Fibromyalgia is a clinical condition of unknown etiology characterized by chronic generalized body pain associated with fatigue and psychological distress. It typically presents in young to middle aged women and can result in sleep disturbance and significant impairment in activities of daily living.
While medical therapy for fibromyalgia exists and may to a limited extent be beneficial in managing pain, physical therapy plays a major role in treatment and rehabilitation. The aim of physical therapy is aimed at deconditioning and muscle weakness. There are different modalities of physical therapy aimed at treating different aspects of fibromyalgia.
1. Cadiovascular Fitness Training
Patients suffering from fibromyalgia are generally inactive and often become physically inactive over time. Exercise has shown benefits in long term management of fibromyalgia, with studies even showing an improvement in pain. In recent years, exercise remains one of the most commonly recommended treatments.
Exercises are ideally low impact and could include Tai Chi, water exercise, and Qi Gong. Water based exercises seem to offer a small degree of advantage over exercises performed on land, but sometimes are not as convenient to perform. Based on patient function prior to initiating therapy, exercise programs can be tailored to the patient specifically.
2. Physical Therapy
Treatment is aimed at increasing overall muscle strength, and is aimed at reducing muscle weakness. Common advice and treatment may include:
- Avoid muscle overloading- ie lifting heavy weights
- Correcting body alignment
- Muscle conditioning and stretching
- Encouraging general activity
3. Muscle Massage
While this provides both psychological and physical relief to some extent, there is no strong evidence that it is useful as an individual treatment modality; rather it is better used in combination with other therapies.
Randomized controlled trials have shown that acupuncture can provide significant improvement in pain reduction and a reduced perception of pain. However its long term benefits have not been adequately studied, and there is no clear guidance on how often treatment should be administered. It may be more beneficial as an adjunct therapy.
5. Transcutaneous Electrical Nerve Stimulation (TENS)
TENS is an electrical based pain reliever. It is more useful for localized pain, and hence its use for fibromyalgia may be limited. However it is an easy therapy that the patient can self administer at home.
Exercise and physical therapy are mainstay treatment options for fibromyalgia. Treatment options need to be tailored to the individual. With optimal therapy, patients can experience a significant improvement in symptoms.