Is the prevalence of joint hypermobility purely a coincidence in CFS and FM? by Celeste Cooper

Shared by ProHealth is Dr. Peter Lowe’s assessment of joint hypermobility in chronic fatigue syndrome.

Is The Physical Examination Normal in CFS? Part 2: Joint Hypermobility, here.

As you will see, I too made this connection in our book “Integrative Therapies for Fibromyalgia, ChronicFatigue Syndrome, and Myofascial Pain: The Mind-Body Connection (rated in the top 100 books on Diseases & Physical Ailments on Amazon in 2013) if you read more about joint hypermobility and Ehler’s Danlos Syndrome on my website here. 

How coincidental could this be?

Another study suggests this phenomenon goes undiagnosed in irritable bowel syndrome, a common comorbid disorder to fibromyalgia, which often overlaps with CFS.

Fikree A, Grahame R, Aktar R, Farmer AD, Hakim AJ, Morris JK, Knowles CH, Aziz Q.. A Prospective Evaluation of Undiagnosed Joint Hypermobility Syndrome in Patients with Gastrointestinal Symptoms. Clin Gastroenterol Hepatol. [Jan 15 Epub ahead of print.]

“Many upper and lower GI symptoms increased with increasing severity of JHS phenotype. Upper GI symptoms were dependent on autonomic and chronic pain factors. JHS is common in GI clinics, with increased burden of upper GI and extraintestinal symptoms and poorer quality of life. Recognition of JHS will facilitate multidisciplinary management of GI and extra-GI manifestations.”

French investigators noted some stark realities in fibromyalgia patients.

“Some patients suffering from fibromyalgia present with clinical signs and alterations in the histopathology, immunohistochemistry and ultrastructure of the dermis similar to the Ehlers-Danlos syndrome, hypermobile type (EDSH). Some types of fibromyalgia possibly represent an undiagnosed EDSH.”

Hermanns-Lê T, Piérard GE, Angenot P. [Fibromyalgia: an unrecognized Ehlers-Danlos syndrome hypermobile type?] Rev Med Liege. 2013 Jan;68(1):22-4.

I can only speak from what I found in my literature review for the 434 page book and my own personal experiences. A stark reality for me is that my own skin is that of someone on long term steroid therapy, but I don’t even tolerate steroids. My wounds heal so slowly that one of my doctors said I should always have a wound care specialist. My skin connective tissue tears like paper and bruises from a feather touch. I have had four shoulder surgeries, one complete reconstruction because it would not stay put, and the other three because of tendon and cuff tears. My hips still pop in and out at will, only contributing to fall risk and aggravation and development of more trigger points, piriformis and sacroiliac pain, and hip bursitis. I have suffered many severe joint sprains throughout my life. I can still put my hands flat on the floor and my therapists are amazed at my flexibility in light of my age and the severe myofascial pain syndrome. And yes, before arthritis, I was what many referred to as double-jointed.

Are our doctors giving this connection serious consideration? 

Could this explain why so many FM and CFS patients 

are susceptible to myofascial pain syndrome?

Keep up the good work Dr. Rowe and fellow astute investigators. A physician should never underestimate the value of a skilled physical exam. We salute you.

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"Adversity is only an obstacle if we fail to see opportunity."

Celeste Cooper, RN

Author, patient/ advocate, fibromyalgia health expert

Books:

Read about Celeste and access to her books at Author Central here

Broken Body, Wounded Spirit: Balancing the See Saw of Chronic Pain [Four book series]

Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain 

Advocacy: 

Fibromyalgia expert on Sharecare, here. 

Participant in the Pain Acition Alliance to Implement a National Strategy, here.

Website: http://www.TheseThree.com

All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  

October is Physical Therapy and Massage Awareness Month: Focus, Trigger Points and Myofascial Pain Therapy

The Physical Therapist

Not all physical therapists are created equal.  If you suspect you have myofascial triggerpoints (MTrPs) or myofascial pain syndrome (MPS), it is extremely important that you do some investigating before you ask your physician for a referral.  A physical therapist that understands the myofascia, what trigger points are, and what they can do is imperative.  The specially trained physical therapist may or may not be one who specializes in sports injury, but they should be educated about myofasical pain syndrome.  If they are specially trained, they can offer active release therapy, myofascial release, or other muscle targeted therapies and education to help you get you back on the road of recovery.

The Massage Therapist or Body Worker

There are many types of massage used for different reasons and massage is gaining favor as a therapeutic intervention for those with chronic pain.  Because there is one particular problem that is inherent in most if not all chronic pain conditions, we are focusing on trigger point massage. A good MTrP therapist or body worker understands the work of the pioneers in myofascial medicine, Dr. Janet Travell, and Dr. David Simons. You might be able to find one who is part of the NAMTP (NationalAssociation of Myofascial Trigger Point Therapists)  or ask for a referral from an integrative pain specialist in your area.  Before you make an appointment you should first ask, “Do you have, or are you, trained in the work of Travell and Simons.”

