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Update on Fibromyalgia and Exercise


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.

Cardio Training

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.

Stretching/Flexibility

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.

Unassisted

Standing Pectoral Stretch

Lat Stretch

Gastrocnemius Stretch

Assisted*

Due to potential injury, these stretches should only be performed by a professional (i.e., personal trainer, physical therapist, etc).

Internal Rotation 

External Rotation

Spinal Transversal Rotation

(Client must be cleared of any spinal pathology.)

Over-the-Shoulder Triceps Stretch

*All of these exercises need/should be performed on a table.

Strength Training

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.  

Scap Activation

Ball Squats

Myofascial Release

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.

Calves

Thoracic-Lumbar

Conclusion

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.

References:

  1. American College of Sports Medicine web site. “Fibromyalgia.” http://www.acsm.org
  2. Black-Brown, C. “Fibromyalgia – Exercise Prescription.” http://www.PTontheNET.com 23 Mar 2000
  3. National Fibromyalgia Association.“What is Fibromyalgia?” http://www.fmaware.org
  4. National Institute of Arthritis and Musculoskeletal and Skin Diseases; National Institutes of Health, Department of Health and Human Services, “Health Information Fibromyalgia” June 2004
  5. Thaxton, Jeff “Fibromyalgia and Exercise” http://www.PTontheNET.com 15 Sep 2006
  6. Webmd web site. http://www.webmd.com/fibromyalgia