Fibromyalgia

So let’s get started with the exercise aspect of this article, there are many types of exercise that can be used, from aerobic, to resistance training, through aquatics and stretches. Each one of those types of exercise has so many sub-types and examples or methods, so finding the correct way might be challenging, but the variety of options means it’s possible.

As with any new client starting their way with exercise, there should be a well built and calculated procedure to make sure that it’s not too hard for them so they would not drop out as soon as we start, and when it comes to FM patients, we also want to make sure that we do not trigger the symptoms and send them home in a worse condition than the one they had before.

Walking, running, cycling, stair climbing and so on, all these can be great if the physical condition allows it. As the saying goes, better safe than sorry, it’s recommended to start of easy and build progress up. If the FM patient is not physically active, a short walk to start the process would be enough, always track the feeling, as a short walk for some is around the neighborhood,

and for others might be to the car and back. A more physically active patient might prefer running, or cycling, as long as they are capable to do it, it’s fine. There are no rules for distance or pace, but there must be some sort of screening done prior to the activity so that the intensity would not exceed the ability of the client and trigger FM symptoms.

Body weight, band resistance, external weight training. Name it as you’d like, as long as we have muscle strengthening, it is great. Why is it so beneficial? Stronger muscles means a patient with FM would require less muscle activation over time in order to perform the same activity. Less muscle activation required would mean a more efficient movement,

and a more efficient movement, drops the risk of experiencing FM symptoms. However, and it is very important, just like with any strength training method, if you over reach and use too much resistance, the patient would experience musculoskeletal pain, with a FM patient, this pain is far more extreme and can be a huge step back with the process.

While there is no straight forward evidence that aquatic exercise is more beneficial than land exercise, at least not any evidence I was able to find, some studies show better results with more severe cases of FM when inspecting aquatic exercise. One of the prime reasons, I think would make the aquatic exercise better for severe cases is the weight reduction, standing for instance would be easier in water when compare to standing on the ground, so the muscles and joints would have less to carry.

Another reason I believe would make aquatics better is the supporting effect of the water, every movement is being supported, so the whole structure of the joints engaging can focus mainly on the motion and less on stabilizing it. I’ve noticed from my experience that helping a joint maintain a certain position is more than enough in order to reduce movement pain, and so the water can have a very large impact doing a similar effect.

I hope we can agree, that if any of these cause a reduction with FM symptoms, a correct and well thought combination of them might show better results. So how should we decide which of these do we want to engage in? It’s not actually ours to decide, it’s patient dependent. Let’s be clear, when you feel tired most of the times, your body is aching, and you hardly sleep, you might not wish to engage in every activity. Understandable.

Find something that the FM patient likes more than other things, this way you help with creating some passion and excitement, instead of immediate rejection. It is more than OK to tell your patient if they need to go and do the process with a different professional colleague if the patient prefers cycling and you are not certified for that, or if your patient would prefer aquatics but you are a master of land exercise. Client well-being should always come first, and you would be much more appreciated by them if you refer them to the relevant professional so they would feel better over time. 

Before moving on to manual therapy, I would like to remind you the importance of the mind when training. Most FM patients are afraid of performing any type of activity, they would prefer to remain with little to no movement at all, maintaining a pain threshold they are familiar with, rather than engaging with an unknown activity that might cause them pain.

Is there a promised way to relieve them of the pain? No. Can we try different methods in order to reduce their pain? Absolutely YES! A successful program would help with building confidence in FM patients, the confidence to move and be active in their daily life without the fear of flaring FM symptoms.