There is physical therapy for fibromyalgia. As a physical therapist, my patients spend much more time with me than they do their physician. They often pose questions about their conditions – including fibromyalgia.
I don’t usually treat patients specifically for their fibromyalgia but I do treat many patients with fibromyalgia. It is a diagnosis that I take into account upon reviewing their medical history on the first visit. I find that fibromyalgia might change my treatment plan but that it need not affect my outcomes – meaning my patients with fibromyalgia can still get better.
I usually give examples of exercises that people can try to help improve their conditions in my posts. However because fibromyalgia patients might react negatively to even simple stretches or exercises, I am not going to suggest anything specific. I highly recommend finding a physical therapist that is comfortable with fibromyalgia to help develop a plan of treatment that is tailored to you.
Before reviewing the role physical therapy plays in managing fibromyalgia, let’s go over the basics of fibromyalgia.
What is fibromyalgia?
Fibromyalgia is complicated and not well understood. It is a chronic, systemic disease that causes tenderness, pain, and stiffness in the muscles and joints throughout the body. This pain is not connected to inflammation and there is no associated damage or deformity in the body. Those suffering from fibromyalgia also have fatigue and difficulty sleeping. There is no definitive test to diagnose fibromyalgia. It is a diagnosis of elimination of other conditions. This means that it is diagnosed when symptoms are present and similar conditions are ruled out.
Can anyone get fibromyalgia?
Yes, anyone can get fibromyalgia. In fact, it is the most common musculoskeletal disorder in the US. However, is much more common in women than in men. Symptoms are most likely to begin between the ages of 20-55.
What causes fibromyalgia?
This is the big question. The most accepted theory is that it is caused by issues in the central nervous system that lead to an increase in perceived pain and an inability to effectively inhibit and regulate pain. This results in widespread pain in the body and extreme sensitivity to stimuli which could include noise, odors, temperature, and pain.
Genetics may also play a role in the development of fibromyalgia although data for this is inconclusive at this time. It tends to run in families but that does not mean one is destined to get fibromyalgia if a parent or family member has it. It also doesn’t mean that you are immune if no one in your family has it.
There are possible triggers for developing fibromyalgia. This might help explain why some people develop it and others do not, especially if it is linked to genetics. Possible triggers include:
- Serious physical trauma or injury
- Virus or infection
- Major operation
- Emotional trauma
- Diet
- Other conditions including rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis
Symptoms of fibromyalgia
There are many symptoms of fibromyalgia. The most common ones include:
- Widespread pain – This pain can be felt more intense in some parts of the body and can also wax and wane. Muscle pain is the hallmark symptom of fibromyalgia.
- Extreme sensitivity to pain (hyperalgesia) – For example, accidentally knocking your elbow in a wall would hurt longer and more intensely than it should. Also you might also have areas on your body that are very tender to the touch.
- Feeling pain from things that normally are not painful (allodynia) – For example, feeling pain from your cat rubbing against your leg
- Stiffness – This tends to occur after you’ve been in the same position for a long time, especially after getting out of bed in the morning.
- Fatigue – This can range from slightly tired to “I can’t get out of bed” tired. Also fatigue can come on very rapidly.
- Difficulty sleeping – Those with fibromyalgia can have difficulty falling asleep and achieving deep sleep. They also tend wake up more often during the night.
- Inability to concentrate – This is referred to as “fibro fog” which includes difficulty with memory or concentration.
- Headaches – These headaches can be mild or severe in nature.
- IBS – Irritable bowel syndrome is more common in people with fibromyalgia.
Things that might make your symptoms worse
Fibromyalgia has flare ups like may systemic diseases. There are certain common triggers that can cause flare ups. These include:
- Increased stress
- Temperature/weather changes
- Diet
- Too much physical activity
- Illness
Who do see if I suspect I have fibromyalgia?
First, you need a physician who understands fibromyalgia. Because there is no definitive cause or diagnostic test for fibromyalgia, some question whether it is a real condition. You should shop around until you find a physician that is knowledgeable about fibromyalgia and will listen to you. This might be a primary care physician or it might be a specialist. Typically rheumatologists have the most experience in treating and diagnosing fibromyalgia. However you might need a team of doctors and other healthcare providers to help manage your condition.
How can a physical therapist help?
A physical therapist should be a key member in the healthcare team for the management of fibromyalgia. There are many ways that a physical therapist can help. These include:
- Exercise plan – Exercise plays a key role in helping manage fibromyalgia. Light aerobic and resistance exercise is highly recommended to help manage fibromyalgia symptoms. It increases tolerance for activity with decreased pain and fatigue. Aerobic exercise is associated with improved mood, energy, and better sleep quality. Physical therapists are experts in exercise and movements of the body. A physical therapist can help prescribe an exercise program appropriate for the individual and help make adjustments to the program when needed.
- Manual therapy – There is some evidence that manual therapy helps decrease pain in individuals with fibromyalgia. This could include soft tissue mobilization, joint mobilizations, joint manipulations, as well as, other techniques.
- Activity management – Physical therapists can help those suffering from fibromyalgia figure how much physical activity they can do without causing increased pain and fatigue. Overdoing can cause a flare up and exacerbate symptoms. It is important to understand how to pace yourself, take rest breaks, and monitor how you are feeling.
Other important types of management
- Relaxation techniques – Since stress is one of the biggest causes of exacerbation of fibromyalgia, it is important to be able to control your stress. Massage, meditation, and gentle yoga classes can be beneficial.
- Talk therapy – A psychologist or mental health counselor can also play a key role in helping learn how to manage stress. Cognitive behavioral therapy has been shown to help decrease pain and improve sleep.
In review
- Fibromyalgia is a chronic, systemic disease. It causes tenderness, pain, and stiffness in the muscles and joints throughout the body.
- It is not well understood. There is no definitive cause or diagnostic test.
- Anyone can get fibromyalgia but it is more common in women and tends to present between the ages of 20-55.
- Find a physician that has experience in diagnosing and treating fibromyalgia.
- A physical therapist can help you develop an exercise plan to help manage your symptoms.
- Relaxation techniques and talk therapy are also key in decreasing pain and preventing flare ups.
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.choosept.com/guide/physical-therapy-guide-fibromyalgia
https://www.physio-pedia.com/Fibromyalgia
https://www.statpearls.com/articlelibrary/viewarticle/65391/