Fibromyalgia 101 for Massage Therapists, Spa & Salon Workers

Fibromyalgia 101 for Massage Therapists, Spa & Salon Workers

By: Selena Belisle, Founder/Instructor CE Institute LLC, Miami FL

Fibromyalgia is a frequently debilitating and painful condition that can have "tender points" on the body. Tender points are specific places on the neck, shoulders, back, hips, arms, and legs. These points can elicit extreme pain when pressure is applied to them.

The American College of Rheumatology approved new revised diagnostic criteria in 2010 for fibromyalgia that eliminated the 1990 tender point testing criteria. The new 2010 diagnostic criteria uses the Widespread Pain Index, and symptom severity scale in place of tender point testing under the 1990 criteria.[i] The 2010 “Widespread Pain Index” (WPI) is shown here in this colorful picture of the body below:   

Despite the new 2010 WPI criteria testing, it’s still important to know where the “tender spots” are when working with fibromyalgia clients.  It is not recommended to place pressure or press directly into these tender point spots as this can be very painful for a fibromyalgia client. Also, avoid massaging any areas of lost sensation or numbness.  Massage therapists and personal care service providers should never work on an area where the client cannot feel because they cannot provide feedback about the pressure or work that is being done in the area.  Below is a 1990 fibromyalgia tender point chart:

Fibromyalgia can also cause disability, a lower quality of life and widespread pain all over the body beyond the “tender points”.  People with fibromyalgia may be more sensitive to pain than people without fibromyalgia. This is called “abnormal pain perception processing”. Fibromyalgia affects about 4 million US adults, about 2% of the adult population. The cause of fibromyalgia is not known, but it can be effectively treated and managed.l 

People with fibromyalgia can sometimes be GREAT candidates for relaxing spa & salon services!  They need it!

The CDC reports US adults with fibromyalgia may have complications such as:

  • More hospitalizations. People with fibromyalgia are twice as likely to be hospitalized as someone without fibromyalgia.
  • Lower quality of life, especially for women. A woman with fibromyalgia has 40% less physical function & 67% less mental health than a healthy woman.
  • Higher rates of major depression. Adults with fibromyalgia are more than 3 times more likely to have major depression than adults without. Screening and treatment for depression is extremely important.
  • Higher death rates from suicide and injuries. Death rates from suicide and injuries are higher among fibromyalgia patients, but overall mortality among adults with fibromyalgia is similar to the general population.
  • Higher rates of other rheumatic conditions. Fibromyalgia often co-occurs with other types of arthritis such as osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis.[ii]

Fibromyalgia is not a general contraindication for massage therapy or spa/salon service, unless the client is having a "flare-up" or has other medical issues that would create a contraindication.  Each client should be serviced on a case-by-case basis with their overall medical health considered prior to servicing the client. Some clients might receive massage during an acute flare-up, again on a case-by-case basis which should be supervised by a licensed physician. Always consult a physician regarding complex client medical conditions. Local contraindications for fibromyalgia include areas of lost sensation.  There are many CE Providers across the United States that teach in-depth classes on working with fibromyalgia.  It is advised to attend one of these specialized board-approved training classes for service providers who wish to work regularly with this condition.

To learn more, please register for quality, affordable, professional training at:


Author Selena Belisle is the Founder of CE Institute LLC in Miami FL.  She is a retired professional athlete and has been practicing massage therapy for over 30 years.  Selena is an approved CE Provider with NCBTMB & the Florida Board of Massage.  She now teaches full time for the Complementary and Alternative Health Care Industries. You can learn more about Selena’s training and CE classes at

[i] Wolfe, F; et al. (May 2010). "The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity" (PDF). Arthritis Care Res. 62 (5): 600–610. doi:10.1002/acr.20140. PMID 20461783

[ii] National Center for Chronic Disease Prevention and Health Promotion | Division of Population Health. “Arthritis.” Centers for Disease Control and Prevention,  3 Apr. 2018,

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