How Physical Therapy Can Help with Fibromyalgia

There are between 4 million and 10 million people suffering with fibromyalgia (Fibro) in the US. Some studies say there are 3 million new cases a year. 75-90% are women, usually diagnosed between the ages of 20-50. People with fibromyalgia are twice as likely to be hospitalized, have a lower quality of life, and are 3x more likely to suffer from depression. There are higher death rates from suicide and injury and higher rates of other rheumatic conditions.
 
But what is fibromyalgia? To be exact, we really don’t know. Historically, fibromyalgia has been a diagnosis of exclusion. All other possibilities were ruled out, and if one didn’t fit, you were diagnosed with Fibro. As our understanding improved, we were able to pinpoint some similarities in patients. Typically, sleep was affected, and pain was widespread (all 4 quadrants of the body). In the ‘90’s, we were using a palpation method as part of the diagnosis for Fibro. There were 9 pairs of points throughout the body that were compressed with a finger. If one was painful, that would be positive. To receive the Fibro diagnosis, you would have to test positive in 11 of the 18 points. We don’t use this test anymore and are back to diagnosis by exclusion. Blood tests are performed to rule out other conditions that could lead to Fibro-like symptoms. Pain scores are administered, and history reviewed. There may be some promise for a blood test called the FM/a test, but studies are still ongoing.
 
Common symptoms of Fibromyalgia include widespread pain, brain fog (commonly referred to as FibroFog), fatigue, lethargy, sleep problems, digestive problems, heat intolerance, and feeling depressed. The most prescribed treatment for Fibro is exercise. Unfortunately for many Fibro sufferers, when they exercise, they are often wiped out for several days. Clinically, we find that people with Fibro can do things, but have no reserve, so their ability to recover is poor.
 
So how can PT help with fibromyalgia?  A customized approach is the only way to treat fibromyalgia. Often this is based on the severity of the symptoms. PT is one of the members of a needed team. In order to get better, we need proper nutrition. You can eat something, but that doesn’t mean you absorb it. We find people with Fibro are often deficient or in the low normal range for magnesium. Gut health is paramount to good nutrition so you can absorb the nutrients you need.
 
In order to move, you need to feel better. Typically, we will work with you through various manual techniques to try to reduce your pain symptoms. We have a variety of approaches we can use, including Primal Reflex Release Technique (PRRT), positional release (strain/counterstrain), soft tissue mobilization, joint mobilization, muscle activation, active release, and trigger point dry needling. As you start feeling better, we get you moving. Exercise starts as specific neuromuscular re-education. We try to retrain how your nervous system interacts with your skeletal system. This improves “functional strength”. As you progress from there, we can move into more traditional exercise, such as hypertrophy strengthening and cardiovascular conditioning. The key is the progression from pain relief to functional strength to traditional strength. In this pathway, we reduce the rebound effect of exercise and allow the body to adapt at it’s on pace to the new demands being placed on it.
 
Resources
Fibromyalgia Prevalence: est. 10 million people in the U.S. (fmaware.org)
Fibromyalgia | Arthritis | CDC

---

Written by PT Plus therapist and co-owner, Mark Snyder

---