Before we discuss Fibromyalgia, I want to start things off with a quick disclaimer.
The information in this article draws from my clinical experience as a Physiotherapist. It's what I've come to understand actively trying to solve the Fibromyalgia puzzle for my patients.
I sincerely hope this article can give those suffering from Fibromyalgia an important new perspective to consider. There's something really important here to discuss so for those unaware - please keep an open mind.
Fibromyalgia is a chronic musculoskeletal pain condition. Unfortunately, it's as common as it is poorly understood.
Characterized by widespread pain, tenderness, and fatigue, Fibromyalgia is estimated to affect between 2 and 4 percent of the American population. That's approximately six to 12 million people.
Staggeringly, it's estimated that 70% of people with Fibromyalgia are yet to be diagnosed.
From what I've come to understand clinically, Fibromyalgia is often a hidden struggle. Most don't have many if any, observable symptoms. No arm in plaster or bruising to show for it.
Don't get me wrong, there are often many legitimate symptoms associated with Fibromyalgia, but little can be seen from the outside. So the natural support and understanding that comes with many other physical issues aren't often there for Fibro sufferers.
Like most chronic pain conditions, Fibromyalgia can not only be a long and painful journey but also an isolated one.
- Approximately 85% of those with Fibromyalgia are women
- Most prevalent in 40-49 and 50-59 age groups
- Depression and Anxiety associated with over one-third of Fibromyalgia patients
- Separated or divorced linked with higher rates of Fibromyalgia
- Obesity, smoking, and lacking a college education also linked with higher rates of Fibromyalgia
It can be an extensive list, but here are some common symptoms associated with Fibromyalgia:
- Persistent muscular pain and tenderness
- Symptoms present over a number of different areas
- Trouble sleeping
- Brain 'fog' - also known as Fibro Fog
- Poor mental health including depression and anxiety
Frustratingly, we don't have a strong understanding of what causes Fibromyalgia.
We are beginning to understand the brain and nervous system's role in pain perception and sensitization. But collectively we're just not there yet, to the detriment of those with Fibromyalgia.
Through my work, I have come to some strong conclusions as to its cause. But we'll get to this soon enough.
Fibromyalgia Risk Factors
The medical industry has found strong links to the following:
- Gender (Female)
- Rheumatoid Arthritis
Other potential risk factors:
- Illness (Viral infections)
- Family History
- Significant Stress
Unfortunately, our ability to effectively and efficiently diagnose Fibromyalgia also needs work.
It's complicated by a lack of reliable testing and classic symptoms shared by other conditions. Similarly, those with Fibromyalgia may also have other conditions at the same time.
As a result, it's often a process of exclusion.
The American College of Rheumatology (2010) agreed upon three criteria for a diagnosis of Fibromyalgia:
- The severity of pain and symptoms (of 19 designated body parts) over the past week, fatigue, poor sleep, and cognitive dysfunction
- Consistent symptoms lasting at least three months
- No other conditions to explain symptoms
Staggeringly, the American Chronic Pain Association suggests that it can take an average of five years to receive an accurate diagnosis of Fibromyalgia.
Because of issues like this Fibromyalgia can often be an emotional rollercoaster. It can be tough for anyone seeking help and wanting to have their feelings validated.
It's Not "All In Your Head"
This also needs to be said.
Nothing highlights the flaws of the medical system more than telling someone their symptoms don't exist.
More so when it's used to explain why we don't have the appropriate answers.
I can appreciate that Fibromyalgia may not have the same physically scannable symptoms as other issues. But this lacks all kinds of empathy and perspective - things vital for such an intensely personal struggle.
It's not good enough.
This won't come as a surprise but there's currently little in the way of a "cure" for Fibromyalgia.
Like many chronic pain disorders, we don't yet understand this issue enough to find people a way out. As a consequence there (unfortunately) aren't too many people who used to have Fibromyalgia.
As it stands, the modern-day treatment of Fibro is dominated by drugs.
A Doctor's visit may result in a smorgasbord of pain relievers, muscle relaxants, anti-depressants, and anti-seizure medications. All for good reason of course. But this often fosters a culture of management rather than supporting your quest to find the finish line. Not to mention the array of side effects you may also have to put up with.
In the States, there are currently three FDA-approved drugs for Fibromyalgia:
- Pregabalin (Lyrica)
- Duloxetine (Cymbalta)
- Milnacipran (Savella)
Beyond medication, there's often a focus on the following:
- General Exercise
- Strength and Conditioning
- Good Sleep Habits
But despite these options, it often feels like we're missing something important. I mean, we pretty much have to be, right? Otherwise, we should have this figured out for our patients by now.
