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1. Fibromyalgia Solutions
from the Field of Manual Therapy and
Complementary & Alternative Medicine (CAM)
Fibromyalgia Using an Integrated Approach five classifications of CAM, including alternative
Fibromyalgia syndrome (FMS) is one of the medical systems (acupuncture, homeopathy),
most commonly diagnosed nonarticular soft tissue biological-based therapy (nutritional supplements),
conditions in all fields of musculoskeletal medicine. dietary modifications, energy therapies (magnetic
One study found, “strong evidence supports therapy), and manipulative and body-based systems
aerobic exercise and cognitive behavioral therapy. (chiropractic care, massage), and mind-body
Moderate evidence supports massage, muscle interventions (relaxation, biofeedback, and
strength training, acupuncture, and spa therapy hypnotherapy).4 (Holdcraft, 2003).
(balneotherapy). Limited evidence supports spinal In this issue, the focus is on evidence for the use
manipulation, movement/body awareness, vitamins, of nutritional approaches; treatments that shift
herbs, and dietary modification. Several substance P plasma levels (acupuncture5, massage
nonpharmacologic treatments and manual-type therapy6; modalities which affect the autonomic
therapies have acceptable evidentiary support in the nervous system (Integrative Manual Therapy;
treatment of FMS.”1 (Schneider,2009). exercise7,8 Qigong, exercises, Reiki, Chiropractic,
Clinical improvements [people felt and and more.
functioned better] and controlled trials support the
Massage Therapy Addresses Fibromyalgia
use of an integrative medicine approach to
"Massage therapy is widely used by patients
fibromyalgia.
with fibromyalgia seeking symptom relief. The
People with FMS have increased quality of life
existing literature provides modest support for use
with a number of forms of Complementary
of massage therapy in treating fibromyalgia. In
medicine as seen in this 2003 study from the Mayo
massage therapy of fibromyalgia, we suggest
clinic. Of the 304 patients invited to participate,
massage be painless, its intensity should be
98% had used some type of CAM therapy during
increased gradually from session to session, in
the previous 6 months. “The 10 most frequently
accordance with patient's symptoms; and the
used CAM treatments were exercise for a specific
sessions should be performed at least 1-2 times a
medical problem (48%), spiritual healing (prayers)
week." 9(Kalichman,2010).
(45%), massage therapy (44%), chiropractic
treatments (37%), vitamin C (35%), vitamin E Neurophysiology in Manual Therapy Practice
(31%), magnesium (29%), vitamin B complex During the past decade, scientific research has
(25%), green tea (24%), and weight-loss programs provided new insight into the development from an
(20%).”2(Wahner-Roedler, 2007). acute, localized musculoskeletal disorder towards
“Some nutritional supplements (magnesium, S- chronic widespread pain / fibromyalgia. Chronic
adenosylmethionine) and massage therapy have the widespread pain is characterized by sensitization of
best evidence for effectiveness with fibromyalgia. central pain pathways. An in-depth review of basic
Other CAM therapies such as chlorella, and clinical research was performed to design a
biofeedback, relaxation have either been evaluated theoretical framework for manual therapy in these
in only one randomized controlled trials (RCT) patients. It is explained that manual therapy might
with positive results.”3 (Sarac, 2006). be able to influence the process of chronicity by, ”
A 2003 review of the literature looked “across (I) limit the time course of [pain] afferent
© 2010 www.VisualizeHealth.Net 1 Musculoskeletal Solutions 07

2. stimulation of peripheral nociceptors. (II) decreased higher than in the comparison group without FMS
sensory threshold [pain tolerance]. 10(Nijs,2009). (56% vs 21%).
CAM users had similar expenditures to nonusers
Qigong Intervention
among patients with FMS ($4,638 versus $4,728).
In a study to evaluate the effect of a 7-week
Patients with FMS who used CAM also had heavier
Qigong intervention on subjects with Fibromyalgia
overall disease burdens than those not using
Syndrome, researchers noted “significant
CAM.”Lind concluded, “CAM use is not associated
improvements were found for the intervention
with higher overall expenditures.”14 (Lind, 2007).
group, at posttreatment, regarding different aspects
of pain and psychological health and distress. Psychology and Coaching for Fibromyalgia
Almost identical results were found for the This article considers four broad classes of
combined group. psychological techniques and their effects on
The overall results show that Qigong has fibromyalgia pain. “Hypnotherapy and writing
positive and reliable effects regarding FMS. A high intervention have demonstrated mild treatment
degree of completion, 93%, and contentment with effects, whereas psychological treatment is
the intervention further support the potential of the effective in fibromyalgia pain.” 15(Thieme,2009).
treatment. The results of the study are encouraging Another study found, visual imagery with
and suggest that Qigong intervention could be a relaxation is a mind-body intervention that may be
useful complement to medical treatment for used for symptom management in Fibromyalgia
subjects with FMS.”11 (Haak,2008) and 12(Wisdom which is a chronic pain disorder affecting 2% of the
Healing Qigong,2010). population in the United States. Another 16 million
Another study looked at aerobic exercise and Hispanics suffer from generically identified
qigong. In this study, “FMS patients ages 8-18 rheumatic diseases that likely include FMS.
16
years were randomized to a 12-week exercise (Menzies,2008).
intervention of either aerobics or qigong. Both These researchers said, “treatment of chronic
groups participated in 3 weekly training sessions. pain has become a multidisciplinary endeavour
Program adherence and safety were monitored at including psychological interventions.
each session. Data were collected at 3 testing Several reviews on systematic research studies
sessions, 2 prior to and 1 after the intervention, and confirm that psychological interventions are
included FM symptoms, function, pain, QOL, and efficacious in the treatment of chronic
fitness measures. musculoskeletal pain, especially back pain, though
Thirty patients participated in the trial. effect sizes are small and, in some cases, moderate.
Significant improvements in physical function, Hypnotherapy in children and adolescents with
functional capacity, QOL, and fatigue were recurrent gastrointestinal pain, examined in a study
observed in the aerobics group. Anaerobic function, of high methodological quality, achieved an
tender point count, pain, and symptom severity exceptional level of symptom relief.
improved similarly in both groups. Regarding different pain syndromes such as
Significant improvements in physical function, chronic back pain, headache, fibromyalgia, and
FM symptoms, QOL, and pain were demonstrated temporomandibular disorder, as well as
in both exercise groups; the aerobics group gastrointestinal pain in children, psychological
performed better in several measures compared interventions proved their significance for the
with the qigong group.”13 (Stephens,2008). achievement of favorable treatment outcome.”17
(Kroner,2009).
Economics and Quality
In a study on complementary medicine usage Pain and Inflammation
among people with fibromyalgia, Lind et al found, Characteristic symptoms of fibromyalgia
“use of CAM by patients with FMS was 2.5 times syndrome include widespread pain, fatigue, sleep
© 2010 www.VisualizeHealth.Net 2 Musculoskeletal Solutions 07

