Physical Therapies

Q. What happens when people with FMS do not exercise?

A. People with fibromyalgia (FMS) often will say that before their illness, they were active, mobile and energetic. But with FMS, their pain makes many activities difficult, if not impossible to do. This leads to the “pain cycle” of avoidance, deconditioning, tightness and, in the end, more pain.

Q. How can a physical therapist help me?
A. A physical therapist (PT) will ask you to share your personal goals and ask you how FMS affects your life. Together, you and your PT can design a program that meets your needs. A PT can teach you how to move with comfort instead of pain. He or she will help you work toward a new, realistic fitness level. Although it may differ from the fitness level you had before FMS, it will be better for you overall. A PT can also help you slowly and safely increase your flexibility and muscle tone. He or she can develop an exercise plan that will stabilize and gently strengthen your muscles so you will have less pain. 

Myofascial release is another tool that is often helpful for people with FMS. Many PTs have special training in myofascial release that can help reduce pain and discomfort. Physical therapists who specialize in edema (swelling) reduction or lymphatic drainage may be helpful in achieving more comfort, less pain and improved function. There is no one answer for all patients which is why you should seek a therapist with years of experience in treating chronic pain conditions. To find a therapist who specializes in myofascial release, edema reduction or lymphatic drainage, search the American Physical Therapy Association's directory.

Q. How do you know your physical therapist specializes in pain medicine?
A. Usually a health care provider who specializes in treating FMS has a team that includes a physical therapist. If your health care provider does not know of a PT who regularly treats FMS or chronic pain patients, you may need to find a PT specializing in chronic pain on your own. Go to your local phone book or search on the Internet and make a list of private PT clinics near you. Call each clinic and request an interview. See a list of questions that you can print out and use during interviews.
 
If you have regularly followed a PT training plan for a while and do not feel that you are getting better, consider changing therapists. There is a vast difference between therapists based on age, interests, setting and training. Choose a therapist who can both inspire and guide you toward well-being and healing. Make sure that you are working with a therapist who understands chronic pain. If the clinic is full of sports medicine patients training for marathons, you may not be in the best setting for your needs.

Q. How can I begin the right training program for me? 
A. Work with your PT to develop a training program to follow during therapy sessions and at home. Your therapist will know how to adjust your program around pain flare-ups and as your FMS symptoms change from day-to-day.  A PT knows how to plan shorter, more frequent programs or plan rest periods during training exercises, if needed.
At the beginning of your exercise program, you may feel like your FMS symptoms are getting worse. Epsom salt baths, ice or heat packs may help during this period to decrease inflammation. Avoid over-training, as too much exercise can make FMS symptoms worse and can be very discouraging.

The success (or failure) of your training program depends on you. A training program can only help if you do your exercises regularly as directed.

Q. How can aerobic exercise help a person with FMS?
A. “Aerobic” means any form of exercise that increases your heart rate for a prolonged period of time. “Light” aerobic exercise is one of the best forms of exercise for a person with FMS. It brings oxygen and nutrition to your muscles for healing. It can also help rebuild the stamina and energy that you lost from being less active. Doing regular workouts of light to medium intensity can greatly decrease your FMS symptoms and improve your quality of life.

Q. What types of aerobic exercise are best for me?
A. Non-impact and low-impact exercises put the least amount of stress on your knees and other joints. Good choices for aerobic exercise include 

• Walking (outside, indoor track or treadmill)
• Biking (outside or on an exercise bike)
• Aquatic therapy, which includes swimming or water aerobics in a heated swimming pool
• Elliptical trainer

Q.What kinds of strengthening can I do, and how will it help?
A. The best strengthening exercises are those that cause you to practice “mind-body” awareness (self-awareness). When you concentrate on breathing and how your body feels during exercise, you are less likely to “over-do” it and make your condition worse. Some exercises and movements that strengthen muscles and promote self-awareness are listed below.

• T’ai Chi helps improve balance and control.
• Feldenkrais helps improve power, coordination and reversibility.
• Pilates helps improve core stability and breathing.
• Light weights done slowly and precisely can help improve muscle tone and joint stability.

Q. How long and how often should I exercise?
A. Experts recommend 20 to 30 minutes of non-stop aerobic exercise as a long-term goal. To safely work up to a brisk 20 or 30 minutes, start out with two to five minutes at your own comfortable pace. Your pace should be fast enough to create a small increase in your heart rate and to challenge your heart and lungs. Ask your health care provider or physical therapist to help you understand what your target heart rate should be when you exercise.

