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Half of teens with fibromyalgia have ‘loose’ joints, may be more pain-sensitive subset

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Article:
The role of benign joint hypermobility in the pain experience in Juvenile Fibromyalgia: an observational study – Source: Pediatric Rheumatology Online Journal, Jun 15, 2012

[Note: the full text of this article is available free here. Other research, in women with hypermobile joints (able to extend joints beyond what is considered ‘normal’), found that 75% of them also suffer from migraines (“’Loose Joints’ Highly Associated with migraine.” Statistics also indicate that joint hypermobility often co-occurs with orthostatic intolerance and/or chronic fatigue syndrome.)]

Abstract:
Background: Juvenile Fibromyalgia (JFM) is characterized by chronic widespread musculoskeletal pain, and approximately 40% of children and adolescents with JFM also suffer from benign joint hypermobility (HM). It is not currently known if the presence of HM affects the pain experience of adolescents with JFM.

The objective of this study was to examine whether there were any differences in self-reported pain intensity and physiologic pain sensitivity between JFM patients with and without joint HM.

Methods: 131 adolescent patients with JFM [ages 11-18] recruited from four pediatric rheumatology clinics completed a daily visual analogue scale (VAS) pain rating for one week and underwent a standardized 18-count tender point (TP) dolorimeter assessment.

Medical records were reviewed for the presence of joint hypermobility. Average pain VAS ratings, tender point count and tender point sensitivity were compared between JFM patients with and without hypermobility (HM + and HM-).

Results

• Nearly half (48%) the sample of JFM patients were found to be HM+.

• HM + and HM- patients did not differ in their self-reported pain intensity.

• However, HM + patients had:
– Significantly greater pain sensitivity,
– With lower tender point thresholds (p = 0.002)
– And a greater number of painful tender points (p = 0.003) compared to HM- patients.

Conclusion: The presence of joint hypermobility among adolescent patients with JFM appears to be associated with enhanced physiologic pain sensitivity, but not self-report of clinical pain.

Further examination of the mechanisms for increased pain sensitivity associated with joint hypermobility, especially in adolescents with widespread pain conditions such as JFM is warranted.

Source: Pediatric Rheumatology Online Journal, Jun 15, 2012. PMID:22704360, by Ting TV, Hashkes PJ, Schikler K, Desai AM, Spalding S, Kashikar-Zuck S. Divisions of Rheumatology, Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, OH; Pediatric Rheumatology Unit, Shaare Zedek Medical Center, Jerusalem, Israel; Division of Pediatric Rheumatology, University of Louisville, KY; Center of Pediatric Rheumatology, Cleveland Clinic, Cincinnati, OH, USA. [Email:
tracy.ting@cchmc.org]

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One thought on “Half of teens with fibromyalgia have ‘loose’ joints, may be more pain-sensitive subset”

  1. DrJamesStoxenDC says:

    I have been asked to lecture around the world to over 50,000 medical doctors and scientists on the LEVER MODEL vs THE SPRING MODEL of the human body.

    Is it possible that the doctor you see is examining, treating and maintaining your body as a lever when it is really a spring?

    Not long ago, I began to see the human form through a whole new lens. The lessons taught in medical schools, medical books and scientific papers about how the body works and how it breaks down, though based on modern medical constructs, just didn’t add up. I felt that current teachings in the medical and fitness industries were missing something big.

    There were just too many unexplained mysteries that perplexed doctors and scientists and left patients feeling hopeless, frustrated and in a chronic state of pain and suffering.

    I felt these answers would provide us with the secrets to the best approach to allow us to reach the true potential of our human body.

    I took off my white coat and considered the human form from different logical points of view: a mechanical engineer, an anatomist and a physicist. I then combined this new perspective with my years of experience interviewing, treating and training hundreds elite athletes in many sports from around the world. What I found was fascinating to me, doctors around the world and I’m excited to share it with you!

    Every movement you make is powered by a miraculous spring mechanism. Once you learn how it works, the important functions it serves, how it breaks down and locks, and how it effects so many aspects of your health, you will see why so many suffer and are misdiagnosed.

    Understanding the human spring will help you understand how certain athletes can high jump seven feet over a bar or run fifty miles without stopping, while other people can’t jog, walk, lift weights of even get up out of a chair without pain. The efficiency of your body’s motion has everything to do with the integrity of your human spring.

