Finding Balance: Holistic Approaches to Fibromyalgia Care with Physiotherapy
What is Fibromyalgia?
Fibromyalgia is a condition classified by chronic pain, stiffness, and tenderness of the muscles, tendons, and joints in the absence of acute inflammation and muscle deformities. Fibromyalgia is characterized by restless sleep, tiredness, fatigue, anxiety, depression, and disturbances in bowel functions. Patients with fibromyalgia display enhanced sensitivity to a wide array of stimuli, such as heat and/or cold, as well as to mechanical (exercise/movement) and ischemic pressure (massage/manual therapy). Fibromyalgia may also present concurrently with additional chronic conditions such as rheumatoid arthritis, osteoarthritis, and other conditions.
What is the cause?
The etiology of fibromyalgia remains unknown, although it is believed to be multifactorial. Fibromyalgia is generally initiated after trauma, surgery, infection, or stress resulting in abnormal sensory processing in the nervous system. Due to fibromyalgia being multifactorial, often multiple health professionals such as Exercise Physiologists, Physiotherapists, Occupational Therapists, Psychologists may be involved within treatment. The number of differing practitioners involved is dependent upon patient presentation.
How is it diagnosed?
Fibromyalgia is usually diagnosed by a doctor or rheumatologist. Previously to be classified with fibromyalgia a patient would undergo a physical examination with physicians checking on 18 tender points assessing for pain/discomfort on at least 11 of these 18 tender points.
New guidelines still considered tender points an important part of the diagnosis, but no longer required that pain be felt in 11 of these points. Before being considered for a diagnosis of fibromyalgia, symptoms must have been experienced for at least three months and all other causes for the symptoms ruled out. Patients must be experiencing widespread pain in both the upper and lower parts of the body on both left and right side, meaning that this is felt in the upper part of the body as well as below the waist. Fibromyalgia is a hard condition to diagnose since there are many different signs and symptoms and often causes misdiagnosis or late diagnosis since these also align with many other conditions.
How can exercise help?
Exercise is commonly recommended in the management of people with fibromyalgia with research supporting aerobic and strength training to improve physical fitness and function, reduce fibromyalgia symptoms, and improve quality of life. There is limited research to support one mode of exercise over another although different modalities have been shown to produce slightly different outcomes. Aerobic exercise interventions were shown to reduce pain, fatigue, depression and to improve health-related quality of life and physical fitness. Strength training was associated with large improvements in global well-being and physical function. A combination of both styles of exercise training (combination of aerobic and/or strength and/or flexibility exercises) was shown to produce large improvements in pain and physical function.
The key findings from the current limited literature on fibromyalgia highlight that to promote an improvement, movement is essential. Establishing a safe and tolerable starting point and a manageable rate of progression is quintessential. Consulting an Exercise Physiologist who specialise in exercise prescription for chronic conditions (anything longer than 3 months) is the safest and most efficient way to get started on improving fibromyalgia.
Current exercise guidelines:
These guidelines below are consistent with the current healthy population guidelines:
(Guidelines taken from ACSM Guidelines 10th edition)
