Fibromyalgia is a chronic pain disorder that affects many individuals. While little is known about the exact pathophysiology or who may be affected, we do know that simple self care can have a huge impact on the intensity, severity, and management of pain. Especially from a movement perspective, there is a lot that can be done.

Fibromyalgia is a widespread experience of pain in the body. This is pain that isn’t localized and can often be debilitating. Fibromyalgia is more likely as we age and occurs much more frequently in women than men. Beyond that, doctors believe that there is a difference in how the brain senses and processes pain. Many individuals who suffer with fibromyalgia also deal with TMJ or headaches as well as fatigue and sleep disturbances.

Movement and exercise is actually the most studied and recommended coping tool for fibromyalgia. Unfortunately, too many of these individuals have been given boiler plate exercise scripts by doctors or trainers and are unable to manage their unique challenges. Exercise creates stress on the body, and oftentimes pain, that must be mitigated. Too much even one time can cause a fibromyalgia flare.

Fibromyalgia pain does tend to come in flare ups, as many chronic conditions do. However, these flares tend to last for months at a time, and as mentioned are extremely widespread, affecting many areas of the body. The feelings of pain are unique to each individual and it’s important to have an idea of what the experience is before making exercise recommendations.

The pain flares cause a spiral of fatigue and sleep issues, which further dampens recovery and can continue spiraling into mental and emotional distress. Managing these concerns also becomes challenging, but again, exercise plays an important role for both. Exercise creates the need for rest and recovery, which can lead to deeper more restorative sleep. Exercise has also been repeatedly shown to have positive effects on mental health.

Balancing the experience of pain and burden of fatigue for individuals who are dealing with fibromyalgia is the key factor in making exercise and movement work. You have to know when to push a bit and when to pull back. You also have to be very mindful of the upper limit. Even with other chronic conditions, the advice is usually to try and push the upper limit a bit, that isn’t the case with fibromyalgia.

When there is no flare, encouraging exercise as a way to build the body back up is great. The typical advice around increasing overload (be it aerobic or strength) is around 10% per week. For an individual with fibromyalgia, that may be both too much and too fast. Baby steps are the way forward here. Even increases as small as 2% every other week are beneficial, especially if that pace does not trigger a flare up.

During relatively pain free times, any exercise that is tolerated is okay. Although research suggests that low intensity aerobic exercise (like walking, biking, or swimming) is usually tolerated best. I always suggest some sort of strength training during less painful times. Building the muscles up will allow them to endure pain easier during the next flare cycle and gives a better base to work from in case of atrophy. While I don’t always love strength machines, this a group that I wholeheartedly believe benefits from them as they support the body in ways free weight exercises don’t. Resistance bands are also a good bet, especially if there is anxiety around the gym.

During flare periods, the goal is to keep the body moving gently as letting it stagnate may cause mobility issues that can further the pain and fatigue. The best recommendations during these times are low level aerobic exercise for smaller chunks of time. Someone might be able to walk for 30 minutes when pain free, but only 5 when flaring. This is another group where anything is better than nothing. Encourage multiple bouts during different times of the day to help manage fatigue, but again, be mindful that pain sucks.

I’m also a big fan of mind-body type exercises during flares. The more meditative nature of these types of movements helps manage fatigue and stress, which in turn will help with sleep disturbances. Additionally, yoga, Tai-chi, and Pilates allow for the motions or poses to be tweaked for ability much easier. Again, one day a bit of standing yoga might feel okay and the next, it might need to be all mat work. These types of exercises also allow props for help stabilize the body and encourage range of motion work, again preserving mobility.

As with any chronic condition, the person dealing with it knows their body and triggers best. While this isn’t strictly related to exercise, it is important. Most individuals who deal with fibromyalgia have had their symptoms invalidated or brushed off at least once. It is up to us as trainers and coaches to believe them and bring their knowledge into our exercise prescriptions so it works for them.

Until next time, move well friends!

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