    Medicine says the body ambulates as a lever. The body does have lever functions but mainly functions as a spring mechanism.

    Video Tutorial #7 The Four Primary Functions Of The Human Spring Mechanism
    http://teamdoctorsblog.com/2011/05/09/video-tutorial-7-the-four-primary-functions-of-the-human-spring-mechanism/

    1. What the theory says is that the HUMAN SPRING stores mechanical energy therefore it is an efficiency mechanism.

    CHRONIC FATIGUE – You use most of your energy throughout the day for ambulating. We walk 10,000 steps a day. When our bodies spring mechanism breaks down it changes from an efficient spring mechanism that uses elastic spring energy to move into an inefficient lever mechanism which uses muscle contraction energy to move.

    A spring is a structure that deforms its physical shape. During that formation process that spring stores potential energy. Then it reforms back to its EXACT original shape and releases the energy back into the mechanism. Think about a spring when you squeeze it down it stores energy and when you let it go that releases the stored energy.

    2. The human spring also provides the protective mechanism for the body. It is the principle mechanism that absorbs forces of the landings during foot to ground impact activities such as walking, running and activities like dance and other sports.

    The human body impacts the ground 3.6 million times a year. The human spring absorbs the force of these impacts of the landings and protects you from these collisions.

    CHRONIC PAIN – When the spring mechanism breaks down your 10,000 springy steps per day can turn into 10,000 bang and twists per day. Understand?

    3. The human spring also allows us to land our bodies on uneven surfaces by adjusting the body weight over the spring mechanism so it can achieve optimum balance.
    That’s why we have 26 bones and 33 joints in the foot and ankle That force coupled with the uneven terrain is distributed across this terrain through these 33 joints. It spreads the force across each joint while still maintaining the mass balanced with the center of gravity over the spring mechanism.

    4. The human spring is integrated into the biomechanics therefore it’s essential for stress and strain free motion.

    If the spring mechanism is designed into the mechanical mechanism of the human body through human motion but if it’s not working the way it should then it will cause abnormal movement patterns that will lead to stress and strain, wear and tear, the release of information, silence and then painful.

    Chronic Inflammation is linked to brain fog, chronic fatigue, feelings of hopelessness, depression, listlessness and mimics fibromyalgia or can be misdiagnosed as fibromyalgia

    Video Tutorial #37 Aches, Pains, Allergies, Fatigue, Brain Fog, Diseases of Aging Have One Common Thread… INFLAMMATION

    http://teamdoctorsblog.com/2012/03/15/video-tutorial-37-aches-pains-allergies-fatigue-brain-fog-diseases-of-aging-have-one-common-thread-inflammation/

    You may find this model a better model for explaining the unexplainable like chronic pain, chronic fatigue and FIBROMYALGIA.

    A Painful Misunderstanding of Human Engineering

    Unfortunately, the entire world doesn’t regard the body as a living spring. Consequently, they are missing out on the most important aspects of how the human body moves, protects itself, recycles energy and functions in a world governed by the laws of nature, physics, engineering and common sense.

    Today’s current medical practices and exercise approaches defy the laws of nature, physics and engineering. Which means they’ll never work. Period.

    In walking there is simplistically the “take off” and the “landing” When you run with braces (shoes) your body has an artificial support and an artificial landing gear.

    When we wear artificial supports during any lifting or exercise we weaken the supports that were supposed to support you.

    Most footwear weakens the spring suspension system, the landing gear that supports our entire spring mechanism

    However doctors continue to add supports to our body

    Most doctors and scientists say human body ONLY works as a lever system

    Why is the body NEVER a rigid lever during running or walking?

    When the foot lands on the ground it rolls from the outside to the inside called rolling from supination to pronation.

    At the same time it is loading from the force of the landing like lowering a weight on the bench press.

    With all that rolling and loading in a three dimensional plane across 33 movable joints it never becomes a rigid lever! Its just impossible to think that can happen with a rolling loading bag of 26 moving bones.

    For me, with my experience studying impacts in sports such as running, jumping and plyometrics, I find it ridiculous to think that the body absorbs these incredible impacts with levers.

    How can a lever protect two objects (earth and human) that predictably will collide over 250,000,000 times in a lifetime?

    Lets see… this object will collide with the earth 250 million times so lets design it as a lever.

