Don’t Give Fibromyalgia the Upper Hand!

Upping Your Exercise Routine

As we know, previous studies have found short-term benefits of exercise for FM. But many of us fail to keep up with exercise programs out of fear that it will worsen pain.

According to a new study, for those who are able, exercising once or twice more weekly (that is: more than you are already doing) may alleviate some of the symptoms.

hydrobicsPatients received individualized exercise prescriptions and completed baseline and follow-up physical activity assessments, to evaluate the relationship between long-term maintenance of moderate-vigorous physical activity (MVPA) and clinical outcomes in FM. MVPA (in this study) was considered to be an increase 10 or more metabolic equivalent hours per week above usual activities  Outcomes included improvements in overall well-being, pain severity ratings, and depression.

“This study shows that if they’re able to stay with the exercise program in the long term it actually is helpful to them,” said Matteson, chair of the department of rheumatology at the Mayo Clinic in Rochester, Minnesota.

Although sustained physical activity was not associated with greater clinical benefit compared to unsustained physical activity, these findings also suggest that performing greater volumes of physical activity is not associated with worsening pain in FM. Future research is needed to determine the relationship between sustained MVPA participation and subsequent improvement in patient outcomes.

“One of the best known therapeutic activities for fibromyalgia patients is exercise,” said Anthony Kaleth, who specializes in exercise testing at Indiana University – Purdue University Indianapolis. “Our study confirmed that result.”

physical-activity_240Any increase in activity, whether or not it was maintained, resulted in positive changes in symptoms and no increased pain, according to the findings in Arthritis Care and Research.

If they had followed the participants for a longer period of time, they might have seen more benefits for people who maintained the program, Kaleth said.

Most people use a combination of medications, including pain relievers, antidepressants and anti-seizure drugs to alleviate fibromyalgia symptoms. Doctors also recommend keeping active with walking, swimming or water aerobics, but many patients are reluctant to start exercising.

“They’re more worried that it’s going to be painful, but that’s more of a psychological effect,” Kaleth said.

physical_activity_web(1)Starting off too vigorously before building up endurance can be painful for anyone, with or without fibromyalgia, Dr. Eric Matteson, chair of the department of rheumatology at the Mayo Clinic in Rochester, Minnesota, said.

“This is a stepping stone I think in terms of the actual result that we found,” Kaleth said.

No Life Without Water

Ever since I discovered the wonders of my warm water class, I have gone on and on and on  about the wonders of water.

OLYMPUS DIGITAL CAMERALike all water exercises, water walking is easy on the joints. “The water’s buoyancy supports the body’s weight, which reduces stress on the joints and minimizes pain,” says Vennie Jones, aquatic coordinator for the Baylor Tom Landry Fitness Center in Dallas. “And it’s still a great workout. Water provides 12 times the resistance of air, so as you walk, you’re really strengthening and building muscle.” You do not bear weight while swimming and walking, however, so you’ll still need to add some bone-building workouts to your routine.

You can walk in either the shallow end of the pool or the deep end, using a flotation belt. The deeper the water, the more strenuous your workout. And it can be done in warm or cold water.

chris rock

Junction,_TX,_swimming_pool_IMG_4344What you need: A pool! That’s it – but for deep-water walking, a flotation belt keeps you upright and floating at about shoulder height.

How it works: You’ll stand about waist- to chest-deep in water, unless you’re deep-water walking. You walk through the water the same way you would on the ground. Try walking backward and sideways to tone other muscles.

Try it:  Stand upright, with shoulders back, chest lifted and arms bent slightly at your sides. Slowly stride forward, placing your whole foot on the bottom of the pool (instead of just your tiptoes), with your heel coming down first, then the ball of your foot. Avoid straining your back by keeping your core (stomach and back) muscles engaged as you walk.

water-walkingAdd intensity: Lifting your knees higher helps boost your workout. You also can do interval training – pumping arms and legs faster for a brief period, then returning to your normal pace, repeating the process several times.

Find a class: If you’re new to water exercises, an instructor can make sure your form is correct, says Jones. Plus, it can be fun to walk with others. To find a class near you, call your local YMCA, fitness centre or Arthritis Foundation office.