3. abnormalities, and distress. FMS patients show postoperative nausea and vomiting, and
psychophysical evidence for mechanical, thermal, chemotherapy-related nausea and vomiting.
and electrical hyperalgesia [heightened pain For migraine, low-back pain, and TMJ jaw
sensation]. To fulfill FMS criteria, the mechanical disorders the results are considered positive by
hyperalgesia needs to be widespread and present in some and difficult to interpret by others.
at least 11 out of 18 well-defined body areas (tender For a number of conditions such as
points). Peripheral and central abnormalities of fibromyalgia, osteoarthritis of the knee, and tennis
nociception [pain sensation] have been described. elbow the evidence is considered promising, but
“Interventions aimed at reducing local pain seem more and better quality research is needed.”22
to be effective but need to focus less on tender (Birch, 2004).
points but more on trigger points and other body “Acupuncture treatment of FMS patients was
areas of heightened pain and inflammation.”18 associated with decreased pain levels and fewer
(Staud, 2006). positive tender points. This was accompanied by
decreased serotonin concentration in platelets and
Fibromyalgia like Criminal Law?
an increase of serotonin and substance P (pain-
In an article comparing Multiple Sclerosis and
modulating substances) levels in serum.23 (Sprott,
Fibromyalgia, Hellstrom, et al. discussed, “the
1998).
difference between the two concepts health and
In a study to systematically review the efficacy
absence-of-disease” saying, “the diagnosis of MS
of acupuncture in fibromyalgia syndrome (FMS),
is similar to a scientific discovery, whereas the
researchers noted, "strong evidence for the
diagnosis of fibromyalgia is constructed more like
reduction of pain was found at post-treatment."24
criminal law. Consequently, diagnosis-based
(Langhorst,2010).
disease prevention and health promotion have to
In this study to evaluate the clinical effect of
comply with a wide range of reality.”19(Hellstrom,
combination of acupuncture, cupping and medicine
1995).
for treatment of fibromyalgia syndrome,
Elimination fo Xenobiotics researchers found, “the therapeutic effect of
In this case researchers describe a 28-year-old combination of acupuncture, cupping and medicine
woman, who had been suffering for more than “5 on fibromyalgia syndrome is superior to that of the
years from severe fatigue, myofascial pain, simple acupuncture combined with cupping or the
obstipation, obesity of trunk, abdominal striae, simple medicine.25 (Jang,2010).
oedema, tinnitus, folliculitis, facial swelling and
Strength and Premature Aging
secondary adrenocortical insufficiency. Therapy
This study looked at strength and premature
consisted of dietary advise, chelating agents,
aging in women with fibromyalgia, women without
supplements, and acupuncture. The patient became
FMS, and older women. “Women with FMS and
completely symptom-free.”20 (Mutter, 2007).
older women who are healthy have similar lower-
International Agreement on Acupuncture body strength and functionality.” FMS potentially
Evidence enhances the risk for premature age-associated
Using the Fibromyalgia Impact Questionnaire, disability26(Panton, 2006).
SF-12, Catastrophe Index, and the Beck Depression
Before and After Evaluation
items as evaluation tools, researchers concluded,
“The Fibromyalgia Impact Questionnaire (FIQ)
“acupuncture treatment as delivered was effective
developed by clinicians at Oregon Health &
at reducing FMS symptoms in this outcome
Science Univ is an attempt to capture the total
study.”21 (Singh, 2006).
spectrum of problems related to fibromyalgia and
Another paper said, “general international
responses to therapy. First published in 1991, it has
agreement has emerged that acupuncture appears to
been shown to have a credible construct validity,
be effective for postoperative dental pain,
© 2010 www.VisualizeHealth.Net 3 Musculoskeletal Solutions 07

