pain and swelling in the joints. Rather, it produces pain in the soft tissues located around the joints and in skin and organs throughout the body along with fatigue.

HOW DO PATIENTS DESCRIBE FM?

The pain of FM consists of diffuse aching or burning anywhere and /or everywhere from head to toe, often accompanied by muscle spasm.

My client with FM refers to these spasms as “flare ups”, she is always tired and her Whole Body Scan’s show very little energy or movement.

The pain varies in severity from day to day and from person to person. It not a progressive condition, nor contagious and sometimes there is remission.

Psychosocially, individuals with FM often face disbelief or accusations of malingering or laziness from others that are unfamiliar with the syndrome. Apparently, it is more common in females (about 90%) than male.

WESTERN PATHOLOGY & SYMPTOMS ASSOCIATED WITH FM:

Chronic sleep disturbances (especially a lack of deep sleep with them waking un-refreshed, feeling negative and adding to the fatigue).

Cognitive dysfunction “fibro fog”- memory loss, impaired concentration, overwhelmed when engaged in multiple tasks.

Body stiffness - especially upon awakening.

Increased headaches or facial pain- often result of tender neck/shoulder muscles which refer pain upwards. TMJ dysfunction.

Gastrointestinal complaints-IBS, abdominal pain, diarrhoea, constipation, bloating and difficulty swallowing (abnormality in smooth muscle functioning of the oesophagus).

Genito-urinary problems - increased frequency of urination, bladder inflammations, painful sexual intercourse/menstruation.

Paraesthesia-numbness, tingling or burning in the hands or feet.

Chest symptoms-chest pain may cause shallow breathing and postural problems.

Disequilibrium-balance problems. If FM affects the skeletal tracking muscles of the eyes, there may be visual confusion and nausea when driving a car, flying or even when reading a book.

Leg sensations-“creepy crawly” feeling of restless legs syndrome.

Sensory sensitivity/allergic symptoms-hypersensitivity to light, sound, touch and odours (hyperactive nervous system). Also feeling chilled or excessively warm.

Skin complaints - eg. Dry, itchy or blotchy skin. Dryness of eyes and mouth is common. Also, swelling of extremities ie. Fingers.

Depression and anxiety

OFFICIAL DIAGNOSTIC CRITERIA (WESTERN PATHOLOGY)

FM has existed throughout history and throughout the world. It was only in 1990 that official diagnostic criteria for FM were established by the American College of Rheumatology (ACR).

*A History of Widespread Pain: chronic, above and below waist, both sides of the body musculoskeletal pain lasting longer than 3 months.

*Pain in 11 of 18 Tender Point Sites on Digital Palpitation: see fig. 1.

Approximately 4kg of pressure (!) must be applied to a tender point and patient must indicate that this location is painful. They do not say if the doctor uses force or does it in a relaxed way.

Interestingly, I find the “Tender Point Sites” seem to correlate with certain tsubos:

1 & 2 Bl 10 or GB 20

3 & 4 GB 21

5 & 6 TH 15

7 & 8 Bl 13

9 & 10 Kd 27

11 & 12 SI 8

13 & 14 GB 30

15 & 16 GB 29

17 & 18 Lv 8

Limitations of the ACR Diagnosis Criteria:

Patient tenderness varies day by day.

Patients can be sensitive to pain in other locations.

Human error-differing amount of digital palpitation/wrong point.

Medically, the cause of this syndrome is still unknown.

POSSIBLE CAUSES:

Trigger traumatic events (eg. accident, shock, stress, infection, surgery).

The development of another disorder eg. rheumatoid arthritis, lupus or hypothyroidism.

Genetic propensity?

Abnormalities in the pain-related chemical transmitters/neurological system.

ALLOPATHIC MEDICATION (WESTERN PATHOLOGY)

Treatment aims at managing the symptoms, yet invariably the drug side effects such as nausea, cramps, flu like symptoms and toxicity can add to the present problem and promote drug dependency.

Pain relief:

Analgesics (ie. Codeine, methadone morphine etc.)

Non-steroid and anti-inflammatory drugs (eg. aspirin, ibuprofen)

Muscle relaxants (eg. Cyclobenzaprine).

Selective Seratonin Reuptake Inhibitors (eg. Prozac, Zoloft, Paxil)

Anti-depressants (various).