    Are you thinking what Im thinking?

    It doesn’t make sense!

    Is it just me or do you think it’s hard to imagine that we can launch our 150 pound bodies against 450 pounds of impact resistance force for over 26,000 consecutive impacts with ultimate efficiency as a lever system.

    If you believe what you are saying, then you are saying that is the way you launch your body against this 450 pounds of resistance or approximately 11,700,000 pounds of work load!

    The same person can’t do 200 calf raises (working as a true lever) amounting to 30,000 pounds of work.

    Here are the exact formulas:

    26,000 impacts/26 miles
    M x A = F (M)150 pounds x (A)3 = 450 pounds force per impact
    450 x 26,000 = 11,700,000 pounds of impact over the course of that marathon
    150 pounds x 200 total calf raise reps before exhaustion = 30,000 pounds of work

    Why do we become exhausted at 30,000 pounds of work during calf raises (working as a true lever) but can run 26.2 miles for 26,000 impacts of 450 pounds of force amounting to 11,700,000 pounds of work?

    Its because:

    The body works as a lever mechanism when doing calf raises.
    The body works as a spring mechanism when walking and running.

    Its obvious which one is more efficient!

    If we look at the body as a spring mechanism we have more effective ways of treating and training the body than as a lever.

    Also looking at the body as a spring mechanism helps us explain many mysteries that baffle doctors and you.

    Like…. CHRONIC PAIN – The body bangs and twists into the ground 10,000 steps a day (walking) rather than springs off the ground so it cannot protect itself from the impacts resulting on an assault on the muscles and joints.

    Maybe that is why my plantar fasciitis, heel spurs, shin splints, knee pain, hip pain back pain and herniated disc won’t heal!

    Like… CHRONIC FATIGUE – The body bangs and twists into the ground 10,000 times a day (walking) rather than the more efficient way of ambulation, springing the mass off the ground. (some have estimated that 25-60 percent of the energy is recycled through this spring action)

    Like all this added together… FIBROMYALGIA

    From my clinical experience, the majority of the people who have injuries from running such as plantar fasciitis, shin splints, heel pain, torn cartilage in the knees, hip pain and herniated discs are because the spring mechanism can’t effectively absorb the impact into the spring.

    Because the human spring is preloaded with compressive force from muscle spasms and locking of joint lay there is no room to load all the impact force.

    Because of that, the impact is absorbed into the tissues as chronic stress and strain, wear and tear inflammation and pain called degenerative joint disease during running or simple walking.

    Then you have the acute injury resulting from an acute overload of the force of impact into the compression spring, the vertebral disc, which is really a plastic deformity.

    I explain elastic vs plastic deformity in depth in Video Tutorial # 143 What I Learned From Studying Javier Sotomeyer Technique About Improved Performance and Reducing Injury Risk
    http://teamdoctorsblog.com/2012/04/18/video-tutorial-143-developing-a-strong-human-spring-is-the-key-to-developing-maximum-jump-capacity-example-javier-sotomeyer/

    There’s no use planning a fitness regime to rival an Olympic athlete unless you first sort out how healthy or otherwise your gait is. You may be able to fly on the track but it’s not going to take too long before you’re grounded permanently if every step you take is the equivalent of a crash landing.

    Hard landings cause shock to the skeleton, and while it might seem like heavily-cushioned shoes would be the answer, they are in fact, likely doing more damage as they dramatically affect the arch spring’s ability to appropriately absorb, store, then release the energy from each step.

    Rather than strapping five inch ‘pillows’ to your feet, the best solution is to repair the spring mechanism in the arches by following the procedures and exercises in this article.
    When your limbs veer outside of the safe range of supination to pronation rolling motion you enter the unsafe range. Any motion of a joint or complex of joints outside its normal range lead to abnormal movement patterns that can cause stress and strain, wear and tear, widespread silent inflammation, which can lead to painful inflammation.

    Inflammation as you know increases your risk for diseases of aging, depression, brain fog, sickness syndrome, listnessness, loss of spirit amongst other problems.

    These muscles must not only be strong enough for us to walk pain free with some energy recycling but also they must possess strength, speed, stamina, suppleness and flexibility.
    When we know how much resistance or impact force the pronation-supination cuff or spring suspension system can resist then we can design the right training program that creates the exact adaptation we need.

