Going Gaga about Fibromyalgia; Is this really the reason Lady Gaga has been in pain?

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by William D. Charschan D.C.,C.C.S.P., I.C.C.S.P. Lady Gaga reported that she has canceled the European part of her tour due to pain on the right side of her body.  She also just released a documentary on Netflix which showed her being cared for in a medical clinic for chronic pain.  She has released photos of people doing an ultrasound to her right shoulder and she has been talking about Fibromyalgia, a diagnosis she was given by her doctors. Is the reason she is in pain Fibromyalgia, is this a PR stunt to promote her new documentary five foot two, or is there something going on that nobody has shared with her because they do not understand why she is in pain? She is undoubtedly one of the most gifted performing musical artists of this decade and works hard at her art. Her Fibromyalgia problem has been echoed by many news outlets and even Dr. Oz has offered his opinion on Fibromyalgia. The book Cheating Mother Nature, what you need to know to beat chronic pain can help us make a different case, with a different point of view.   This blog post is an educational exercise based on the concepts of the book. A number of previous educational briefs using the ideas featured in the book have been published on this blog.  My previous predictions have been accurate including those on Usain Bolt, Tiger Woods and Roger Federer to name a few. The history of Fibromyalgia is that is was a diagnostic disease classification created in 1990 by Rheumatologist.  They gathered a number of cases together who were not previously diagnostically classified as a disease, who demonstrated similar findings including tender points, lack of sleep, and chronic pain that seemed to be without a clinical basis found on routine evaluation. The diagnostic criteria were developed to describe people who were in chronic pain, but medically, physicians were unsure why. Over the years, using these criteria, hundreds of thousands of people were treated with antidepressants, Lyrica, and other medications with the idea being that Fibromyalgia was a systemic disease. How this relates to the physical manifestations including tender points is discussed in Cheating Mother Nature.  The problem with fibromyalgia is that it was developed by healthcare providers who had little training in diagnosis and treatment of musculoskeletal pain and dysfunction, even though rheumatologists see many patients with systemic pain and inflammatory disease processes. To justify prescribing a medication, a series of symptoms must be classified as a disease which may explain why Fibromyalgia was created. Most chronic pain problems when treated by medical providers involved a medication of some sort so criteria such as Fibromyalgia were necessary for doctors to prescribe and treat these pain patients. Of the cases I have treated and seen in practice, most Fibromyalgia diagnosed sufferers have physical manifestations that resulted in tender points, as well as systemic joint pain. For some who have been diagnosed with the condition for years, the pain and the mechanism behind it have made life quite difficult physically as well as mentally. Since most medical and osteopathic doctors diagnosing Fibromyalgia use a clinical decision process without the knowledge of how to properly evaluate musculoskeletal pain syndromes, many of these patients are misdiagnosed because they had an actual physical problem, that can be evaluated with a thorough physical exam. If the appropriate diagnostic and physical treatment methods were used, these patients can and would improve without the use of medication.  The question we should ask ourselves is; how can we resolve a mechanical problem with a medication? Some have depression as well, and as a result, Medicare is requiring doctors screen for this using a form such as the PHQ-9.   A different point of view based on engineering principals and body mechanics If we look at the photos above, and there are quite a few of Lady Gaga, whose real name is Stefani Germanotta. If we look closely at the arrow, Ms. Germanotta's left foot turns out and falls in on the left side.   This is known as foot overpronation which is an inherited trait. While there are many photos of her standing, walking, and performing, the left foot falling in is consistent in all of our photos.   This is meaningful because Ms. Germanotta's foot will turn out and fall in when she walks, causing the left hip to also drop, which is difficult to see in these pictures. You may also notice in a couple of these photos her right shoulder also leans forward and inferior. which may mean there is a lot of tension on this as the fascia surrounding the left oblique tightens and restricts right shoulder mobility.  This is most likely the mechanism behind why Ms. Germanotta is in such pain.  As you can see on the diagram to the right taken from Myers Anatomy Trains, in the front and the back are fascia he refers to as spiral lines which have likely tightened on Ms. Germanotta and are contributing to her right-sided pain pattern. Physically, the fascia is like an exoskeleton that drives movement and has its own neurological system.  Fascia adapts to the forces placed upon it so if those forces are uneven, as is most likely based on Ms. Germanotta's body mechanics, she is likely suffering more from poor body mechanics than a systemic disease state.