MY CLIENT’s MEDICATION:

Lithium (mood stabilizing drug for depression) long term 10yrs

Trimipramine (tricyclic anti-depressant with sedative properties)

Thyroxine (underactive thyroid gland)

Gold injections (for previous rheumatoid arthritis diagnosis)

Buprenorphine (pain relief)

Butran’s Patches (pain relief)

Cinnarizine (blocks brain receptors to stop vomiting. Nausea side effect of other medication)

Steroid injection (anti-inflammatory)

I privately think of her as “heavy metal client”)

OBSERVATIONS, SHIATSU DIAGNOSES AND TCM.

On her first appointment my client F appeared pale, stiff, upright and tense. She barely moved, her voice was weak and her body language was minimal. F said she was tired all the time especially on waking and she had a small appetite, yet felt bloated. F resembled a thin, cardboard cut-out of a person.

In her youth F was a Ballerina. She is now a retired Ballet Teacher, her age: 57 years.

Physically she can only raise her arms from her sides a little way. Most joints are “frozen” because of her extreme “holding on” from living with chronic pain.

F describes herself as “cold to the bones” yet when she has a “flare up” or muscle spasm of excruciating pain there is local heat. Generally her hands and feet are cold, numb and often tingly. When she is stressed, there are more flare ups and she doesn’t know where or when the pain will come -it seems random and moves about.

I asked her what was going on in her life when these symptoms first began. There was no accident, shock or trauma specifically. At the time (1989) F was having difficulty in relationship with her eldest son and her husband was made redundant, but soon found other employment.

In 1992 F was diagnosed with Rheumatoid Arthritis (RA) and in 2002 this diagnosis changed to Fibromyalgia (FM).

Dealing with the pain and fatigue makes F both depressed and angry. She says that the pain killers have little effect on her condition and being afraid of her own anger, she is afraid to come off the anti-depressants.

The pain disturbs her sleep, wakes her up and there is general insomnia. In the morning she is un-refreshed and has trouble remembering things and functioning. All this adds to feeling negative.

For 17 years F has been on various medications and she is angry that the doctors were unable to answer her questions, that they were unclear about her diagnosis and just prescribe drugs and more drugs. However, her anger has now induced her to do something about her health herself. She has had enough of this condition and was realising that it was up to her to take positive action and the time was now. This was why she had come for Shiatsu.

On connecting with her Hara the first time, it was clear that she was hardly breathing and there was very little energy in her body or legs.

Hara Diagnoses from: 1/3/06 - 2/2/07

Jitsu: Kyo: Composite:

LI Ht No joy=no life. Build-up of stuff to let go of.

Stiffness from poor elimination. Toxins/emotionally.

Lv TH Pain from blocked/stagnant ki

Lv Kd Too toxic to move

Lu TH lack of circulation and blocked intake of ki

Lv TH Lv heat not moving and “flare-ups” in leg and

shoulder

Lv TH pain from blocked/stagnant ki

Lv TH pain from blocked/stagnant ki

GB Kd exhausted and irritated by condition “up tight”

GB LI tightness ready to release

Lv Lu Lu ki rising, Lv ki blocked

Ht Lv central core under pressure, Lv ki hidden

LI Kd letting go of fear (breakthrough session)

Lv Sp accepting self-nourishment

Whole Body Scans often showing not much ki or flow and congestion.

From a TCM perspective her internal cold “cold to the bones”, pale complexion, poor appetite and extreme fatigue “I just lay in bed all day without the energy to do anything” suggest Kd Yang deficiency. Kd’s failing to receive Ki.

Kidney’s nearly always affected in chronic conditions.

Her tongue is dark pink, no coat with red (no moxa then) around the sides (Lv GB). Pain and muscle spasms (Lv GB related), which move about (wind). Depression and feeling wound up (repressed anger)-certainly her emotional state is influencing Liver function, pointing to Lv Ki Stagnation.

As Kd is mother of the Lv in Five Elements, a deficiency of Kd will also encourage Lv Ki Stagnation.

F tends to be anaemic, feels hot in places (empty heat), she has poor memory, thirst and insomnia suggesting Blood Deficiency (Lv).

Lv Yin Deficiency has the same symptoms as above but F has not mentioned dry eyes and shows no red cheekbones. However, F is restless and anxious because she cannot “do what she wants to do” and this adds to her frustration and unfulfilled dreams which affect her Soul (Hun) and result in her feeling disconnected, depressed and isolated.

RELEVANCE TO SHIATSU PRACTICE & HOW SHIATSU HELPS MY CLIENT

Remembering how to breathe:

F did not realise that she was hardly breathing. On the first session focussing on my hand on her Hara and the other hand on her lower back we did “Bellows Breathing” with her hands resting on top.

Between the first and second treatment she “forgot” to practise, but thereafter got the idea and felt the benefit.