    This article focuses on deep tissue massage, self-help treatments like stretching to increase arch flexibility, resistance training, running drills, plyometric training, and sports training to strengthen the pronation and supinatiion cuff or landing muscles sufficiently to safely spring back the forces of impacts of simple walking, running and sports drills without allowing the foot to over pronate or over supinate.

    Studies have linked over pronation/supination to conditions such as:

    foot pain
    plantar fasciitis
    ankle pain
    sprained ankles
    heel pain
    heel spurs
    knee pain
    hip pain
    back pain
    knee injuries
    menisus tears
    herniated discs that don’t heal

    When these abnormal movement patterns persist this can lead to chronic conditions related to chronic inflammatory response such as chronic pain, chronic fatigue, fibromyalgia, brain fog and inflammatory diseases of aging.

    Some doctors feel that people with chronic conditions of the weight bearing joints are unable to ambulate without some form of support. Some do not offer a program that focuses on restoration of the necessary strengthening of the pronation supination cuff muscles, which could allow a restoration of the spring suspension system to allow them to recapture activities of their youth. Instead they support the body, which eventually does not allow it to support itself.

    I call this standard of care approach, barefoot to bedridden.

    Footwear (two supports)
    Motion Control Footwear (six supports)
    Orthotics (six supports)
    A Cane (seven supports)
    Four Prong Walker (10 supports)
    In a wheelchair (wheels)
    Bedridden (full body support)

    If you find yourself in this approach where all the doctor is doing is adding progressive supports rather than restoration of function you will want to read on on what steps to take to restore the natural spring of the connective tissue structures, how to strength in the muscles that suspend the spring mechanism, what muscles prevent over pronation and/or over supination and maintain the arch spring.

    Human Spring Approach Active Rehabiltation

    I have developed a 3 phase approach to restoring the the natural spring to the body which mainly emphasizes the most commonly neglected area of the body for strength training.

    The three steps to my human spring approach are:

    1. Release the stiffness or locking of the joints of the spring mechanism so the muscles can pull through full range of motion to maximize development.

    2. Strengthen the pronation supination cuff, landing muscles AKA spring suspension muscles with lever resistance exercises.

    3. Strengthen the pronation supination cuff, landing muscles AKA spring suspension muscles with spring impact exercises.

    The most common problem with aging comes from a breakdown in the balance, reflexes and inability to support the upper body with the feet and legs. We see this natural progression of footwear, orthotics, orthopedic shoes, cane, walker, wheel chair and bedridden recommended by the doctor simply because their muscles could no longer support them anymore.

    This progression of barefoot to bedridden can happen faster with injuries that they can’t recover from such as:

    Injuries that don’t get restored to normal function – Chronic foot and ankle conditions like bunions and the complications from bunion surgeries, plantar fasciitis, heel spurs, Mortons neuromas, foot pain, chronic knee conditions and the inability to cover fully from knee surgeries, hip conditions and the inability to restore normal hip function after hip replacement surgeries, back Injuries and surgeries that don’t fully recover from

    Decisions to support vs decisions to restore the muscle strength of the spring suspension system that allow for natural spring function.

    The body is a giant spring with 7 floors of springs:

    The arch
    The subtalar joint
    The ankle mortise
    The knee
    The hip
    The spine
    The head-neck

    Where is the force of the impacts go when the spring loading mechanism os overloaded?
    The overload force is loaded into the tissues as negative stress on tendons and muscles and/or compressive overload of compressive springs.

    The compression springs are the meniscus of the knee, the vertebral discs and the cartilage of the hip.

    The result could be herniated discs, degenerative discs, hip joint degeneration, meniscus tear or knee joint degeneration.

    The overloaded stress on the other structures could manifest as

    plantar fasciitis
    heel spurs
    heel pain
    foot pain
    tibialis posterior tendon dysfunction
    ankle sprain
    shin splints
    TFL & illiotibial band syndrome
    gluteus medius pain
    lower back pain
    mid back pain
    neck pain syndromes
    headaches

    If there is an overall breakdown of the entire mechanism this could manifest into:
    chronic pain syndrome – (inability to spring back from impacts)

    -chronic fatigue syndrome (inability to recycle energy through the spring)
    -misdiagnosed fibromyalgia (doctors did not understand the true cause of your suffering)
    -diseases of aging related to chronic inflammation
    -depression related to chronic inflammation

    Essentially, the overloading of the spring mechanism and the inability of the spring suspension system to handle the impact forces of walking and running is what is getting in the way of the healing process.