So with all this in mind, I think we are doing our best but, as harsh as this sounds, ultimately falling short. As a consequence, those with Fibromyalgia are often left feeling frustrated, unsupported and still looking for answers. All things that can contribute to making their condition worse.
And this is where I'd like to try and help. Clinically there seem to be some tangible factors influencing the onset and persistence of Fibromyalgia. If we can get on top of these factors, perhaps things will become clearer.
What I've Come To Understand Clinically
From my work as a Physiotherapist, it seems Fibromyalgia can be broken down into two root issues.
As mentioned above, Fibromyalgia is classically associated with a number of persistent aches and pains throughout the body.
Interestingly, each individual area is not necessarily Fibro-specific. These tender areas are often the same vulnerable spots those without Fibromyalgia experience. It's just that those with Fibromyalgia have a more sensitized and persistent experience.
For example, most modern humans will have some Gluteal tenderness when poked and prodded. Perhaps a three or four out of ten. Those with Fibro may not need to be touched to expose the tenderness, it'll just hurt regardless. And if you did press in that pain may range from a six to a twelve depending on the person.
This is where the nervous system comes into play.
The Nervous System
The nervous system's influence on Fibromyalgia should be considered the most important part of the equation - based on my clinical experience.
Most likely due to the fact that it is itself already chronically heightened and sensitized.
It's also hard to see and measure.
From my experience, this is why there remains confusion as to the cause, diagnosis, and effective treatment of Fibromyalgia.
Unfortunately, this is also why some people are made to feel like it's all in their head.
And to explain how this may link everything together, it's important to talk about the sensation of pain.
To understand pain is to get a strong sense of how Fibromyalgia may act, re-act and persist.
What Is Pain?
Traditionally, we've always thought of pain as "tissue-specific". We roll an ankle, injure the ligaments and the tissue gives us pain.
Interestingly, we now know this isn't the case.
Thanks to great thinkers like pain scientist, Professor Lorimer Moseley (author of Explain Pain), we are now able to look at pain differently.
Pain is not necessarily a signal from injured tissue to protect itself. Instead, pain is a consequence of your brain's interpretation of threat.
It's a powerfully protective assessment made on your behalf - depending on the circumstances.
And this brings us to an important point.
If you are surrounded by circumstances that are already stressful, what will that do to your overall pain experience?
Understanding Stress and the Fight or Flight Response
Stress is an interesting topic in today's modern world.
In a primal sense, stress initiates our "Fight or Flight" response. This automatic process is controlled by the Autonomic Nervous System (ANS). It best prepares us to fight for our lives or flee to safety.
That sudden rush of blood is unmistakable.
What's important to understand is the ANS is made up of two sub-systems. The Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS). The SNS gives you a sympathetic boost in human function. Whereas the PNS brings you back down again - among a host of other important bodily functions.
However, in today's modern world, our relationship with this stress response has morphed. The fleeting "life or death" moments still seen in the animal kingdom no longer dominate. It's now just life.
Who reading this has any of the following:
- Financial stress
- Work stress
- Relationship stress
- Family stress
- Past mental or physical trauma
- Current mental or physical trauma
- Body image stress
- Time stress
- Cultural stress
- Religious stress
- Peer pressure
Stress is often just there in the background. All... the... time.
Often without an endpoint.
As a consequence, it's very easy for the modern nervous system to be up all the time. It may be fighting the good fight against these stressors without the necessary respite.
Consider the life of a dog.
They're often asleep or at least taking it easy.
But what happens when there's a knock at the door? They'll most likely spring to life to deal with a potential threat. Most will run towards the door, some will run away. Both are valid survival strategies.
The person at the door will also have an appropriate response depending on how threatened they feel in return.
This is the work of the Sympathetic Nervous system.
Interestingly, how quickly does the dog fall back asleep again once the situation is diffused? It can almost seem instantaneous.
The SNS initiates the Fight or Flight response, but the PNS takes over once the perceived threat has ended.
Nowadays the modern nervous system is often chronically heightened. As a consequence, we resemble a dog continuously barking at the front door rather than sleeping peacefully.
These ideas may help explain individual differences in pain tolerance, pain threshold, and pain experience - especially with Fibromyalgia.
If we consider pain a neurological threat assessment, how catastrophic can things be if it's already heightened beforehand?
Consider this as well.
How frustrating is getting stuck behind a slow-moving car when you're running late?
But what if you weren't already running late?
The same slow-moving car may barely register if at all.
It's important to remember the slow-moving car isn't the problem. The already heightened state of the nervous system is.
In short, our brain and nervous system can feel chronically threatened before we've leaped out of bed in the morning. This can reduce our tolerance to imperfect situations and amplify the consequences throughout the day.
And this is what I've come to appreciate when treating people with Fibromyalgia.