Gently Wobbling and Rolling:

Of arms, legs and body in cloth sling to encourage looseness and letting go.

Micro rotations of ankles and wrists:

To gently encourage joint flexibility and flow of Ki and Blood, especially down legs and arms. Also encouraging relaxation and letting go.

Gentle Tonification with Palming and Thumbing:

Especially down leg meridians to help energize and “fill” legs.

Muscle Release Technique:

On SCM muscle causing stiff neck.

Pressure Point Use

For pain relief, muscle release, calming mind.

USEFUL PRESSURE POINTS (SHIATSU PRACTICE)

LI 4, 10, 11, 15, 16

Lu 1, 5, 7, 9

Ht 1, 3, 7, HP 6

SI 3, 9, 10, 11

Kd 1, 3, 7, & 27

Bl 13, 18, 19, 23

Lv 3, 4

GB 20, 21, 30, 31, 34

St 36

Sp 3, 6

GV 4

CV 4, 6, 17

RECOMMENDATIONS (SHIATSU PRACTICE)

Stretching to warm up and Gentle Joint Rotations on awaking and before getting out of bed

Daily Connecting, Grounding and Hara Breathing

LI 4 (pain relief); Lv 3(relieves muscle spasms and cramp);

St 36 (stamina); for self-use

Gentle Exercise: Swimming or Tai Chi

Creative pursuits - F has joined an art class.

Diet:

Less baked food (her husband is a Baker),

Less cold/raw food ( esp. in winter)

More lightly cooked vegetables and grains

Warm, strengthening food eg. aduki beans

Iron tonic- Floradix

Check for vitamin/mineral deficiency, especially Magnesium.

Serotonin level?

“Serotonin is a neurotransmitter that is known to play a role in regulating sleep patterns, mood feelings of wellbeing, concentration, digestion.

One hypothesis of the pathophysiology FM causation is a dysregulation of serotonin and norepinephrine in the neural synapse, contributing to FM symptoms”(Wikipedia).

Miranda Holden’s “Awakening Weekend” in London with me.

Miranda operated an “Open Chair” system which any member of the audience might choose to sit in and have a one to one with Miranda. We witnessed and participated in an enquiry and unwinding process delving into the emotion that was causing the person a problem or blockage. It was amazing to witness how an entrenched pattern of fear or pain or anger could be transformed with such grace.

Miranda radiates Love and she holds the space so exquisitely that we experience unity and interconnectedness.

This w.e was transformational for F in getting in touch with her Inner Knower or God Self. I was smiling on the inside out!

Client F is reading Miranda’s book “Boundless Love”.

www.awakeningwithmiranda.com

BACH FLOWER REMEDIES (I am a practitioner).

Dr. Edward Bach:

“Health depends on being in harmony with our souls”.

“Health is our heritage, our right. It is the complete and full union between soul, mind and body; and this is not a difficult far-away ideal to attain, but one so easy and natural that many of us have overlooked it”.

Dr Bach discovered 38 Flower Remedies, each for a specific emotional and mental state with the subtle effect of transforming negative attitudes into positive ones, stimulating one’s own potential for self-healing. He believed that attitude of mind plays a vital role in maintaining health and recovering from illness. The remedies work by treating the individual rather than the disease or symptoms. The remedies are completely safe, have no unwanted side effects and are non-addictive.

“Heal Thyself” is a book by Dr Bach which my client has read.

My client has been taking various combinations of the ones listed below up to seven at a time:

Rock Water: F’s Personality Type.

It is for people who set themselves high standards, are over-conscientious and often overwork, but are never satisfied with their achievements. Self-repression and self-denial are the order of the day. There is a tendency towards inflexibility, to follow “shoulds” and “oughts”, to do things out of duty and be rather hard on oneself. With an element of self-sacrifice, there is disappointment if they do not meet their own high ideals. A perfectionist who doesn’t allow herself to have fun.

Rock Water is made from a healing spring. It is the only Flower Remedy that is not a flower. People who need it tend to be too “rock” and not enough “water”.

We generally choose one type (see above) and the others (see below) are to address the emotional mood and/or state of mind.

Mimulus: For when there is specific fear. In F’s case fear of condition worsening, fear about where the next flare up would locate, and/or fear of coming off the prescribed medication.

Impatiens: For F’s frustration and impatience, because she is unable to do what she wants to do!

Olive: For F’s physical, mental and emotional exhaustion.

Gentian: For feeling generally low and negative.

Gorse: This one is indicated when the person feels desperate. When there is no hope, no point, no focus, hopelessness and despair.

