Chiropractors, Massage, and PT for Fibromyalgia and CFS

How to Find a Qualified Therapist

A physical therapist moves a woman's leg
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Have you seen or considered seeing a chiropractor, massage therapist or physical therapist for your fibromyalgia (FMS) or chronic fatigue syndrome (CFS or ME/CFS)? It could be a really good idea, or a really bad one, depending on which therapist you chose.

A May 2008 study looked into what's called "manual therapy" as a fibromyalgia treatment. Manual therapy is basically any therapy in which the practitioner puts hands on you and manipulates your body in some way.

Because the study looked at issues of central sensitization, it would also apply to people with ME/CFS. Researchers came to 3 interesting conclusions:

  1. To keep pain from becoming chronic, it's crucial to relieve pain (from injuries or structural problems) quickly to keep nerve endings from becoming sensitized. (That applies to people both with and without central sensitization.)
  2. For people with central sensitization, relatively minor injuries can sustain the sensitization process (keep us hypersensitive to pain and other stimuli). Manual therapy, and any exercises prescribed as part of it, should therefore take into account the fact that our bodies react strongly to sensation. Basically, they should be gentle and appropriate to what we can handle without increased symptoms.
  3. Manual therapists ignoring sensitization and the process of maintaining it can cause more harm than good by triggering or sustaining central sensitization.

    As a manual therapy patient, you need to communicate with the therapist about your pain threshold (at what point sensation becomes pain) and whether your pain increases after treatment.

    This also underscores how important it is for you to be careful who you trust to -- quite literally -- take your health in their hands.

    You shouldn't let anyone touch you who doesn't understand central sensitization and how it affects you.

    So how do you chose a manual therapist? For some general information, here's a great article from Alternative Medicine Expert Cathy Wong: How to Find a Complementary / Alternative Practitioner.

    Beyond that, though, the most important thing is asking the right questions. Before you make an appointment, ask: "Does the therapist have experience with chronic fatigue syndrome or fibromyalgia treatment?" "Does the therapist understand how to work with central sensitization?"

    It's important to have these questions answered before you start treatment.


    Manual Therapy. 2008 May 27. [Epub ahead of print] "From acute musculoskeletal pain to chronic widespread pain and fibromyalgia: Application of pain neurophysiology in manual therapy practice."