Ms. Germanotta has likely experienced pain in the feet, knees, shins, as well as neck pain.

If you look closely in the photos at the top of this article, you may also notice that her shoulders are uneven with the right shoulder hanging lower than the left side.   This is a common compensation because when the foot on the left side turns out, it will cause a twisting effect throughout the body almost like a DNA strand. Apparently, I was not the only one who has noticed this, since Brian Rothbart, DPM, a podiatric researcher I have told others about has noticed this as well. This torsion can cause shoulder and upper body pain.  Typically, most people tend to have the pain opposite the side of overpronation, which matches up with what I read today in the NJ Star-Ledger who recently put out her own documentary on her struggles with pain. [caption id="attachment_3359" align="alignleft" width="134"] Overpronation[/caption] Overpronation also causes a twisting of the body since the first ray of the foot on her left side hits the ground late, causing a twisting of the body.  The myofascia in the core region will distort over time since it acts as an exoskeleton.  Since Ms. Germanotta has been like this since she was young, she was used to being stiff and tight. The increased demands of dancing, acting, performing, and exercising have tightened this further which will cause the body to distort as we see in the diagram to the left.  The tight fascia will alter the way she moves and it most likely the reason for her chronic pain and the problem is aggravated by intense activity. Apparently, Lady Gaga has a massage therapist who travels with her to allow her to function but she may need to get some better advice.   Being a proponent of massage, it can be quite helpful.  In Ms. Germanotta's case, she may benefit from the eyes and mind of a good holistic sports chiropractor who understands gait and specializes in myofascial release. She may also benefit from Dr. Rothbart's expert observations and approach to the feet as well. While there are many photos of her standing, very few photos of her walking in low or flat shoes were found, however, I did find this video that for a brief moment shows what overpronation does on her left hip while she walks in NYC with her bodyguards.  See the video below You may notice how when she steps her left hip drops, as discussed earlier when describing the effect of overpronation.  She likely will feel better in heels since they would level her hips if they are two inches or higher. While it is difficult to see, if a left hip drops while walking like this, upper body compensations will also occur resulting in tight fascia, joint strain, and joint pain. Most people do not realize poor structure and function can cause chronic pain, and neither do their doctors unless the problem is visually extreme.  In the case of Lady Gaga, she is a high-level performer, who no doubt has to work out constantly.  As her song says, she was Born This Way, with a body that is likely very stiff and may need a different point of view to balance it out, reduce her pain and help her overcome mechanical compensations that are inherited.   Her problems are quite common in the general population, which often is given poor advice since the reason they are in pain is poorly understood by most medical providers. I would assume that during an evaluation, she would have problems doing a squat, raising her hands above her head fully, and exercise is likely becoming more painful because of tight fascia in her legs, and upper body.  A holistic point of view and an active approach to evaluation can clarify the true causes of why she is in pain. If by some chance, Ms. Germanotta does read this post, I would ask her to verify whether my assumptions are correct. How can we help Ms. Germanotta? Here are some suggestions.
  1. Off the shelf foot orthotics can help level her hips, improve leg efficiency, and reduce upper body pain and stiffness. Custom orthotics maybe even more effective if they are made correctly.  Since she spends a lot of time in heels, an orthotic is not very helpful in shoes with heels that are two inches or higher.
  2. Myofascial Release Treatment to resolve fascial system restrictions that are affecting her gait.
  3. Chiropractic manipulation to the spine and extremities.
  4. Appropriate corrective exercises to reduce mechanical distortions and improve movement patterns.
  5. Curcumin is a good natural anti-inflammatory.  This may help in managing her pain safely, without medicinal side effects.   She should also have a food sensitivity test to see if perhaps the flare-ups of pain may have a systemic nature.
Based on my observations from videos, still photos, and Dr. Rothbart's observations as well, Ms. Germanotta is ready for a second opinion from a different type of provider who better understands the musculoskeletal system.  Fibromyalgia is a diagnosis leading to medication, by providers who have little training in the musculoskeletal system.  There is more than enough evidence here to suggest there is more to her pain that the diagnosis suggests. Cheating Mother Nature is available through Amazon.com and other fine booksellers in both softcover and digital formats.