Cherry Plum: For fear of losing control. This can be relevant on all or some level ie. Mental, emotional and physical.

Hornbeam: As things are such an effort -such as rising out of bed in the morning. That Monday morning feeling.

Larch: For lack of confidence.

Red Chestnut: Over concern for others’ wellbeing.

White Chestnut: worrying and excessive thinking with thoughts going round and round.

Sweet Chestnut: For extreme mental anguish.

Chestnut Bud: The pattern breaker-when it’s time to make some changes.

Walnut: Affords some protection when going through emotional life changes.

Rescue Remedy: The combination of 5 remedies: Rock Rose, Star of Bethlehem, Clematis, Impatiens and Cherry Plum. For any stressful situation or when feeling stressed and under pressure.

CLIENT’S FEEDBACK

“Although I cannot relax /sleep easily due to constant pain, I find Shiatsu relaxing and sleep better afterwards. I feel clearer and more positive and generally lighter”.

“My shoulders/hips feel freer”. F could raise her arms to shoulder height for the first time in years.

Following one session she said that: “it felt like waste was being eliminated via my big toe”.

F has improved her diet and is eating less bakery and more vegetables.

SELF HEALING AND SELF TOLERANCE

One day F described how on awakening she would lie in bed, worrying and thinking about her struggle with the day ahead.

This highlights the importance of our Thinking and Intention because “Mind leads the Chi, Chi leads the Blood”. What we focus on expands and F was focussed on struggle and pain.

In a nutshell she was at war with herself!

Knowing that she used to be an active member of the Christian Church, I asked her how she felt about God:

“abandoned” was her reply.

I knew from past conversations and Body Scans she felt isolated, let down and depressed. It seemed that F was cutting herself off from the universe, yet believing it was God’s doing because she asked me: “is that what God wants?”

I replied “it seems to me God is God, God just is, God is still there. What do you want?”

F affirmed that she wanted to feel better, be less dependent on others and paint a picture she had envisioned.

As in Shiatsu “tuning in”, but seated on chairs together, I encouraged her to open to the universe or God and connect with the ground and breathe. Breathing can lead to change. More oxygen=more chi =more energy and vitality. Less stagnation, less pain and better elimination-letting go of toxins and old emotional stuff.

F is allowing herself more fun, more rest periods, consequently less worrying, less “shoulds” and “oughts”.

F has become less hard on herself. Easing up is encouraging her to be accepting, kind and loving with herself.

She looks softer, breathes more easily and is more relaxed.

She smiles more.

F has more understanding of her condition and has experienced it differently through changing her attitude.

F is paying attention to her “self-talk” and what she is thinking, especially if she feels negative. She now realises she can choose more positive thoughts.

Being less fearful of muscle spasms suddenly gripping her, she has found they are less frequent and she hasn’t experienced any in the last few months.

CONCLUSION:

Healing is always self-healing and our attitude and intention is all important and powerful.

Be clear what you want and don’t focus on what you don’t want!

F is discovering that She is the key to healing and in this position of self-responsibility, she is stopping blaming God or the doctors and feeling more empowered to make a difference in her own life.

Through learning to breathe, relax and gently exercise she has reduced chronic pain and has gained the locus of control.

Shiatsu has been a catalyst for this change and her support throughout.

BIBLIOGRAPHY

The Foundations of Chinese Medicine: Giovanni Maciocia

REFERENCES

www.fmnetnews.com www.fmparthership.org http://en.wikipedia.org/wiki/Fibromyalgia

SOCIAL MEDIA DISCUSSIONS

Rick Van Hassel, Shiatsu Therapist: Wondering if anyone has recommendations for treatment strategies around client with Fibromyalgia? Timothy Phillips: Over the years I have found that a very Yin style of shiatsu pressure is effective. Very gentle and holding the points for four or five seconds each. Certainly calming the Shen, particular attention to liver and Gall Bladder. Nancy Web: Stress and trauma is always part of the root cause and a precursor to developing symptoms so Shen is always involved. Some examples that I have uncovered is any type of abuse, death in the family, flight attendant that was stressed by constant jet lag, PTSD etc. The mind is having a hard time digesting some aspect of life (ST/ SP) and the body starts showing symptoms. Yin nurturing techniques based on assessment (No dispersing) Gentle rocking (No bouncing, which is more yang) eases the nervous system. Holding and rocking into points allows you to assess them more deeply in a nurturing way. Chris Joynes, Shiatsu Practitioner: I have had success treating Fibromyalgia by doing more of a light style eight extra acupressure/Jin-Shin-do type of treatment. I tonify first then hold the four gates to relax and spread the qi. Points for