4. reliable test-retest characteristics and a good osteoporosis and osteoarthritis, differences in
sensitivity in demonstrating therapeutic response to radiation and chemotherapy, and the
change.”27(Bennett, 2005). differences in chronic facial pain, chronic fatigue
syndrome, and fibromyalgia.”46 (Slavkin, 2002).
Manual Lymph Drainage Therapy
This study analyzed and compared the effects of Exercise, Psychology and Health Coaching
manual lymph drainage therapy (MLDT) and “Recent pharmacological treatment studies have
connective tissue massage (CTM) in women with focused on selective serotonin and norepinephrine
primary fibromyalgia (PFM). reuptake inhibitors, which enhance serotonin and
The Fibromyalgia Impact Questionnaire (FIQ) norepinephrine neurotransmission in the
and Nottingham Health Profile were used to descending pain pathways.
describe health status and health-related quality of There is also evidence to support exercise,
life (HRQoL). cognitive behavioral therapy, education, and social
In both groups, significant improvements were support in the management of FMS.”47 (Arnold,
found regarding pain intensity, pain pressure 2006) and 48(Rossy 1999).
threshold, and HRQoL The results indicate that Another study stressed the importance of active
these manual therapy techniques might be used in participation. “Non-pharmacological treatments
the treatment of FMS. However, MLDT was found involving active participation of patients, such as
to be more effective than CTM according to some exercise and psychotherapy, seem to be more
subitems of FIQ (morning tiredness and anxiety) effective than those that involve passive physical
and FIQ total score. 28(Ekici,2009). measures, including injections and operations.”49
(Henningsen, 2007).
Homeostasis and the ANS
Other researchers reported several important
“The main component of the stress response
findings. “First, there was strong evidence that
network is the autonomic nervous system (ANS).
mind-body therapies were more effective for self-
FMS is proposed to be a sympathetically [fight or
efficacy (a measurement of an individual’s belief
flight] maintained neuropathic pain syndrome, and
that she or he can cope effectively with a
genomic data support this contention. Autonomic
challenging situation) than waiting list or treatment
dysfunction may also explain other FMS features
as usual controls.50 (Burckhardt,1994) and 51
not related to pain.”29(Martinez-Lavin, 2007).
(Vlaeyen,1996).
A number of approaches have been successful in
Second, there was strong evidence that exercise
changing signs and symptoms of autonomic
was more effective than mind-body therapies for
nervous system dysfunction including Reiki30,
short-term improvement in pain intensity or tender
Myofascial Massage31,32 Muscle Energy & other
point pain threshold and physical
biomechanical approaches33, Integrative Manual
function.52(Martin,1996)& 53 (Wigers, 1996).
Therapy34,35 Manual Lymph Massage & Lymphatic
The evidence on the effect of exercise on
techniques36,37, Traditional Chinese Medicine &
symptoms of fibromyalgia would tend to
Acupuncture38,39 Chiropractic40, Rolfing41,Cranial
recommend any manual therapy treatment that
Therapy42, Lavender essential oils and hot foot
enabled the client to get back to regular exercise
bath43,Exercise44 and Yoga45.
and the support of a health coach to help with goal
Mars and Venus in the Mix setting and accountability..
Talking about the difference between men and
The Touch Research Institute - Massage
women, researchers in this study considered,
Therapy Studies
“puberty or menopause, the unique differences in
“Massage therapy helped to improve sleep
the prevalence of autoimmune diseases and
patterns, decrease pain, fatigue, anxiety, depression
disorders (Sjogren's syndrome, Hashimoto's
and cortisol levels in adults with fibromyalgia.”54
disease), differences in the onset and progression of
© 2010 www.VisualizeHealth.Net 4 Musculoskeletal Solutions 07

