Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue, and sleep disturbances. The word fibromyalgia comes from the Latin term for fibrous tissue (fibro) and the Greek ones for muscle (myo) and pain (algia). Tender points are specific places on the body on the neck, shoulders, back, hips and upper and lower extremities where people with fibromyalgia feel pain in response to slight pressure.
Although fibromyalgia is often considered an arthritis-related condition, it is not truly a form of arthritis (a disease of the joints) because it does not cause inflammation or damage to the joints, muscles or other tissues. Like arthritis, however, fibromyalgia can cause significant pain and fatigue, and it can interfere with a person’s ability to carry on daily activities. Also like arthritis, fibromyalgia is considered a rheumatic condition. In addition to pain and fatigue, fibromyalgia patients can experience headache, morning stiffness, restless legs syndrome (RLS) and numbness or tingling of the extremities.
The causes of fibromyalgia are unknown, but there are probably a number of factors involved. Many doctors associate fibromyalgia with a physically or emotionally stressful or traumatic event, such as a fall, car accident or repetitive injury. It is also believed that people with rheumatoid arthritis have a higher risk in developing fibromyalgia. For others, fibromyalgia seems to be spontaneous.
Although pain and fatigue may make exercise and daily activities difficult, it’s crucial to be as physically active as possible. Research has repeatedly shown that regular exercise is one of the most effective treatments for fibromyalgia. People who have too much pain or fatigue to do vigorous exercise should begin with walking or other gentle exercise and build their endurance and intensity slowly. Although research has focused largely on the benefits of aerobic and flexibility exercises, a new supported study is examining the effects of adding strength training to the traditionally prescribed with aerobic and flexibility exercises. Having the knowledge of treating fibromyalgia is a great opportunity for any fitness professional since more than 10 millions Americans have this illness.
When training someone who has fibromyalgia, there are many components to be considered. When developing an efficient program, the order and progression of each area is the most important variable. The easiest way to create an effective program is to break the program down into three areas: cardio, stretching/flexibility and strength.
This is the first aspect to any training program. We all know that cardiovascular training is important, and that goes double for clients who have fibromyalgia. The better someone’s aerobic capacity, the greater his blood flow and Vo2 max will become, not to mention increased metabolic rate, increased energy levels and reduced stress. They will all lead to more relaxed muscles and thus lessen the chance of injury or pain. Along with the rest of these benefits, a good cardiovascular will stimulate the nervous system as well help burn calories and control your client's weight.
Every cardio program needs to have a baseline. After you establish a baseline, then slowly progress the program to ensure your client does not adapt or plateau.
Depending on the strength and ability of your client, the equipment and time will change. Good equipment to use is the treadmill, arc trainer and bike (using cardio that focuses mainly on the legs). The length of each workout will change gradually, but starting out, you want to keep the time at five to 15 minutes with a heart rate of 65 to 80 percent of your client's max heart rate. As your client's ability increases and his pain lessens, you need to add to the intensity to avoid plateau.
There are many benefits to stretching such as pain relief, increased flexibility, increased energy levels, stress relief and relaxation, just to name a few. A regular stretching program can help lengthen muscles and make daily activities easier and more enjoyable. Chronically tight muscles contribute to poor posture, which in turn can affect energy levels, not to mention appearance. Stretching also improves circulation of blood to the joints and muscles, which will increase the ability of the body to carry nutrients to the cells, increase the rate of recovery form injury and remove toxins and waste byproducts. Stretching may also help prevent injury, by preparing muscles and joints for activity and movement, especially if muscles are tight.
Here is a list of stretches that should to be added to any fibromyalgia program. Each stretch should be held for at least 25 to 35 seconds, and the force applied depends on your client’s flexibility and pain threshold.
PLEASE NOTE: All of the below stretches and exercises are designed for fibromyalgia patients. Since fibromyalgia can be located on either the lower or upper body, the program is designed to work the entire body to both increase strengthen and flexibility to achieve the greatest benefit.
Standing Pectoral Stretch
- Have your client stand against a wall and form a 90/90-degree angle with his arms. Make sure his elbow does not fall below the angle of his shoulder.
- He should slowly lean forward, leading with his chest.
- Have your client place his feet shoulder width apart and grab an unmovable object.
- He should bend his knees and lean back. The more he leans back, the greater the stretch.
- Have your client stand in a staggered stance (one leg slightly in front of the other) near a wall, doorway or large stationary object.
- His feet need to be flat and the back leg straight. Then have him lean forward, leading with the torso.
Due to potential injury, these stretches should only be performed by a professional (i.e., personal trainer, physical therapist, etc).