Many of the symptoms associated with Fibro are the consequence of a nervous system chronically up for a fight.
This may explain why relatively common musculoskeletal aches and pains become amplified, especially if the stress is significant.
There are two modern stressors from the list above that stand apart from the rest.
Mental and physical trauma.
From what I see clinically, those with Fibromyalgia may share something deeply personal going on behind the scenes. Something beyond the daily stress of the modern world.
As nasty as this is, I'm talking about the heavy, important things. Mental, physical, or sexual abuse, broken family relationships, severe loss, cultural shifts, etc.
I'm no mental health expert, but these significant life events seem to leave an indelible mark. They certainly speak to a significant level of stress the nervous system has to persistently respond to.
Again, the nervous system may already have a significantly elevated baseline of activity thanks to these events.
So with all this in mind, our ability to unravel Fibromyalgia may depend on a few things. We need to understand why someone's nervous system has become heightened. We may also need to pair this with techniques that promote a more Parasympathetic state.
Fibromyalgia Suggested Treatments
Based on everything we've just discussed, here is what I've been trying to achieve with my patients, beyond just the pharmaceuticals and standard care.
1. Set The Conditions For Good Musculoskeletal Function
Again this is no different from what most without Fibromyalgia requires, but it still means the following:
We want good strength and mobility, but also the practice of good movement mechanics, postures, and positions.
Your body needs to function better so that a heightened, sensitized nervous system has little to heighten and sensitize.
This will differ for each person so it's important to get some specific guidance from a trusted health professional.
If you're looking for some general guidance, consider the following:
Overall strength is crucial, but we want you to be strong in the right areas. Areas that support normal human function.
Thanks to the modern world these areas are prone to weakening.
- Pelvic Floor
Most people will benefit from a general strength program. But save valuable time and energy by having a program tailored to you in person.
Much like weakness, it's rare to find someone today who isn't stiff and tight somewhere.
These areas are prone to stiffness and tightness for various reasons:
- Ankle Joints
- Thoracic Spine
- Upper Neck
Related: For the best way to mobilize your tissue, check out my take on why Power Bands should replace traditional stretching.
Little is more important when discussing the maintenance of basic human function, strength, and mobility than practicing good postures, shapes, and positions.
The sedentary nature of our modern world can wreak havoc if we aren't paying attention long-term.
It's not quite as simple as just sitting up straight, but it's not a bad place to start either. The added strength and mobility from above will certainly help.
Take away as many unnecessary reasons for your musculoskeletal aches and pains as possible.
2. Down-Regulate a Chronically Heightened Nervous System
Thankfully, this is an area of strong focus in modern science.
We are now working with simple techniques to consciously regulate the nervous system. A feat long thought impossible.
And those with Fibromyalgia may be some of the biggest beneficiaries of these really simple ideas.
The body associates certain breathing patterns with different physiological states.
With this in mind, we can utilize these breathing patterns to prompt changes in our nervous system.
It's an idea no different from taking a few deep breaths when you're nervous. Or even many controlled breaths when giving birth.
From what I find clinically, we can use deep breathing to gradually down-regulate a chronically heightened nervous system.
One such technique is Box Breathing.
Box Breathing is as simple as it is effective. Deliberately slow and deep nasal breaths can prompt the body to down-regulate. Potentially in a matter of minutes.
Clinically, these effects are still apparent for those with Fibromyalgia. However, it requires a long-term commitment if we are to chronically de-sensitize a chronically sensitized state.
Because of this, you can't judge the effectiveness of Box Breathing by whether your symptoms are immediately better.
The goal here is to feel like you're consistently creating a calmer and more relaxed state. You want to feel like you're establishing a better baseline over time.
Cold showers and ice baths are another technique to consider.
While it's understandably a less-than-enticing option, its neurological benefits outweigh any initial trepidation.
The cold is a simple way to 'reset' your nervous system and help you out of a heightened state.
It's worth noting that many with Fibromyalgia find the cold a trigger for their symptoms.
This may sound strange but please don't rule it out immediately. To most, the cold can act as just another threat to the system - causing a heightened reaction. But it doesn't have to.
Instead of jumping straight into a completely cold shower, consider easing into it (as per the image above).
Start with your usual warm shower and drop the temperature a little at the end. Only go to a level where you can still calmly deep breathe - and then come back again tomorrow. Eventually, you'll be able to tolerate an entirely cold shower but take your time getting there.
Alternatively, try a few cycles of deep breathing to down-regulate your nervous system beforehand. Make it less reactive initially so that you are less likely to trigger your symptoms.
Don't unnecessarily threaten your nervous system, give it a chance to acclimate.
Remember, exposure to the cold is normal. At the end of the day, this is an exercise in de-sensitizing a chronically sensitized system. Aim to experience the cold trigger-free eventually.