general body pain like ST36 work well- be wary of pushing too hard at first as client is holding onto pain for a reason. Work gently at first, tonifying over a few treatments, then build up to light dispersal. Rick Van Hassel, Shiatsu Therapist: I also find the Yin treatment style helpful, slow and steady treatment…holding points slightly longer. As well, a very appreciative & nurturing presence that supports the client’s psychological and physical states. Liv/Gb excess with Sp/St depletion has come up as well as specific Bladder Meridian work. Shirley Scranta, Shiatsu Practitioner: Also consider Governing Vessel and Conception Vessel. Suggest foods to nurture Stomach Spleen and Liver. Magnesium-rich foods such as beets and beet juice are great additions. The gentle shiatsu is very effective. Governing Vessel and Conception vessel are important. Liver, Stomach and Spleen are all involved. Other techniques to consider: Shiatsu Shin Tai and Cranio-sacral and Reiki. Essentially, diet must also change. Use foods that nurture Earth and foods to nurture Liver. Add sources of magnesium or magnesium gel. Eliminate all white flour, white sugars, bakery items. Add healthy oils, green leafy vegetables, beets and fruits. I haven't seen any research, but feel Vitamin D is also needed. Tina Rea, Shiatsu Practitioner at Shiatsu for Health: Over the last 19 years I have worked with some client’s fibromyalgia. In many cases the have other inflammatory conditions. Most common are chronic fatigue, MS and HIV positive. Digestive problems tend to be a major issue as well. With all my clients I assess the same, whole body scan, hara assessment, meridian scan of the Kyo Jitsu meridians. As noted by others ST/SP and GB/LV present quite often. My touch and tempo really depends on the client. Not only how sever their symptoms but also their level of trust in the Shiatsu work. I might start out using more palming then fingers or thumbs. More ki projection with light fingers. My speed varies as it does with any client and session. I do not hold points or work in the yin approach. Spending some time at the beginning of the session on abdominal massage/ampuku. This really helps to focus their energies. Do you do moxa treatments? A light short treatment. Too much will have the opposite effect. I agree with Mary on the importance of being in the water. Watsu would be best. I also recommend to clients to just get in the water to do pool walking and gentle stretching. It is very important to do exercise. To move the body.

Nicole Swierkowski, Shiatsu therapist: Do some trauma research. Clifford Andrews is good. Restless legs are part where the body is stuck in the trauma stage of "Flight". Check where clients feels unable to escape, and feels stuck emotionally/mentally. Vigorously working LV/GB works for my client when her legs kick off during a session. Also recommend to check out TRE - Trauma release by David Berceli where client can learn to discharge stress through a practice of shaking. Dominique Eschle Thomet I have fibromyalgia. And I work also with Shiatsu since a while yet. So.... "lucky me" as I'm a therapist quite well aware of this disease ! And be prepared to read a non-English speaker please... Thank you all for what has been said here, it makes undoubtedly sense. 1) Ampuku (Hara work) is a key to start TTT, 2) then yes Earth and Wood have to be treated though Wood can be quite painful if the receiver is having a crisis => fibromyalgia, as you all know, is a disease with "ups & downs" so be aware of the state in which the receiver is when you see him/her. 3) The verticality is important too, Shen & Water, as if we had to help to maintain good roots and good connection with Heaven.

4) A gentle touch is most important too : we (who suffer from fibro) are quick to feel pain as we live with pain all the time. As we don't have proper nights, our nerves are always on alert so have just an Earth touch - nourishing - or, when you want the receiver to really get the message, have a Water touch - again and again, slow, gentle but deep => as if you (Water) want to dig the Grand Canyon ! - 5) Shiatsu work on head, feet and hands is just great too ; a nice way to calm and act on the distal side. It's as if we had always to re-anchor the receiver, to fix the person here and now. Balance in the 2 axes is a point too : Fire-Water and Wood-Metal. Lung & LI are also concerned here; the receivers are constantly confronted to their limits, often off limits... and we'd like them to get rid of their excess of all. Personally, when I suffer I like a calming and nourishing TTT but when I feel quite well, a dispersing way of treating is THE way to help me with plenty of stretches as if my body wanted to grow in every direction! But no shaking please....! Of course, Shiatsu is just one way to help the receiver. Nutrition, movement and environment are often to be changed if we want to have a better life. Water, as already said by a few of you is a great help (aqua gym, Watsu, swimming, ...) But here, we, practitioners, can just advise and eventually send our clients to colleagues who can work in partnership with us to improve the receiver's health. We have our limits !