Fibromyalgia...you may have heard about the condition from a friend or family member, or maybe even from your own doctor or health care professional–but do you really know what it is and how to tell if that’s what you’re truly suffering from? Fibromyalgia affects almost 5 million people in the US, 80% to 90% of whom are women. It is a chronic condition that often is extremely difficult to diagnose or agree upon. Usually diagnosed between 30 and 50 years of age, the symptoms–mainly fatigue and widespread chronic pain–can present much earlier. Although there is no conclusive cure at this time, there is help in the way of treatments. Physical Therapy can help in three important ways:
- Improve your function and quality of life
- Understand and manage your pain
- Decrease your fatigue
What Exactly Is Fibromyalgia?
While the actual cause of Fibromyalgia is unclear, it is thought to be related to changes in how the nervous system processes pain. While it may develop gradually over time, it could also be triggered by a number of factors including trauma, surgery, arthritis, infection, or even major emotional stress. Individuals who have systemic conditions such as Lupus, Rheumatoid Arthritis, or Ankylosing Spondylitis seem to be more susceptible to develop Fibromyalgia. It is important to realize that Fibromyalgia is not just one single condition–it is a very complex syndrome that involves many different factors. With Fibromyalgia it is not uncommon to experience any of the following:
- Widespread pain on both sides of the entire body, often described as a “dull achiness”
- “Tender points”–areas on your head, neck, shoulders, elbows, chest, hips, or knees that are painful to touch
- Muscle stiffness, most notably in the AM
- Memory problems and difficulty thinking
- Pain/cramping in the pelvis or abdomen
- Irritable bowel or bladder syndrome
- Difficulty in getting a restful night’s sleep (often waking up fatigued)
- TMJ (jaw) pain
And oftentimes stress can exacerbate (worsen) your symptoms.
How is Fibromyalgia Diagnosed?
You will need to make sure that you work closely with your health care providers to obtain an accurate diagnosis of Fibromyalgia, since there are no X-rays, blood tests, or muscle biopsies that can be used to diagnose it. It’s extremely critical to have a thorough medical evaluation to rule out conditions other than Fibromyalgia, since many conditions can cause pain and fatigue. Lyme’s Disease, rheumatologic or infectious disease, metabolic disease, hypothyroidism, or side effects due to medication can all mimic the symptoms of Fibromyalgia.
A diagnosis is made based on key symptoms, once other conditions have been ruled out–extreme fatigue, pain in multiple “tender points” (specific areas that are sore to the touch and that move around), difficulty sleeping, memory problems, and anxiety. Your Physical Therapist should be able to accurately identify Fibromyalgia based on a comprehensive medical history and a thorough evaluation. Of particular importance is the pattern of your symptoms–e.g., there are 18 possible tender points–the more you have, the greater the likelihood that you have Fibromyalgia. If your Physical Therapist is certain that you do, in fact, have Fibromyalgia they would most likely recommend you see a rheumatologist (a physician who specializes in arthritis) for medical care that includes medications.
How Can Physical Therapy Help If You Have Fibromyalgia?
Living with Fibromyalgia can certainly be trying. You may experience different pains and symptoms on a day-to-day basis. Avoiding activity as a result of your pain could be detrimental as your overall physical fitness might be diminished. There has been extensive research that supports the use of aerobic and strengthening exercises, in addition to education, to help combat Fibromyalgia. However, fear is a powerful deterrent–that is, fear of pain often prevents individuals from even starting an exercise program. This is why your Physical Therapist is so critical. They should provide you with a customized exercise program and should educate you in how to interpret your pain signals, as well as how to manage and decrease your symptoms. They can also provide you with information on local support groups, exercise programs, and self-help programs available through a local Arthritis Foundation office.
Using Exercise To Help Manage Your Symptoms
Regular exercise, in moderation, is a crucial part of managing Fibromyalgia. Reducing body mass index can actually reduce the risk of developing Fibromyalgia. Studies have shown that the following treatments can decrease pain and improve function, general health, and sleep in individuals with Fibromyalgia:
- Manual Therapy
- Strengthening Exercises
- Aerobic Exercises
- Deep Breathing
- Tai Chi
- Aquatic Exercises
- Recreational Activities
Your Physical Therapist should create a custom exercise program designed specifically for you. To make sure you have the greatest chance for success, they should also instruct you to:
- Start Slow
- Pace Yourself
- Set realistic goals for physical activity and exercise
- Modify your program during stressful times
A properly designed aerobic exercise program can not only benefit you by improving your overall fitness but also can improve your quality of life by training your heart and lungs as well as your muscles. These types of exercises would include brisk walking (where you can carry on a conversation but still need to take deep breaths), bicycling, using an elliptical or stair stepper, and swimming.
If your symptoms are severe, your Physical Therapist should start you off slow and gradually increase your overall activity level and tolerance for exercise. This would mean starting you off with exercises that you could perform for short periods of time (such as 10 minutes) and then slowly increasing your tolerance for longer exercise. It has been shown that even short, 10-minute exercise sessions done 2-3 times a day can increase your strength and endurance. If your symptoms are a little milder, your Physical Therapist might want to concentrate on strengthening your muscles or increasing your cardiovascular fitness. Aquatic exercises in a pool may be the recommendation to help decrease stiffness and reduce pain while you exercise.
Don’t be alarmed if you have a slight increase in discomfort after initiating an exercise program, even if you start out gradual. Your Physical Therapist should prepare you by instructing you in things such as stretching exercises and relaxation techniques that you can perform at home. Also, having other conditions in addition to Fibromyalgia, such as tendonitis, arthritis, or heart disease can make it more difficult for you to exercise. Your Physical Therapist should be expertly trained to individualize treatment for those conditions, and considering the effect that they might have on your Fibromyalgia symptoms and on your ability to exercise.
Decreasing Your Pain And Increasing Your Range Of Motion
To alleviate your pain, your Physical Therapist has a number of beneficial treatment options at their disposal:
- First and foremost is manual therapy techniques to help relieve pain in your muscles and other connective tissue. This may include myofascial release, joint mobilization, and muscle energy techniques, followed by contracting or relaxing certain muscles to make them more flexible
- Soft tissue massage can help to improve blood flow to the tissues and promote relaxation of the muscles to help decrease pain and stiffness and break up any scar tissue
- Certain states allow for a Physical Therapist to perform dry needling to help relief pain. This consists of inserting very fine wire-like needles into the painful areas of the muscle. Delaware is a state that permits this technique.
Use Of Special Techniques
Research has shown that the best results often come from combining a variety of treatments. Exercise, “mind-body techniques,” and appropriate medications can all work together to help you manage your symptoms. Some techniques, such as cognitive behavioral therapy and meditation, can change your responses to pain and promote relaxation. The use of biofeedback may be utilized to help you decrease pain and control muscle tension by using a device that gives you information about the amount of tension in your muscles. Lastly, your Physical Therapist can instruct you in how to set a routine time for going to bed and waking up to allow for good restorative sleep. You should be discouraged from sleeping in the daytime to avoid throwing off your sleep cycle.
If you or someone you know is experiencing the signs and symptoms of Fibromyalgia, don’t wait to take action. Call my office at once at (302)691-9055 or visit my website at www.wildermanphysicaltherapy.com to schedule your FREE 30 minute consultation to see how Physical Therapy can help. Don’t delay–schedule now!