Experts also encourage a one to two minute “warm-up” and “cool-down” on both ends of the aerobic exercise.  This simply means to start out at a slow pace to warm-up your body before speeding up to your brisk pace and then slow down at the end to cool your body down.  Increase the aerobic portion (the two to five minutes) by one minute every week.  It will take you a long time to reach the 20 to 30 minute goal, but this is a very safe progression.  Do aerobic exercise four to five times per week to get the best results.

Q. How can stretching exercises help me?
A. The impact of stretching is best described by modifying an old adage: “If you don’t use it, you’ll lose it…if you don’t loosen it well!” Stretching exercises can increase your flexibility. Stretching during workouts may also help you to tolerate training more easily. Stretching throughout the day may help decrease stiffness and tightness, especially on days when you are sitting a lot. However, although flexibility helps loosen tight muscles and makes daily activities easier to do, it only offers short-term relief. For example, stretching exercises may increase your flexibility today, but tomorrow your muscles may be stiff and tight again.

Q. What is posture training and why is it so important for a person with FMS?
A. Many people with FMS already have very flexible joints, yet they feel a need to constantly stretch. While stretching offers short-term flexibility, posture training can give you longer lasting pain relief than stretching muscles around already flexible joints. Posture provides support to the skeleton so that your bones are stacked in a natural anatomical position. Good posture removes the type of stress on bones and joints that can lead to tight muscles.

Posture training should focus on your posture throughout a 24-hour period. Posture awareness over a 24- hour day can be divided into three 8-hour periods (based on the schedule of an average person). Look at the chart below and think about times of the day that you have the most pain. Pick the appropriate column and ask yourself those questions. Once you pinpoint your problem areas, you can find some practical, and in some cases, easy solutions that can increase your comfort and decrease pain.

Using the right posture to sit, stand, walk, bend and lift promotes coordinated muscle use. It can help prevent any one muscle group from being overworked. Practicing good posture can help you feel less tired at the end of the day.

Q. What is resistance training? 
A. Resistance training is a form of strength training. It requires your body to push against a force or to remain in place while a force is applied. Examples of resistance training are aquatic therapy, Pilates, light weights and elastic band therapy. Aquatic therapy, such as water aerobics, uses the force of water to create resistance against your arms and legs as you move. The faster you try to move, the more force you will have to work against. The resistance of the water helps strengthen your muscles, while the buoyancy keeps stress off your joints. Only a small amount of research has been done on the benefit of resistance training for people with FMS.

Q. What other forms of physical therapy are used to treat FMS?

 

• Electrotherapy: This type of therapy sends tiny, safe amounts of electrical current to the muscles and nerves. It can help increase blood flow. It can also decrease pain to the area where it is applied by scrambling or blocking pain messages from going to the brain. Examples of electrotherapy include TENS, electro-acupuncture and iontophoresis. Interferential electrotherapy may be used in combination with ultrasound to go deeper into your muscles and nerves to relieve more pain.

• Ultrasound: This therapy has been used to treat a number of short-term and long-term musculoskeletal disorders. Ultrasound uses sound waves to help relieve pain, but it is not used alone as a treatment for FMS.

• Laser therapy: This is also called low light laser therapy (LLLT).This therapy uses a beam of light to relieve pain. Some experts believe that laser therapy is very helpful in treating chronic pain conditions like FMS; while other experts do not agree. The US Food and Drug Administration (FDA) has approved the use of laser therapy for treatment of carpal tunnel syndrome. More research is needed on laser therapy for FMS and other conditions.

The Feldenkrais Method

The Feldenkrais method is a type of bodywork that uses gentle movements to promote personal awareness of the body, increase flexibility and improve coordination. One of the key philosophies of the Feldenkrais method is that there is no separation between the mind and body and that, as the body strengthens and gains new forms of movement, the mind will also strengthen and improve.

Unlike manipulative physical therapies such as massage or Rolfing, Feldenkrais practitioners generally view the work as a way to expand one’s knowledge of self and promote the connection between the mind and the body. Classes – called “Awareness through Movement” – focus on teaching small, precise movements that can be beneficial to people of all fitness levels and abilities. One-on-one Feldenkrais is called “Functional Integration.” Many people find the experience relaxing and helpful.

For more information, please see our full article on the Feldenkrais Method or visit www.feldenkrais.com.