    Is there any Science Physics to Your Human Spring Theory?’

    The human body and the earth are two objects that collide 10,000 times a day (steps), which is 3,650,000 collisions a year meaning these two objects collide around 100,000,000 before your thirtieth birthday. These objects are on the earth so they abide by the same laws of nature, physics and common sense that all other colliding objects do.

    When I looked into the physics of a spring mechanism, I discovered the secrets to training the human body for maximum performance are revealed by the simple laws of physics, combined with the laws of nature, primarily those associated with adaptation. We can determine forces of mass and acceleration with simple math equations.

    These, in turn, help us create more effective scientifically-based training programs because we will know how much force our spring can withstand without breaking down. Imagine having a fitness training approach that gives you the healthy stress almost perfectly matched to the strength of your healthy human spring! Well, if you use my approach, you’ll get the most out of exercise and reduce the chance for injury because you’ll be doing your workout according to the laws of physics.

    The Human Spring Approach looks at the human body as a model like an engineer or physicist.

    The engineer will look at the human body as seven floors all interlocking separated by springs on two springs. The seven floors of interlocking springs also have spring energy.

    Currently, doctors do not look at the body in this way and many fitness trainers don’t either.

    The first most important law of springs is Hookes Law

    Hooke’s law is named after the 17th century British physicist Robert Hooke. He first stated this law in 1660.

    Hooke’s law of elasticity discovered by the English scientist, Robert Hooke in 1660, which states that, for relatively small deformations of an object, the displacement or size of the deformation is directly proportional to the deforming force or load. Under these conditions the object returns to its original shape and size upon removal of the load.

    Elastic behavior of solids according to Hooke’s law can be explained by the fact that small displacements of their constituent molecules atoms, or ions from normal positions is also proportional to the force that causes the displacement. Encyclopedia Britanica reference

    What it says is that the more force we can load into the human spring called spring displacement of the more counteracted or the full force will spring back called direct storage of force.

    How can you test the maximum loading capacity of the human spring?

    The only way to test if the spring suspension system is released is to do a gait study or a video of the body impacting the ground in various movements and at progressively increased speeds.

    The forces or loads on the body are dependent on

    -how the load is applied
    -how quickly the load is applied.

    KEY: To be more precise in our approach we need to test the suspension system under stress from these progressive loads to determine the estimated strength level.

    KEY: After that we can determine what training load and forces the suspension system can handle to be able to select the best exercises to prescribe that will allow the suspension system tissues to adapt safely yet increase strength progressively.

    Example: A 150 pound man:

    -has 75 pounds of load on both feet during standing
    -has 150 pounds on one foot when standing on one foot
    -has 150 x 1.25 = 187.5 pounds on the landing foot (F = M x A)
    -has 150 x 3 = 450 pounds on the landing foot (F = M x A)

    Bodybuilders routinely tack on 20, 30, 40 and even up to 100 pounds of muscle mass onto their frame in their lifetime but they forget that during walking the impact forces are increased by 1.25 and during running the impact forces or three times the bodyweight.

    Many gain that winter weight or just get caught up in work, family and our diets get way off track for a few and we gain 10, 20, 30 pounds until we decide we should start running for the cardio to burn off some of that fat.

    We don’t realize that for every 1 pound of bodyweight we gain it is 3 pounds increase impact force on our joints in the landing. Chances are the spring mechanism may already be dropped and locked because out spring was already in an overload state for several months and for some, several years.

    What means the additional mass loaded onto the human spring mechanism creates 30, 60 and 90 pounds of additional impact force into the joints of the human spring mechanism.

    Dont worry because even for those extremely overweight with little to no spring in your step you can implement this approach. Watch this video of a lady who had locked feet and was over 300 pounds. She set a goal to lose the weight and restore her spring mechanism. Watch her interview on WGN Channel 9 talk about it. Im very proud of her!

