Ruby counts herself as one of the 2-4% of the world’s population diagnosed with fibromyalgia syndrome (FMS). Many of the people she knows think the diagnosis is absolute tosh; but fibromyalgia is the third most common diagnosis in the rheumatism family, making a stealthy finish tucked behind osteoarthritis and rheumatoid arthritis. Like almost half of all people with FMS, Ruby is beyond blue; she is frankly depressed. She can’t fall or stay sleep, she feels like her joints won’t budge every morning and is often so weary that her work suffers. Her family believe she is lazy, her workmates think she is crazy and she no longer knows where to turn.
Treatment Options for FMS
Fibromyalgia was given its current name in 1976, but the syndrome has been described clinically since the 1800s, if not before (some historians think that Florence Nightingale suffered from FMS during the Crimean War). From the beginning, it has always been a tough nut to crack within the rehabilitation profession. The medical focus has been on providing education on strategies for coping, sleep tools, nutritional counseling, energy conservation and stress management. But what about good old-fashioned hard work? Both resistance training and aerobic conditioning have shown promise for the FMS patient. Although aerobic forms of exercise have been explored more within the literature than resistance exercises, both modes of exercise offer almost unlimited potential for the management of fibromyalgia. A deconditioned state does nothing if it does not promote a continuous cycle of pain, immobility, fatigue and depression.
Considerations When Designing Exercise Programs for FMS
Helping patients with fibromyalgia keep active is one of the most useful ways to manage their symptoms. When designing a program for individuals with FMS, it is useful to first consider some of the more common issues that arise with this population.
For the patient with FMS, fatigue, like pain, is a constant concern. Individuals who act as weekend warriors and give “their all” during therapy may end up unable to participate in daily life post-exercise.
Depression and Social Isolation
Fibromyalgia has a huge impact on social interaction and mood. Individualised sessions of one to one therapy may not address the root of this concern: the need for peers who understand and can commiserate with each other. Consider enrolling patients in group classes instead of one to one therapy; this is especially useful if the group class has a strong social component.
Need for Predictability
Individuals with FMS can become dependent on ritualised behaviors to the extent of presenting with anxiety when these rituals are disturbed. Therapists who routinely add novelty to treatment sessions may engender a sense of quiet desperation in patients who simply long for a reliable level of training intensity.
Hypersensitivity to Pain
Patients with FMS often present with strong pain sensitivities and they may over-react to the sensory overload present during exercise sessions.
Patients with FMS need to exercise and they need to do so consistently. Aquatic exercise in warm water is often suggested as the perfect solution for this population. Because an aquatic environment makes it possible for individuals to move easily without being bombarded with pain, patients may be willing to move in ways they would never (and should never) attempt on land.
With exercise, a cycle of movement freedom can be birthed and then reared into something sustainable. It is possible to manage FMS. It just takes time and a willingness to keep on keeping on.
Andrea Salzman, MS, PT graduated from the University of Alabama at Birmingham with a Master’s degree in physical therapy in 1992. Over the last two decades, she has held numerous prominent leadership roles in the physical therapy field, with a heavy emphasis on academic writing and administrative functions. Between 1995 and 1998, Salzman served as the Editor-in-Chief of an American Physical Therapy Association (APTA) journal. In 2010, Salzman received one of the highest honors given to a physical therapist from the American Physical Therapy Association, the Judy Cirullo Leadership Award. Between 2012 and the present, Salzman has written 12 physical therapy courses for Care2Learn, Relias Learning and reviewed over 100 other course offerings. Currently, Salzman continues in her writing, leadership and administrative roles at Aquatic Therapy University and 10K Health.