Fibromyalgia (FM) is a chronic pain disorder characterized by widespread musculoskeletal pain, profound fatigue, sleep disruption, and cognitive difficulties (“fibro fog”). It is understandable to question whether a hands-on therapy like chiropractic care, which involves physical manipulation, could worsen a condition already defined by pervasive pain. While chiropractic care can be part of a comprehensive management strategy, the nature of FM introduces a specific risk that aggressive treatment may temporarily intensify symptoms.
Understanding the Sensitivity: Why Chiropractic Poses a Risk
The primary reason a standard chiropractic adjustment can provoke a negative reaction in FM patients is central sensitization. This change in the central nervous system causes an abnormal amplification of pain signals. The brain and spinal cord become hyper-responsive, lowering the threshold at which a stimulus is perceived as painful.
In this heightened state, non-painful touch or pressure can be registered as intense pain, a condition known as allodynia. A high-velocity, low-amplitude (HVLA) chiropractic adjustment involves a quick, forceful thrust and is a significant physical stimulus. This aggressive manipulation can overwhelm the hyper-sensitized nervous system, triggering a widespread pain flare rather than localized relief.
The physical presence of widespread tender points compounds this issue. These areas are exquisitely sensitive to pressure, making deep tissue work or firm manual therapy a potential trigger for a full-body flare-up. The resulting pain is the nervous system’s overreaction to the mechanical input, not typically an injury. Therefore, traditional adjusting techniques are often not ideal for individuals with FM due to their hypersensitivity.
Signs That Treatment Is Exacerbating Symptoms
Patients must distinguish between expected post-treatment soreness and a genuine symptom exacerbation. Mild, localized soreness is common after a chiropractic session, particularly in the initial stages. This discomfort is often compared to the feeling after a new workout and typically subsides within 24 to 48 hours as muscles and joints adapt.
A true FM flare-up is characterized by a widespread increase in symptoms that extends far beyond the adjusted area. Signs of exacerbation include a return of the pervasive dull ache, a marked increase in fatigue, and worsening cognitive fog. If the pain is severe, lasts longer than 48 to 72 hours, or includes new symptoms like heightened sensitivity to light or sound, the nervous system was likely over-stimulated. Immediate communication with the chiropractor about this systemic worsening is necessary to modify the treatment plan.
Selecting a Safe and Modified Chiropractic Approach
For chiropractic care to be safe and beneficial for FM patients, the provider must adopt a modified, low-force treatment protocol. The initial phase must involve a detailed patient history to identify known physical triggers and assess the patient’s current sensitivity. Treatment should begin with the lightest possible touch to allow the nervous system to acclimate without triggering a protective pain response.
Low-force adjustments, such as those delivered by an instrument like the Activator tool, or gentle mobilization techniques, are preferred over aggressive manual manipulation. These methods apply controlled force that is less likely to provoke a systemic reaction. Soft tissue work, including gentle massage or myofascial release, is often incorporated to address muscle tension while avoiding deep pressure on tender points.
The treatment plan must be progressive; intensity or duration should only increase gradually if the patient shows tolerance and improvement. Safe chiropractic care for FM is best executed as part of a multidisciplinary approach, coordinating with other healthcare providers like rheumatologists and physical therapists. The chiropractor’s role is to restore mobility and function using techniques that respect the patient’s altered pain processing.