    TV Special Medical Report: “When Exercise Accelerates Aging!” Dr. James Stoxen, DC on WGN, Channel 9

    http://www.youtube.com/watch?v=1HaDXiMu8RM&feature=player_embedded

    SHE WAS DIAGNOSED WITH FIBROMYALGIA TOO

    The Ultimate Study to Determine the Status of Your Human Spring

    The most accurate way to determine the strength of your human spring mechanism is to see how it reacts to progressively greater force impacts. The way I test athletes and patients spring suspension system is to do a video taping of walking, running and the performance of sports such as sprinting or jumping barefoot.

    Then I replay the video tape evaluating and reviewing with the patient, the movement pattern carefully in slow motion to see if the landings show the foot and ankle are springing and are rolling from supination to pronation within a safe range.

    You can learn more about this by looking at a variation of gait analysis called “The Toe Raise, Foot and Ankle Alignment Test.

    How to do Video Evaluation of Your Walking (Gait)

    -Stand about 10 feet away and videotape and later observe motion of the ability of the foot and ankle to stay in the safe range during-

    -Two Leg Standing
    Normal Pace Walking
    Fast Walking
    Various Jogging Speeds
    Running
    Sprinting
    Plyometrics

    For many of you simple standing is beyond the ultimate strength levels.

    This imbalance of impact forces vs cuff strength is what causes your foot to roll out of the safe range as your impacts overloaded the ability of the tibialis posterior (over pronation) or the peroneus group (over supination) to maintain the foot in the safe range.

    What if your arch connective tissue spring mechanism locked?

    Oh, and I forgot the one day when you were standing too long talking to your friend… Your suspension system fatigued (tibialis posterior), the arch dropped and it locked at the metatarsal cuneiform joints (forefoot-mid foot / mid arch joint complex).

    So, as you know, your muscles cannot pull against locked bones. So, your exercise program cannot even get started until you release all the muscle spasms from around this joint of the foot so your joint will move when the muscle contracts against it.

    Phase I – Start with the spring release techniques before doing any strength training and especially before any impact training exercises!

    Why not brace the dropped and locked arch?

    Some doctors call it over pronation and treat it with a brace, a motion control shoe or the infamous orthotic.

    What about the spring loading?

    Doesn’t the orthotic effect loading if it is under the arch?

    The orthotic cannot restore the spring. Also, the orthotic occupies space in the shoe and the your shoe compresses the arch from the top.

    I have many video tutorials loaded in my site that can help you to understand this better so you can sort out if this chronic condition is a mystery or easily explained.

    This article was drafted from these two posts

    Video Tutorial #28 Self-Tests & Exercises To Reduce Over Pronation and Over Supination From Impacts During Walking and Running

    http://teamdoctorsblog.com/2012/06/18/video-tutorial-28-the-impact-absorbing-landing-muscles-of-the-human-spring-mechanism-testing-and-training-the-spring-suspension-muscles/

    Video Tutorial #12 Is Running Bad For Your Knees? How Does The Body Spring Back Safely From Impacts Of Running and Walking?

    http://teamdoctorsblog.com/2012/06/13/video-tutorial-12-is-running-bad-for-knees-how-the-body-springs-back-safely-from-impacts-of-running/

    Also the

    This is why I feel many doctors cannot sort out the issues patients have with fibromyalgia.

    Also, I know that manual therapy and deep tissue treatment for these conditions that are 20 minutes or an hour 3 days a week don’t make a dent in relieving them. Listen to this interview, on pain exorcism where I talk about treatments that I do that take 20 – 50 hours of deep tissue to reverse abnormal reflexes in the brain that are buried deep for years.

    RADIO INTERVIEW: Dr. James Stoxen DC Shares About ‘THE PAIN EXORCISM’, BFM 89.9 The Buisness Station, From Kuala Lumpur, May 25, 2012
    http://teamdoctorsblog.com/2012/05/29/radio-interview-dr-james-stoxen-dc-share-interviewed-about-the-pain-exorcism-bfm-89-9-the-buisness-station-from-kuala-lumpur-may-25-2012/

    Please feel free to make comments no ones condition is the same as anyone else’s.

    I am not saying you all have a breakdown of the spring mechanism however this is what I have found as the most common cause of why patients do not heal when diagnosed by other doctors with fibromyalgia.

    This is a presentation of information and not an opinion on all fibromyalgia so please don’t accuse me of saying your fibromyalgia is not fibromyalgia

    Please have an open mind

    Thanks

    Dr James Stoxen DC
    President Team Doctors
    http://www.teamdoctorsblog.com

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