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Objective: to investigate how therapeutic mas-sage, combined with stretching, can really con-tribute to the treatment of fibromyalgia (FM) symptoms. Design: Feasibility study. Setting: A single center. Participants: Twenty women having a preexisting diagnosis of FM based on American College of Rheumatology criteria were recruited. Intervention: Subjects received a total of 18 sessions of light massage administered by a physical therapist twice a week and then performed passive stretching exercises. Main out-come measures: heart rate (HR) and Heart Rate variability (HRV), the assessment of joint flexi-bility through elettrogoniometer, the Fibromyal-gia Impact Questionnaire (FIQ), the Pittsburgh Sleep Quality Index (PSQI), and the Borg scale or Rating of Perceived exertion (RPE). Evalua-tions were conducted at the screening visit (T0), immediately at the end of the session of mas-sage (T1) and after completion of 18 sessions (T2). Results: HRV showed an improvement in terms of decreased sympathetic tone and in-crease of parasympathetic tone at the end of treatment. Also joint flexibility showed a sig-nificant improvement at T2 compared with the screening. FIQ, PSQI, RPE did not change. Conclusions: the findings highlight the excellent compliance of FM patients to the combined therapy of massage and stretching, showing an amelioration of muscle stiffness and an improvement of autonomic nervous system with a decrease of sympathetic tone and an increase of parasympathetic tone. The questionnaires did not show any ameliorations, probably because in these patients the perception of quality of life is distorted compared with more objective pa-rameters, such as muscle rigidity, the articular mobility and the autonomic nervous system

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A combination therapy of massage and stretching increases parasympathetic nervous activity and improves joint mobility in patients affected by fibromyalgia