The Role of Manual Lymphatic Drainage in Fibromyalgia

Fibromyalgia, also known as fibromyalgia syndrome, fibromyositis and fibrositis, is one of the most
common chronic pain conditions, affecting millions of individuals in the United States and worldwide.
While numbers on the prevalence of fibromyalgia in the literature vary considerably, the American
College of Rheumatology (2008) estimates the number of individuals affected in the U.S.to be 5 million1.
The National Fibromyalgia Association (NFA) estimates the number to be 10 million in the U.S., and 3-6%
of the world population2.
While fibromyalgia can occur in women and men of all ethnic groups and ages, the condition is more
common in middle-aged women (80%) and those women who have a family member affected by
fibromyalgia are more likely to develop the condition themselves (American College of Rheumatology,
2004).
These numbers clearly indicate that fibromyalgia is a common condition; it is a syndrome rather than a
disease, which includes a number of signs, symptoms, and medical problems that tend to occur together
but are not related to a specific, identifiable cause.
The most prevalent symptom is chronic widespread pain and tenderness (sensitivity to touch), in
muscles, joints and soft tissue, fatigue and sleep disturbances.
These main symptoms of fibromyalgia are identical with those of many other conditions, explaining why
fibromyalgia is difficult to diagnose. Physicians often have to rule out other potential causes of these
symptoms before making the diagnosis of fibromyalgia. The absence of diagnostic laboratory tests and
no generally accepted, objective test for fibromyalgia present additional stepping stones in making the
correct diagnosis.
Some physicians unfortunately may not be able to proper diagnose this condition and tell the patient
there is little that can be done.
Specific causes for fibromyalgia are unknown, but it is thought that a number of factors may be involved
that could trigger fibromyalgia, which may include:

• Physical or emotional trauma 
• Abnormal pain response, i.e. problems with how the central nervous system (brain and spinal cord) processes pain - areas in the brain that are responsible for pain may react differently in fibromyalgia patients
• Infection, such as a virus – however, none has yet been identified
   
   

Physicians have to rely on the patient’s self-reported symptoms, the history and a physical examination,
which includes checking of specific manual tender points.
This examination is based on criteria set by the American College of Rheumatology (ACR) for the
diagnosis and classification of fibromyalgia3.

To receive a diagnosis of fibromyalgia, the patient must meet the following diagnostic criteria: 

• Widespread pain in all four quadrants of the body for a minimum duration of three months. Then four quadrants include both sides of the body, above and below the waist line
  
• Tenderness or pain in at least 11 of the 18 specified tender points when pressure is applied (see
  illustration)
   

Individuals affected by fibromyalgia may feel pain at other sites as well, however, those 18 standard
possible sites on the body are the criteria used for classification
 

Several studies on the effectiveness of manual lymph drainage (MLD) in the treatment of fibromyalgia
indicate that MLD yields positive results in terms of pain relief, stiffness, sleep and general health
status 6, 7, 8.
The result of a randomized controlled trial comparing manual lymph drainage with connective tissue
massage in the treatment of women affected by fibromyalgia suggests MLD to be more effective in the
treatment of fibromyalgia than massage 6.
 

It is unfortunate that the term massage is often wrongly used to describe MLD.
The origin of the word massage is derived from the Greek massain (to knead) and is used to describe
such techniques as effleurage, petrissage, vibration, etc.
Compared to traditional massage, the pressure applied with manual lymph drainage is much lower in
intensity. The goal of these techniques is to manipulate the lymphatic structures located in the
subcutaneous tissues. In order to achieve the desired effect, the pressure should be sufficient enough to
stretch the subcutaneous tissues against the fascia (a structure separating the skin from the muscle
layer) located underneath, but not to manipulate the underlying muscle tissue. 

The amount of pressure needed in MLD is sometimes described as the pressure applied stroking a newborn’s head