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? for Dr. P & community-active release therapy & myofacial release
Anon_138261 posted:

My primary care has recommended I find a Physical Therapist who does active release, for some new muscle pain issues I am having. For anyone unfamiliar, read here:

In addition to some new muscle pain, I have severely herniated disc in my low back. Although my pain mgt. physician & primary care doc does not believe neither my new muscle pain or back pain is related to the fibro, I think they are. Not caused by maybe, but related, yes. They claim because the areas do not fall into the usual tender points of fibro. I thought the latest diagnosis method was not relying so much on the tender points?

I still question whether I have fibro or myofacial pain syndrome or both. When you press on a myofacial point, it should elicit pain elsewhere, which doesn't happen for me. But then again, research deeply into myofacial pain syndrome and you will find it always doesn't elicit pain elsewhere.

I have yet to find medical information which really differentiates the two. Words like "typically" or "usually", get thrown in there, but not everyone is typical or usual. Going back to the pioneer days & Dr. Devan Starlanyl, she felt they were related. I guess it really doesn't matter as long as something helps.

After 10 plus years of seeking ALL sorts of treatment, like spinal manipulation, dry needling, electric stim, massage, heat/cold, ultrasound, physical therapy, all kinds of meds, anti-epileptics, anti-depressants, muscle relaxers-specifically flexeral & skelaxin and , nsaids, vicoden/profen, tramadol, lidoderm pain patches, I have a hunch it's fibro. In addition to my treatments thus far, I walk, workout, & stretch routinely. So there is a maintenance factor in there(you can't just go to therapy a few times and expect it to be the cure) With this new thing I will try, IF the pain goes away, it's probably myofacial which responds better to treatment vs. fibro which we all know is tough to treat.

This type of therapy seems more aggressive for fibro or myofcial or both if you suffer from both. It's not the usual physical therapy you get which I call stuff I already do at home & doesn't help.

There isn't anyone locally trained in active release. However, there is a Chiropractor who was trained in Myofacial Release. I did some research & find both techniques to be similar. What is the difference in these disciplines?

Mark Pellegrino, MD responded:
I bet your hunch is right: most of my patients who have researched fibro and feel it fits them are usually right!

100% of those with fibro also have myofascial pain syndrome. This basically means that in addition to the generalized fibro symptoms, there are regions of worse pain and muscle spasms/trigger points that constitute myofascial pain syndrome. However, the reverse is not true: that is, not everyone with MPS has fibro.

I'm a big fan of manual therapy, including active release in those with fibro. This therapy is probably working on the MPS component of the fibro esp, but I don't really make a big deal about trying to "separate" fibro and MPS in someone who I've diagnosed fibro. The therapy goal is to individualize the program to the patient's specific needs and problem areas and get the best outcome.

Different health professionals can be trained in manual therapy and specific myofascial releases, strain/counterstrain, massage, nueromuscular techniques, manipulation, craniosacral therapy etc. The key is to find someone trained and experienced in manual therapy and fibro.

Even if one has already tried numerous therapies for fibro with less than optimal results, working with someone experienced in manual therapy is often very helpful. It's not a cure, of course, but it can help you manage better.

Dr. P
sebastian_16 responded:
Hi Anon_138261, my name is Scott and I recently joined WebMD FM forum about a month ago after meeting someone awhile back who was diagnosed with this terrible condition about a year and a half ago. I'm trying to not only understand FM better, but also see what treatments people with FM have found to be successful in helping to manage their pain & fatigue better. I have a good friend who is an Occupational Therapist who recently told me he has treated many FM patients with good success in reducing pain using the SCS method of 'manual therapy' treatments that Dr. P mentions in his reply to your question a couple years ago. I'm wondering if you pursued SCS, or other form of treatment and if so, I'm wonderwondering what you think/thought of it. Thanks and I hope you are doing/feeling better these days. Respectfully, Scott

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