5. (Sunshine, 1996). what comes to consciousness while doing so.
“FMS patients slept better (showed lower This healing modality has seen some dramatic
activity levels suggesting more deep sleep), had results with chronic back pain, fibromyalgia, spinal
lower substance P levels and less pain following a cord injuries, migraines, brain injuries, cerebral
month of biweekly massages.”55(Field, Delage, et palsy and ADD.
al. 2003) and 56(Field, 2002). Organized into easy to understand sections, the
In another study researchers looked at “40 book includes a step-by-step protocols used to
patients with FMS randomly assigned to a promote healing.60(OmegaBookCentre, 2005).
movement/massage therapy group or a relaxation
Spa Therapy
control group 2x/wk for 3 weeks. The
“This study investigates possible effects of a
movement/massage group showed decreased
combined spa and physical therapy program on
depressed mood, state anxiety and regional pain
pain and hemodynamic responses in various
immediately after the first and last sessions of the
chronic diseases.
study”57(Field, 2002).
The patients with ankle arthrosis, fibromyalgia
Neurotransmitter Substance P and cervical disc herniation reported the highest
“Substance P (SP), a neurotransmitter stored Visual Analog Scale (VAS) score before treatment.
within the afferent nociceptive fibers, is likely to be After the therapy program, VAS scores were seen
involved in the pathogenesis of musculoskeletal to decrease.
pain,” said investigators of “SP immunoreactive To decrease pain and high blood pressure
(SP-ir) nerve fibers in the upper trapezius of without hemodynamic risk, a combined of spa and
patients with FMS and myofascial pain syndrome PT program may help to decrease pain and improve
(MPS) by immunochemistry. Our results point to hemodynamic response in patients with irreversible
a peripheral hyperactivity of the peptidergic pathologies.”61 (Cimbiz, 2005).
nervous system in FMS as well as in MPS.
Osteopathic Manual Therapy (OMT)
Findings support the notion of pathogenetic
“Twenty-four female patients were randomly
involvement of the afferent nervous system in the
assigned to one of four treatment groups.
development and perception of myofascial
Participants' pain perceptions were assessed by use
pain.58(DeStefano, 2000).
of pain thresholds measured at each of 10 bilateral
Nociception & Opiods tender points using a 9-kg dolorimeter, the Chronic
The mechanism of nociceptive [pain sensation] Pain Experience Inventory, and the Present Pain
dysfunction and potential roles of opioid Intensity Rating Scale. Patients' affective response
neurotransmitters are unresolved in the chronic pain to treatment was assessed.
of FMS and chronic low back pain. FMS was Significant findings between the four treatment
distinguished by higher cerebrospinal fluid Met- groups on measures of pain threshold, perceived
enkephalin-Arg6-Phe7, systemic complaints, and pain, attitude toward treatment, activities of daily
manual tender points, and lower pain thresholds living, and perceived functional ability were found.
compared to the low back pain and normal This study found OMT combined with standard
groups.59 (Baraniuk, 2004). medical care was more efficacious in treating FMS
than standard care alone.62(Gamber, 2002)
Neurofascial Process and Pain
“Sharon Giammatteo, PhD, PT developed Integrative Manual Therapy
Integrative Manual Therapy, a comprehensive This article discusses a 46 year old woman with
system of healing for body, soul and spirit. complaints of total body pain and fibromyalgia. She
Neurofascial Process exercises involve placing was treated with Integrative Manual Therapy (IMT)
one's hands over specific parts of one's body for with a focus on the immune system and lymphatic
extended periods of time, and simply "being-with" drainage. Also treated with Endermologie63 (LPG,
© 2010 www.VisualizeHealth.Net 5 Musculoskeletal Solutions 07

6. 2004), the woman had significant improvements other stress-associated conditions in patients with
including a decrease in her medications and fatigue chronic fatigue syndrome and fibromyalgia.
levels. The clinical overlap between conditions may
IMT therapists find treating the structural reflect a shared underlying pathophysiologic basis
components of the body and improving lymph involving dysregulation of the hypothalamic-
drainage will improve the detoxification process, pituitary-adrenal stress hormone axis.
positively affect the autonomic nervous system, and Multidisciplinary clinical approach to TMJ
thereby improve a client’s function and quality of disorders would improve diagnosis and
life. outcomes.66(Korszun, 1998).
The anticipated treatment outcome is twofold: 1)
Resistance Training, Chiropractic and
subjective reports of decreased pain with improved
Fibromyalgia
function, and 2) objective improvements
The objective of this study was to evaluate
documented in range of motion, posture, gait, and
resistance training (RES) and RES combined with
cardiovascular endurance.
chiropractic treatment (RES-C) on fibromyalgia
Post treatment, the Physical Therapists reported
(FMS) impact and functionality in women with
“a reduction of all medications by two-thirds
FM.
including a reduction of Neurontin from 900
Both groups completed 16 weeks of RES
mg/day to 200 mg/day secondary to decreased pain.
consisting of 10 exercises performed two times per
Decreased pain specifically: upper back pain
week. RES-C received RES plus chiropractic
(decreased from 12/10 to 0/10); wrist pain (10/10 to
treatment two times per week.
3/10); bilateral lower extremity pain (7/10 to 2/10),
Strength was assessed using one repetition
based on a 0-10 subjective pain scale. Increased
maximum for the chest press and leg extension.
endurance to complete work activities / duties and
FMS impact was measured using the FMS impact
a report of being more alert at work.
questionnaire, myalgic score, and the number of
The client also had decreased swelling and fluid
active tender points. Functionality was assessed
reduction, as evidenced by a decrease in clothes
using the 10-item Continuous Scale Physical
size by 1 full size, despite no diet change. There
Functional Performance test. Analyses of variance
was also a decrease in girth measurements: waist at
with repeated measures compared groups before
umbilicus from 53 to 48 inches and bilateral thighs
and after the intervention.
from 26 to 24 inches.64(Koch & Lunn, 2004).
Both groups improved in the strength domains;
Energy Medicine however, only RES-C significantly improved in the
The National Institutes of Health (NIH) is pre- to postfunctional domains of flexibility,
funding numerous Energy Healing (EH) studies balance and coordination, and endurance.
examining its effects on conditions including TMJ In women with FMS, resistance training
disorders, wrist fractures, cardiovascular health, improves strength, FMS impact, and strength
cancer, wound healing, neonatal stress, pain, domains of functionality. The addition of
fibromyalgia, and AIDS (NIH, 2004a). It is also chiropractic treatment improved adherence and
suggested that EH may have positive effects on dropout rates to the resistance training and
various orthopaedic conditions, including fracture facilitated greater improvements in the domains of
healing, arthritis, muscle and connective functionality.” 67(Panton,2009).
tissue.65(DiNucci, 2005).
TMJ and Fibromyalgia
The purpose of this study was to determine the
comorbidity of temporomandibular disorders and
© 2010 www.VisualizeHealth.Net 6 Musculoskeletal Solutions 07

7. References
1. Schneider, M., H. Vernon, et al. (2009). "Chiropractic management of fibromyalgia syndrome:a
systematic review of the literature." J Manipulative Physiol Ther 32(1): 25-40. [Medline Abstract].
2. Wahner-Roedler, D., P. Elkin, et al. (2007). "Use of complementary and alternative medical therapies
by patients referred to a fibromyalgia treatment program at a tertiary care center." Mayo-Clin-Proc. 2005
Jan; 80(1): 55-60 IBIDS: International Bibliographic Information on Dietary Supplements: from
http://grande.nal.usda.gov/ibids/index.php.
3. Sarac, A., A. Gur, et al. (2006). "Complementary and alternative medical therapies in fibromyalgia."
Curr Pharm Des. 12(1): 47-57(IBIDS: International Bibliographic Information on Dietary Supplements):
from http://grande.nal.usda.gov/ibids/index.php.
4. Holdcraft LC, Assefi N, Buchwald D. Complementary and alternative medicine in fibromyalgia and
related syndromes. Best Pract Res Clin Rheumatol. 2003;17:667–683. doi:
10.1016/S1521-6942(03)00037-8.
5. Sprott, H., S. Franke, et al. (1998). "Pain treatment of fibromyalgia by acupuncture." Rheumatol Int
18(1): 35-6.
6. Field, T., J. Delage, et al. (2003). "Movement and massage therapy reduces fibromyalgia pain." Journal
of Bodywork annd Movement Therapies 7, 49-52., 11-17.
7. Martin L, Nutting A, MacIntosh BR, Edworthy SM, Butterwick D, Cook J. An exercise program in the
treatment of fibromyalgia. J Rheumatol. 1996;23:1050–1053.
8. Wigers SH, Stiles TC, Vogel PA. Effects of aerobic exercise versus stress management treatment in
fibromyalgia. Scand J Rheumatol. 1996;25:77–86.
9. Kalichman, L. (2010). "Massage therapy for fibromyalgia symptoms." Rheumatol Int 30(9): 1151-1157.
[Medline Abstract].
10. Nijs, J. and B. Van Houdenhove (2009). "From acute musculoskeletal pain to chronic widespread pain
and fibromyalgia: application of pain neurophysiology in manual therapy practice." Man Ther 14(1): 3-12.
[Medline Abstract].
11. Haak, T. and B. Scott (2008). "The effect of Qigong on fibromyalgia (FMS): a controlled randomized
study." Disabil Rehabil 30(8): 625-633. [Medline Abstract].
12. Wisdom Healing Qigong (2010) http://www.qifieldtherapy.com/zqg.html
13. Stephens, S., B. M. Feldman, et al. (2008). "Feasibility and effectiveness of an aerobic exercise
program in children with fibromyalgia: results of a randomized controlled pilot trial." Arthritis Rheum
59(10): 1399-1406. [Medline Abstract].
14. Lind, B. K., W. E. Lafferty, et al. (2007). "Use of complementary and alternative medicine providers
by fibromyalgia patients under insurance coverage." Arthritis Rheum 57(1): 71-6.
15. Thieme, K. and R. H. Gracely (2009). "Are psychological treatments effective for fibromyalgia pain?"
Curr Rheumatol Rep 11(6): 443-450. [Medline Abstract].
16. Menzies, V. and S. Kim (2008). "Relaxation and guided imagery in Hispanic persons diagnosed with
fibromyalgia: a pilot study." Fam Community Health 31(3): 204-212. [Medline Abstract].
17. Kroner-Herwig, B. (2009). "Chronic pain syndromes and their treatment by psychological
interventions." Curr Opin Psychiatry 22(2): 200-204. [Medline Abstract].
18. Staud, R. (2006). "Are tender point injections beneficial: the role of tonic nociception in fibromyalgia."
Curr Pharm Des 12(1): 23-7.
19. Hellstrom, O. W. (1995). "Health promotion and clinical dialogue." Patient Educ Couns 25(3): 247-56.
20. Mutter, J., J. Naumann, et al. (2007). "Elimination of xenobiotics in a female patient with fibromyalgia,
chronic fatigue, and trunk obesity." Forsch Komplementarmed 14(1): 39-44.
21. Singh, B. B., W. S. Wu, et al. (2006). "Effectiveness of acupuncture in the treatment of fibromyalgia."
© 2010 www.VisualizeHealth.Net 7 Musculoskeletal Solutions 07

8. Altern Ther Health Med 12(2): 34-41. [Full Text].
http://www.immunesupport.com/library/showarticle.cfm/ID/7077
22. Birch, S., J. K. Hesselink, et al. (2004). "Clinical research on acupuncture. Part 1. What have reviews
of the efficacy and safety of acupuncture told us so far?" J Altern Complement Med 10(3): 468-80.
23. Sprott, H., S. Franke, et al. (1998). "Pain treatment of fibromyalgia by acupuncture." Rheumatol Int
18(1): 35-6.
24. Langhorst, J., P. Klose, et al. (2010). "Efficacy of acupuncture in fibromyalgia syndrome--a systematic
review with a meta-analysis of controlled clinical trials." Rheumatology (Oxford) 49(4): 778-788.
[Medline Abstract]
25. Jang, Z. Y., C. D. Li, et al. (2010). "[Combination of acupuncture, cupping and medicine for treatment
of fibromyalgia syndrome: a multi-central randomized controlled trial]." Zhongguo Zhen Jiu 30(4):
265-269. [Medline Abstract].
26. Panton, L. B., J. D. Kingsley, et al. (2006). "A comparison of physical functional performance and
strength in women with fibromyalgia, age- and weight-matched controls, and older women who are
healthy." Phys Ther 86(11): 1479-88.
27. Bennett, R. (2005). "The Fibromyalgia Impact Questionnaire (FIQ): a review of its development,
current version, operating characteristics and uses." Clin Exp Rheumatol 23(5 Suppl 39): S154-62 from
www.myalgia.com/FIQ/Bennett%20FIQ%20review.pdf and http://www.myalgia.com/FIQ/FIQ_B.htm
28. Ekici, G., Y. Bakar, et al. (2009). "Comparison of manual lymph drainage therapy and connective
tissue massage in women with fibromyalgia: a randomized controlled trial." J Manipulative Physiol Ther
32(2): 127-133. [Medline Abstract].
29. Martinez-Lavin, M. (2007). "Biology and therapy of fibromyalgia. Stress, the stress response system,
and fibromyalgia." Arthritis Res Ther 9(4): 216.
30. Mackay, N., S. Hansen, et al. (2004). "Autonomic nervous system changes during Reiki treatment: a
preliminary study." J Altern Complement Med 10(6): 1077-81.
31. Delaney, J. P., K. S. Leong, et al. (2002). "The short-term effects of myofascial trigger point massage
therapy on cardiac autonomic tone in healthy subjects." J Adv Nurs 37(4): 364-71.
32. McNamara, M. E., D. C. Burnham, et al. (2003). "The effects of back massage before diagnostic
cardiac catheterization." Altern Ther Health Med 9(1): 50-7.
33. Beard, J. P., W. H. Wade, et al. (1996). "Sacral insufficiency stress fracture as etiology of positional
autonomic dysreflexia: case report." Paraplegia 34(3): 173-5.
34. Giammatteo, T., & Weiselfish-Giammatteo, S. (1997). Integrative manual therapy for the autonomic
nervous system and related disorders : utilizing advanced strain and counterstrain technique. Berkeley,
Calif.: North Atlantic Books.
35. Wheeler, L. (2004). Advanced Strain Counterstrain. Massage Therapy Journal, 43 Winter(4), from
www.amtamassage.org/journal/winter05_journal/mtjWinter05.html
36. Crowell, T. (2005). The relationship between bone bruises and lymphedema after fracture: a case
study. Townsend Letter for Doctors and Patients, Jan [Full Text].
http://www.findarticles.com/p/articles/mi_m0ISW/is_258/ai_n8592733).
37. Trettin, H. (1992). "[Neurologic principles of edema in inactivity]." Z Lymphol 16(1): 14-6.
38. Wong, R. and S. Sagar (2006). "Acupuncture treatment for chemotherapy-induced peripheral
neuropathy--a case series." Acupunct Med 24(2): 87-91.
39. Longbottom, J. (2005). "A case report of postulated 'Barre Lieou syndrome'." Acupunct Med 23(1):
34-8.
40. Cuthbert, S. C. (2003). "Applied Kinesiology and the Myofascia." Collected Papers International
College of Applied Kinesiology, 2002-2003;1:95-103.
© 2010 www.VisualizeHealth.Net 8 Musculoskeletal Solutions 07

9. 41. Cottingham, J. T., S. W. Porges, et al. (1988). "Shifts in pelvic inclination angle and parasympathetic
tone produced by Rolfing soft tissue manipulation." Phys Ther 68(9): 1364-70.
42. Sergueef, N., K. E. Nelson, et al. (2002). "The effect of cranial manipulation on the
Traube-Hering-Mayer oscillation as measured by laser-Doppler flowmetry." Altern Ther Health Med 8(6):
74-6.
43. Saeki, Y. (2000). "The effect of foot-bath with or without the essential oil of lavender on the autonomic
nervous system: a randomized trial." Complement Ther Med 8(1): 2-7.
44. Tsai, M. W., W. C. Chie, et al. (2006). "Effects of exercise training on heart rate variability after
coronary angioplasty." Phys Ther 86(5): 626-35.
45. Singh, S., V. Malhotra, et al. (2004). "Role of yoga in modifying certain cardiovascular functions in
type 2 diabetic patients." J Assoc Physicians India 52: 203-6.
46. Slavkin, H. C. (2002). "Distinguishing Mars from Venus: emergence of gender biology differences in
oral health and systemic disease." Compend Contin Educ Dent 23(10 Suppl): 29-31.
47. Arnold, L. M. (2006). "Biology and therapy of fibromyalgia. New therapies in fibromyalgia." Arthritis
Res Ther 8(4): 212.
48. Rossy LA, Buckelew SP, Dorr N, Hagglund KJ, Thayer JF, McIntosh MJ, Hewett JE, Johnson JC. A
meta-analysis of fibromyalgia treatment interventions. Ann Behav Med. 1999;21:180–191
49. Henningsen, P., S. Zipfel, et al. (2007). "Management of functional somatic syndromes." Lancet
369(9565): 946-55.
50. Burckhardt CS, Mannerkorpi K, Hedenberg L, Bjelle A. A randomized, controlled clinical trial of
education and physical training for women with fibromyalgia. J Rheumatol. 1994;21:714–720.
51.Vlaeyen JW, Teeken-Gruben NJ, Goossens ME, Rutten-van Molken MP, Pelt RA, van Eek H, Heuts
PH. Cognitive-educational treatment of fibromyalgia: a randomized clinical trial. I. Clinical effects. J
Rheumatol. 1996;23:1237–1245.
52. Martin L, Nutting A, MacIntosh BR, Edworthy SM, Butterwick D, Cook J. An exercise program in
the treatment of fibromyalgia. J Rheumatol. 1996;23:1050–1053.
53. Wigers SH, Stiles TC, Vogel PA. Effects of aerobic exercise versus stress management treatment in
fibromyalgia. Scand J Rheumatol. 1996;25:77–86.
54. Sunshine, W., T. Field, et al. (1996). "Fibromyalgia benefits from massage therapy and transcutaneous
electrical stimulation." Journal of Clinical Rheumatology 2, 18-22.
55. Field, T., J. Delage, et al. (2003). "Movement and massage therapy reduces fibromyalgia pain." Journal
of Bodywork annd Movement Therapies 7, 49-52., 11-17.
56. Field, T., M. Diego, et al. (2002). "Fibromyalgia Pain and Substance P Decrease and Sleep Improves
After Massage Therapy." J Clin Rheumatol 8(2): 72-76.
57. Field, T., Diego, M., Cullen, C., Hernandez-Reif, M., Sunshine, W., & Douglas, S. (2002).
Fibromyalgia pain and substance P decrease and sleep improves after massage therapy. Journal of Clinical
Rheumatology, 8, 72-76.
58. De Stefano, R., E. Selvi, et al. (2000). "Image analysis quantification of substance P immunoreactivity
in the trapezius muscle of patients with fibromyalgia and myofascial pain syndrome." J Rheumatol 27(12):
2906-10.
59. Baraniuk, J. N., G. Whalen, et al. (2004). "Cerebrospinal fluid levels of opioid peptides in fibromyalgia
and chronic low back pain." BMC Musculoskelet Disord 5: 48.
60. Omega Book Centre (2005). Body Wisdom Book Review: Light Touch for Optimal Health By Sharon
Giammatteo, Ph.D. $27.95. 210p. Soft. ISBN 1-55643-356-5 North Atlantic Books. www.CenterIMT.com
61. Cimbiz, A., V. Bayazit, et al. (2005). "The effect of combined therapy (spa and physical therapy) on
pain in various chronic diseases." Complement Ther Med 13(4): 244-50.
© 2010 www.VisualizeHealth.Net 9 Musculoskeletal Solutions 07

10. 62. Gamber, R. G., J. H. Shores, et al. (2002). "Osteopathic manipulative treatment in conjunction with
medication relieves pain associated with fibromyalgia syndrome: results of a randomized clinical pilot
project." J Am Osteopath Assoc 102(6): 321-5.
63. Endermologie (LPG) www.endermologie.com/ and http://health.einnews.com/news/fibromyalgia
64. Koch, T. S. and L. Lunn (2004). "The Treatment of a Client Diagnosed with Fibromyalgia Syndrome
Utilizing Integrative Manual Therapy." Connecticut School of Integrative Manual Therapy e-Journal: from
www.centerimt.com/e-journal/articles/ej00010.htm.
65. DiNucci, E. M. (2005). "Energy healing: a complementary treatment for orthopaedic and other
conditions." Orthop Nurs 24(4): 259-69.
66.Korszun, A., E. Papadopoulos, et al. (1998). "The relationship between temporomandibular disorders
and stress-associated syndromes." Oral Surg Oral Med Oral Pathol Oral Radiol Endod 86(4): 416-20.
67. Panton, L. B., A. Figueroa, et al. (2009). "Effects of resistance training and chiropractic treatment in
women with fibromyalgia." J Altern Complement Med 15(3): 321-328. [Medline Abstract]
© 2010 www.VisualizeHealth.Net 10 Musculoskeletal Solutions 07

11. Transformational Shift Module
Musculoskeletal Solutions
Kimberly Burnham, PhD
Matrix Energetics Practitioner Certified
Integrative Manual Therapy Certified
www.KimberlyBurnhamPhD.com
1. General
2. Knee Joint www.VisualizeHealth.net
3. Hip Joint
4. Shoulder Joint
5. Wrist Joint
6. Bone Health
7. Fibromyalgia