Experts tell us that to get the most benefit, it is important to learn how to do self therapy between professional sessions. Your physical therapist, specially trained massage therapist, or body worker, and even some integrative pain specialists can show you how to do this or make referrals to materials that teach you.

If you have had a long standing history of MPS, and trigger points that have been neglected, it will take perpetual work to get and keep myofascial trigger points under control, but don’t give up.

So, what is a trigger point?

Trigger points are knotted up muscle fibers in a taut band of muscle. They are EASILY felt unless behind bone or other muscles, or the band of muscle affected is too tight, in which case "specific myofascial therapy," must be used to loosen up the taut band of muscle in order to isolate the specific myofascial trigger point (MTrP) causing pain, dysfunction and radiation of symptoms in a specific pattern associated with that specific MTrP.

Common Abbreviations© 

• MPS: myofascial pain syndrome 
• CMP: chronic myofascial pain
• MTP: myofascial trigger point 
• TrP: trigger point 

•  From Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN and Jeffrey Miller PhD

What do MTrPs do?

Myofascial trigger points can mimic many things and cause pain, dysfunction, and shortening of the muscle affected by this knotted up muscle fiber. Numbness and tingling, burning, certainly pain, can all result from a MTrP which is entrapping a nerve. These symptoms can be local or radiate in a specific pattern that remains consistent among all patients. Circulation/temp changes can occur if MTrPs are located next to a blood vessel, and swelling can develop if the MTrP is located next to a blood or lymph vessel).

You can learn more detailed information about trigger points and myofascial pain syndrome on my website here. 

What is Myofascial Pain Syndrome?

The development of trigger points can occur from usual muscle strain or injury, surely you or someone you know has woken up with a “crick” in their neck.  Generally, these are isolated events that can be easily and successfully treated. But, when trigger points start to develop in all four quadrants of the body, and they persist for over three months, it is important to consider the existence of myofascial pain syndrome.  Myofascial pain syndrome has been found in many if not most chronic pain conditions, including but not limited to, fibromyalgia and chronic fatigue/myalgic encephalomyelitis, migraine, spinal degeneration, teeth grinding, restless leg syndrome, TMJ, interstitial cystitis, irritable bladder, arthritic joints, and can result from post surgical scaring. When not treated by a therapist who understands the work of Travell and Simons, the patient does not get any lasting relief.

The pain that exists because of trigger points depend upon the location of trigger points and you can refer to the links following to decide if you need to know more about trigger points and how they can affect the body and various diseases.

There are many dedicated physical therapists and myofascial body workers that dedicate their lives to helping you.  Many times the therapies they use to treat you can put them at risk for developing myofascial issues, whether they work specifically with the myofascia or not. So please take the time this month to tell them thank you.

Following are few articles written with you in mind:

• Defining Myofascial Trigger Points (MTrPs)
• Neck Pain, Migraines, and Myofascial Trigger Points
• Are FM Tender Points Really  Myofascial Trigger Points
• Costochondritis vs. Myofascial Trigger Points 
• Scream “4,”Cervicogenic Migraine and Myofascial Triggerpoints: June Awareness 
• Exposing the Cover Up of Myofascial Trigger Points inFibromyalgia, Mention in CFS/ME
• Foot Problems
• EHLERS-DANLOS SYNDROME
• Fibromyalgia
• Pelvic Pain, Bladder Disorders, Prostate Problems, Fibromyalgia, Chronic Fatigue Syndrome, and Other Female and Male Related troubles: Is it more than co-incidence?
• Pelvic Floor Muscles and Pain-Not gender specific
• Chiropractic and massage therapy in treating fibromyalgia
• Chest Wall Pain, Esophageal Spasm, and GERD 
• BODY-WORK: The Anatomy’s’ Labor of Love. Manual therapies you might find helpful for chronic pain. 
• Human Touch: Soft Tissue and Massage Therapy in Chronic Pain Conditions
• FM Tender Points are NOT the Same as Myofascial Trigger Points

You can learn more about trigger points and myofascial pain syndrome, including various treatments known to help in “Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection.” Available from our publisher Healing Arts Press and Imprint of  INNER TRADITIONS, Bear and Company here, Amazon here,  Barnes and Nobel, here, and other major retailers. It is also available in Kindle and Nook.

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All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  

Celeste Cooper is a retired RN, educator, fibromyalgia patient, and lead author of the Broken Body Wounded Spirit: Balancing the See Saw of Chronic Pain devotional series (coauthor, Jeff Miller PhD), and Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain: The Mind-Body Connection (coauthor, Jeff Miller PhD) She is a fibromyalgia expert for Dr. Oz, et al., at Sharecare.com, here, and she advocates for all chronic pain patients as a participant in the Pain Action Alliance to Implement a National Strategy, here. You can read more educational information and about her books on her website, http://TheseThree.com