- Have your client lie supine and form a 90/90 degree angle with his shoulder and elbow with palms down.
- Make sure his elbow is hanging off the table.
- Place one hand on his shoulder, and the other on his wrist.
- Slowly press the wrist down rotating the shoulder internally.
- Have your client lie supine and form a 90/90 degree angle with his shoulder and elbow with palms up.
- Make sure his elbow is hanging off the table.
- Place one hand on his shoulder and the other on his wrist.
- Slowly press the wrist down, rotating the shoulder externally.
Spinal Transversal Rotation
(Client must be cleared of any spinal pathology.)
- Have your client lie supine with his arms straight out to the side, with one leg bent about 90 degrees and the other leg straight.
- Place one hand on your client’s shoulder, and place your other hand on your client’s bent knee.
- Press the knee down and across, causing the spine to do a transversal rotation.
Over-the-Shoulder Triceps Stretch
- Have your client sit comfortably on the table.
- Stand behind your client and take one of your client’s arms by the wrist and extend it over his head.
- Bend his elbow and place your other hand on his triceps, just below his elbow and push, causing a deep stretch extending from the shoulder through the triceps to the elbow.
*All of these exercises need/should be performed on a table.
Before you start a strength program, you must wait until your client’s pain has lessened due to his on-going cardio and stretching programs, in order to avoid more pain or injury. Strength training can be very dangerous in any level of fitness, but when someone suffers from fibromyalgia, that risk is greatly increased. Fibromyalgia patients cannot progress as quickly and should be allow more time to increase weight, repetitions and sets.
Strength training is one of the most important aspects to any program. Improving strength will help correct posture, which will relieve stress and some minor to major aches and pain. It will also help to increase energy levels, and best of all, it will stimulate mood. As stated before, strength training is a very important part of the program with many benefits.
When starting out, it is important to check and correct the client's posture, if necessary. In most cases, clients have bad posture due to overactive anterior muscles, and lengthened posterior muscles. Regardless of where they are overactive, you must strengthen the antagonist muscles. Examples are shown below.
- Stand as you would as if you wore performing a bent-over row.
- Arms should be hanging straight down, rotate the hands outward with thumbs pointed away from midline.
- With a slight bend in the arms, perform a shoulder abduction, contracting the muscles between the scapula (i.e., rhomboids).
- Perform a squat and place a ball between the client’s thighs, right above the knee.
- You may have the client perform this movement without assistance, but it would be smart to start this movement with the help of a Swiss ball.
This is a technique used to alleviate fascial tissue. As fascial tissue becomes tight and inflamed, it can lead to dysfunction throughout the body including poor circulation, poor posture, chronic aching, fatigue and pain. Myofasical release creates a heating effect that melts muscle adhesions, restoring muscle back to a healthy state.
The benefits of myofascial release are very important to any program, especially your fibromyalgia program. As the muscles become healthier, your client will experience increased joint range of motion, flexibility and decreased pain. Also, as the muscles become rejuvenated, blood, oxygen and vital nutrients are allowed back into the muscles, which will produce healthier and stronger muscles.
- Tightness in the calves can cause poor posture and other minor to serve problems.
- Have the client lay prone on a table, relaxed and comfortable.
- Place a towel or rolled mat under the client’s ankles to help avoid pain in the knee.
- Start at the bottom of the calve and roll toward the knee. Always roll towards the heart never away.
- The back is the primary area for stress and fibromyalgia.
- Have the client lay prone on a table, relaxed and comfortable.
- Start from the top of the hip and roll upward.
- Stay to one side of the spine, making sure not to roll directly on the spine.
In order for you to help alleviate some of your client’s pains caused by fibromyalgia, it will take commitment towards a gradual workout regime consisting of cardio, stretching and strength training.
Fibromyalgia is not a disease but a syndrome that can and will affect daily life. People with fibromyalgia may experience some limitations, and it is our duty as fitness professionals to educate ourselves on this condition so we can help them live fuller, healthier lives.
- American College of Sports Medicine web site. “Fibromyalgia.” http://www.acsm.org
- Black-Brown, C. “Fibromyalgia – Exercise Prescription.” http://www.PTontheNET.com 23 Mar 2000
- National Fibromyalgia Association.“What is Fibromyalgia?” http://www.fmaware.org
- National Institute of Arthritis and Musculoskeletal and Skin Diseases; National Institutes of Health, Department of Health and Human Services, “Health Information Fibromyalgia” June 2004
- Thaxton, Jeff “Fibromyalgia and Exercise” http://www.PTontheNET.com 15 Sep 2006
- Webmd web site. http://www.webmd.com/fibromyalgia