Ginevra Liptan, MD, explains trigger points and myofascial release bodywork.

1. Myofascial Web and
Fibromyalgia
Fibromyalgia Information Foundation
2014 Annual Conference
Ginevra Liptan, MD

2. Fibromyalgia (FM) pain
Hyper-reactive spinal cord and brain called
“central sensitization”
Pain generated from muscle tissue

3. 18 tender points used to
diagnose FM

4. Fibromyalgia muscle pain sources
-Fascia –connective tissue around muscle
-Myofascial trigger points

5. What is fascia?
 Connective tissue network
 Surrounds both individual and groups
of muscles
 Highly sensitive to pain
 Contracts to give muscles extra
strength

6. Myofascial “web”

7. Connective tissue that
envelopes muscles

8. Connective tissue that’s left after
muscle cells dissolved

9. Fascia in FM
 Increased tension
 Inflammation
 Prone to “ knotting up”( myofascial trigger
points)

10. Myofascial trigger points
 Hyper-irritable or taut band of muscle
 Painful on compression
 Refers pain
 Can occur in any muscle under strain

11. Myofascial trigger point

12. Treatments for fascia/trigger
points
 Myofascial release (MFR)
 Trigger point injections
 Self-care

13. Myofascial release therapy
 Manual traction and prolonged assisted
stretching
 Breaks up painful adhesions in the
connective tissue surrounding muscle

14. MFR is not massage

15. Myofascial release for FM

16. Castro-Sanchez et al . 2011
 20 weeks myofascial release therapy
 Compared to sham ultrasound
 Significant improvement in pain and tender
points
 Pain reduction persisted at 1 and 6 months post-
intervention

17. Our study- MFR vs. massage
Women between the ages of 21 and 50 with a
confirmed FM diagnosis
Randomized to myofascial release or Swedish
massage
Therapists had advanced training using the
John F. Barnes MFR approach
90 minutes weekly for 4 weeks

18. FIQ-R Percentage Change in
Myofascial Release SubjectsPercentagechangeinFIQ-R
Myofascial release subjects 1–8
A change of 14% or more is considered significant

19. FIQ-R Percentage Change in
Massage SubjectsPercentagechangeinFIQ-R
Massage subjects 1–4
A change of 14% or more is considered significant

20. Trigger point injections
 Injection of lidocaine
 “Dry needling”

21. Trigger point self-treatment

22. Resources
www.theracane.com
www.myofascialrelease.com
Book:
The Trigger Point Therapy Workbook:Your Self-
Treatment Guide for Pain Relief by Clair Davies
Web sites: