A massage therapist is placing their hands on a client who is laying face down draped with a white cotton sheet on a massage plinth

Massage for Clients with Fibromyalgia

Eight years ago I had the worst massage of my life! I had been seeing my massage therapist for almost a year, and she was excited to try out a new Gua Sha tool on the bottoms of my feet. Because of our long-standing relationship and my history of great massages with her, I wanted to support her enthusiasm and said she could go ahead and try it out. However, my instincts told me, “this is not going to end well”. The next day, I was having muscle spasms so bad in my feet’ bottoms and up my legs that I could barely walk. I learned the hard way never to let a massage therapist use a tool on me again.

Although I don’t think she misused the tool, what I do think happened is that the tool did not allow her to feel how my body was responding to the massage, and as a result, adjust her pressure accordingly. 

Now, you may be wondering why I couldn’t just say it wasn’t feeling good? Well, I have Fibromyalgia (FM), which means my nervous system is hypersensitive, and often pain signals are firing from all areas of my body at once. It can often be challenging to decipher what is the source of the pain. The best massages I have had have been when the therapist gives ME feedback on where the tension is and the adjoining muscles. This type of feedback allows me to become more aware of problem spots and try to relax those muscles more consciously.  

Massage has been one of the best pain relievers for me by far; however, after one of these episodes, I often find myself shying away from more treatments out of fear of triggering another FM flare. Sometimes it takes me a year or more to get the confidence to return.

I was diagnosed with Fibromyalgia 12-years ago. I have discovered many of the dos and don’ts of massage therapy for FM in that time. I realize now that I should have spoken up and said I didn’t want to take the risk that a massage tool could cause muscle spasms, but we are human, and sometimes it’s natural to want to protect someone’s feelings over our own. Now, I don’t hesitate to say no to massage tools, but the next time a client with FM comes to you, please consider these top three Dos and Don’ts for your next FM client. (As they too may be hesitant to speak up like I was).



  • Give your client feedback on what you are feeling. They may not know precisely where pain and tension are originating. When you are in so much pain day after day, a common coping mechanism is “tune it out”. Helping your client get in touch with what is going on in their body helps them mindfully reduce tension.

  • Massage areas that have no complaints or pain. The deeper you can get your client to relax, the better the massage’s outcome will be. I have personally found that massages on the hands, feet, and especially around the scalp and behind ears are particularly relaxing when you keep a gentle pressure. When touch doesn’t trigger pain, it is easier to stop bracing yourself and simply enjoy and relax.

  • As many as 70% of FM patients also have irritable bowel syndrome (IBS), and constipation-predominant IBS is particularly common among people with FM. Abdominal massage for the relief of constipation can go a long way to relieving multiple FM and IBS symptoms at once, including lower back pain and chronic fatigue. Your client may not be aware of the connection between IBS and other symptoms, so always check the current status of their gut health and offer this type of massage accordingly. (Especially if there are complaints of lower back pain as well).


  • Avoid background music with extremely high or low pitched sounds. An overly sensitive nervous system characterizes FM - in my experience, this affects my hearing as well. Someone with FM may also have tinnitus (ringing in the ears). Make sure the background music you are playing doesn’t have instruments like chimes or gongs that are sometimes prevalent in “meditative” or “spa” playlists.

  • Stay away from deep tissue work. The “hurts so good” approach does not apply to people with FM. Spend extra time warming up the muscles, especially in the area of the clients’ primary complaint. This may require heating one area with a heating pad while you work to relax other muscles. What would take you one session with a non-FM client may take you 2 or 3 sessions with an FM client. Patience is key.

  • Avoid stretching the client. Up to 64% of people with FM also have Joint Hypermobility, and for many, it has yet to be diagnosed. However, many will be aware that joints are very tender and particularly irritated with pulling and stretching motions. Just because a joint can stretch that far doesn’t mean it should! If stretching out a stiff joint is called for, a good rule of thumb is to keep the range of motion at 50% of what the client can move.

Finally, it took me years to figure out how multiple diagnoses were related to, or common with, patients with FM. It can be overwhelming to write down all the health issues on a new intake form. Your ability to understand FM’s complexities can be incredibly empowering for your clients who have unfortunately likely experienced some form of ignorance along with dismissive treatment from healthcare professionals in the past. Unfortunately, FM continues to be an under-studied syndrome within the medical community. The absolute best thing you can do for your client is to educate yourself and them, so thank you for reading (and hopefully sharing) this article. I know it will improve the quality of life for someone with Fibromyalgia!

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