12. Musculoskeletal Health
Transformational Shift Modules from Visualize Health can be used in many ways
1. As Informational Modules on complementary and alternative medicine (CAM)
approaches for a particular condition or body system. These are 4‐10 pages of research from
The Burnham Review on what the allopathic (traditional) medical system and others are
saying about Integrative Medicine approaches for a particular condition. This creates a
morphic field around what is useful and accessible from complementary and alternative
medicine.
2. As a ME Modules to shift and notice what is different about a particular
condition, set of symptoms or way of viewing health. These modules containing an
energetic download and can be used by Matrix Energetics practitioners for themselves, their
family or clients or they can be used by an individual. Use multiple selves to work with each
of the images, two pointing, time travel to before the symptoms.
3. As a Ho’oponopono Clearing Device. The images are designed as
Ho’oponopono clearing devices embodied with the energies of “I am sorry, Please forgive
me, I thank you and I love you.”
4. As a Frequency or Motility for practitioners adept at feeling energies,
frequencies & motilities.
5. As a Health Coaching Tool. The Health Coaching wheel focuses on various
aspects of the specific conditions and what health would look like at a perfect 10. This
wheel can be discusses with your Health Coach, used in visualizing what each aspect of your
life at a perfect 10; used in a Matrix Energetics two point way or dropping the pebble or
used as a dowsing tool to find aspects in your life or body that can shift.

13. Soft Tissue & Joint Health Morphic Field
Mind Body
Musculoskeletal Reflex Points Connection Muscle Strength Training
Transformation of Musculoskeletal System
What area feels best? Respiratory Function
Motor Imagery Impossible is Just a Word
NeuroFascial Process manual lymph drainage therapyAyervedic & Herbal Now in the Nervous System
Energy
Extracellular Matrix Balance
Yoga and Wisdom Healing Qigong
Medicine Boswellia
Biofeedback and Meditation
Wide Range of Realities
Exercise
Arnica Taumeel
Health Coaching for Muscle s System
vitamin C, vitamin E, magnesium,
Cognitive behavioral coaching
Homeopathy
vitamin B complex, green tea
Healthy Clean Food & Environment
First do no harm.
Neuromuscular Function
spa therapy
Mitochondria
Substance P
One Minute Wave
Aerobic exercise
Advanced SCS for Digestive Function
Strength Neurotransmitter (balneotherapy)
concentration in
balance
I AM
Serotonin
Jt Blood Flow
platelets
Health Coaching Green
Connective Tissue Tea
Joint function
&Quality of Massage Therapy TaiChi
Life
Acupuncture Reflexes Connecticve System Flow Safety & Flexibility
Soft Tissue Synchronizers
Integrative Manual Therapy
Peptidergic
Movement
Visualizing Bone Health Nervous System Oscillation
Prayer
CranioSacral Rhythms Combined Approach
Matrix Energetics Frequency 4 for the Joint Structure

14. Integrative Medicine Module Panel
Health Visualization Matrix
Coaching Goals Energetics
on Clip Board Client Centered Two Point
Practice
Integrative Manual
Therapy (IMT) Reiki Energy Integrative
Symbols Medicine
Yoga Stretching
Polarity Osteopathic Range of Motion
Therapy Manual Practice
Treatment
Feldenkrais Wisdom Healing
Qigong
Form Formlessness Ho’oponopono
I Love you
Transformational
Shift Downloads
Acupuncture Herbal Therapy
Meridians Tapping Shiatsu Acupressure
Reflex Points Kimberly Burnham, PhD
Matrix Energetics Certified
Health, Wellness, Integrative Manual Therapy Certified
Complementary &
Alternative Medicine Recovery & www.KimberlyBurnhamPhD.com
(CAM) Experts www.VisualizeHealth.net
Consciousness Wellness@VisualizeHealth.net

16. Musculoskeletal Health 7
Comfortable Movement
Bone, Connective Tissue, Strength, Endurance and Quick
Muscle Integrity Recovery Times
You are
10
Here Relaxed, Well developed
muscle tone
0
Rapid Eye
Movement Sleep
Ideal Digestive Function
Neuromuscular Communication
Flexible
Health Coaching Wheel Transformational Shift Module www.VisualizeHealth.net

17. The Wheel Of __________________
Kimberly Burnham, PhD & Visualize Health
Call 860‐221‐8510 or visit www.VisualizeHealth.net or www.HealthCoachingU.com
_______________
_______________ _______________
_______________ _______________
_______________ _______________
_______________

18. Musculoskeletal Health 7
Gratitude Connective
2242 Practice Tissue
Nutrition
Change Now
Multiple
Support & Super
Resources Healing Circulation
Super
powers MoveNow
Walking
Running Joint
Jumping Nutrition
Window Homeopathic
Dropper HopNow
Traumeel
ME Transformational Shift Module www.VisualizeHealth.net

19. www.VisualizeHealth.net
Musculoskeletal Health 7
I Love
I Love You I Thank
You
You
I Love
I am Now
You Sorry
What is
Different??
I am
Sorry
I Thank
I Thank
You Vitamins
You Energetics
Healing Noticing &
Super Observing
powers
Please Ideal
Forgive Connective Energy
Me Tissuse Flow Awesome Life
Systems
Active
Healthy Food &
Life Time &
Elimination Process Space
Enough
Ho’oponopono Clearing Device Transformational Shift Module