Don’t forget the water: You still need to drink water – even while exercising in the pool.

 

 

Good Vibrations

Vibration can help reduce some types of pain, including pain from FM, by more than 40 per cent, according to a new study published online in the European Journal of Pain.


When high-frequency vibrations from an instrument were applied to painful areas, pain signals may have been prevented from travelling to the central nervous system, explains Roland Staud, MD, professor of rheumatology and clinical immunology in the University of Florida College of Medicine in Gainesville.

If you think of a pain impulse having to travel through a gate to cause discomfort, the vibrations are closing that gate. “When the gate is open, you feel the pain from the stimulus. It goes to the spinal cord. When you apply vibration you close the gate partially,” says Dr Staud. You can still feel some pain, but less than you would have felt without the vibrations, he adds.

Subjects were split into 3 groups: 29 had FM, 19 had chronic neck and back pain and 28 didn’t have any pain at all. Dr Staud and his research team applied about five seconds of heat to introduce pain to each participant’s arms and followed that with five seconds of vibrations from an electric instrument that emits high-frequency vibrations that are absorbed by skin and deep tissue.

A biothesiometer

A biothesiometer

Dr Staud used a biothesiometer, an electric vibrator (not THAT kind of vibrator – get your mind out of the gutter!) with a plastic foot plate that can be brought into contact with the patient’s skin.

Compact TENS

Compact TENS

Similarly, you could buy/borrow a Transcutaneous Electrical Nerve Stimulator (TENS), which is a medical device, designed specifically for the purpose of assisting in the treatment and management of chronic and acute pain; and it does exactly what Dr Staud is suggesting. I am currently borrowing a compact TENS machine. The pulse rate is adjustable from 1-200 Hz.

Following the use of heat and vibration, patients were asked to rate the intensity of their pain on a 0-to-10 scale and found that the experimental pain, as opposed to their chronic pain, was reduced by more than 40 per cent with the use of vibration. What was of particular interest was that the patients in the study with FM appeared to have the same mechanisms in their body to block or inhibit pain through the use of vibration as those in the pain-free group.

“Fibromyalgia patients are often said to have insufficient pain mechanisms, which means they can’t regulate their pain as well as regular individuals. This study showed that in comparison to normal controls, they could control their pain as well,” Dr Staud explains.

What they don’t know is how long the pain relieving effects will last.

I used the TENS on my arms two days ago and the pain has not returned (yet! Knock on wood!) If I choose to buy it, it will cost me $175.00 from www.tensaustralia.com.au

Dr Howard, a rheumatologist and director of Arthritis Health in Scottsdale, Ariz., says this study is still very interesting. “Vibration is another way of minimizing pain, and it sounded like it would be more helpful for regional or local pain rather than widespread pain,” he says.

Dr Staud says this theory is still very much in the testing stages and the vibrating instrument used in this study isn’t available to the public. “Although we didn’t test it, I think that the size of the foot plate of the biothesiometer is relevant. I wouldn’t suggest that everybody should go out and by any vibrator to use for pain relief. But pending a commercial product this is entirely feasible,” he explains.

Until then, Dr Staud’s message for patients is that vibration involves touch, and that can provide pain relief.

Dr Howard agrees that this study reinforces the importance of touch therapy, like massage, and even movement therapy, like gentle exercise, for people with chronic pain.

“When you have pain, you want to stop what you’re doing and protect the area. But for some types of pain that’s not the right thing to do,” Dr Howard says.

You do, however, need to know what types of pain touch is good for and for which ones it isn’t. Dr Howard says his general rule is to baby your joints and bully your muscles.

“Fibromyalgia patients often shrink away from touch therapy and movement. The foundation of treatment is to use movement and touch and stimulus to help with their pain, but their natural reaction is to withdraw and avoid tactile activity. Don’t be afraid. Don’t avoid it,” Dr Howard says.

Good forms of touch therapy include massage and the use of temperature – both hot and cold. Good forms of movement therapy include tai chi, yoga and swimming/warm water exercising.