Make this a part of your daily routine to see the best results.
Aside from deep breathing and cold showers, consider these other basic options to soothe your nervous system.
- A general massage that respects your comfort zone
- A simple heat pack for painful areas
- Let a lacrosse ball, baseball or tennis ball gently press into your tight and tender tissue
- Get some sunshine
- Get out into nature
Alternatively, consider trying Jill Miller's brilliantly effective "Gut Smash" technique. This exercise biases the Vagus Nerve which forms an integral part of all things PNS. Anything similar to her Coregeous ball works a treat.
Where To Go From Here
Fibromyalgia is a delicate issue.
A lack of clear understanding may contribute to an already tough mental and physical condition.
From what I'm finding, Fibromyalgia may be the consequence of a nervous system that's been up for years.
One covertly deals with intense regular and/or sinister stressors behind the scenes.
This may intensely sensitize otherwise simple musculoskeletal areas. Those are always at the mercy of poor postures, shapes, and mechanics.
As a result, the path through Fibromyalgia may be lined with basic techniques geared towards down-regulation.
This may need to happen to some degree before any musculoskeletal symptoms can settle.
Drugs aren't my area of expertise but they clearly still have a place. They may offer more short-term support while we address the deeper musculoskeletal and neurological issues.
Frequently Asked Fibromyalgia Questions
Hopefully, you can appreciate it most certainly is. Unfortunately, one challenge facing so many with Fibromyalgia is that most symptoms can't be seen. This question inevitably comes up because human beings don't easily accept things we can't see or feel ourselves. If you have been diagnosed with Fibro please take some solace in the fact that you aren't going crazy. Similarly, if you know someone with the condition do them a favor and refrain from ever asking this question. Questioning its legitimacy can really invalidate how they feel - something that may only contribute to the severity of their symptoms long-term.
Thankfully Fibromyalgia is not a progressive condition. It comes with many mental and physical challenges but all are considered relatively stable. The symptoms associated with Fibro can dramatically increase (flare-up) and regress (remission) but generally from a steady baseline.
As it stands there are three drugs approved by the FDA for use in treating Fibro. Pregabalin (Lyrica), Duloxetine (Cymbalta) and Milnacipran (Savella) are those drugs. There is some evidence to suggest that medical marijuana may also help with both THC and CDB providing benefits. When discussing pain and pain medication it's always worth remembering the role the brain and nervous play in any outcome. Treating the symptoms is important, but working hard on restoring some normality to the chronically heightened nervous system is the priority long-term.
At this stage, there is no official cure for Fibromyalgia. From my experience, this may be because we are yet to fully understand the depth of the condition. As mentioned in this article, a cure may involve treating the musculoskeletal dysfunction associated with Fibro but also de-sensitizing a chronically sensitized system. We may also need to better understand the role of inflammation and the gut in this equation before we can truly solve this puzzle.
Fibromyalgia itself is not suspected to be hereditary. However, the deeper nervous system sensitivity that underlines it may be. Furthermore, the many cultural, religious, and social pressures - which may contribute to a heightened nervous system, are often passed down through generations. Nothing is guaranteed in terms of an eventual diagnosis but the predisposing factors may be hereditary nonetheless.
Many who suffer from Fibromyalgia also deal with Depression as well. It is believed that one does not cause the other but both are potential symptoms of deeper inflammatory and neurological states. For this reason, Fibromyalgia is often linked to (or confused with) chronic fatigue syndrome. As a consequence, treatment of these issues should focus just as much on influencing these deeper states as treating the obvious symptoms.
Exercise has a wonderful ability to help those with Fibromyalgia. It has many mental and physical benefits but also provides an opportunity to get outside with friends and family, engage with nature and get some sunshine and fresh air - basic things that also positively influence the health and function of the body.
While not considered life-threatening, Fibromyalgia is certainly quality of life-threatening. The severity of symptoms can vary for everyone however it is common for those with Fibromyalgia to feel affected in some way by their mental and physical symptoms.
I'm obviously a little biased here, but I can't see a reason why you would need to see a Chiropractor for Fibromyalgia. If you do see a Chiropractor and feel like they help provide you with short-term relief, then by all means continue to see them - as long as you feel it's a worthwhile use of your time and money. However, please don't expect an adjustment to have the power to solve a complicated nervous system issue.
Fibromyalgia is ultimately a multi-faceted, deep-seated, chronic condition.
We may never be able to hit a home run with Fibro. But my clinical results suggest I'm at least swinging in the right ballpark.
Hopefully, these ideas can make sense of a tricky condition for many. This may not be news to some long-sufferers of Fibromyalgia, but hopefully, there's some useful information regardless.
You most definitely shouldn't take the word of some random Australian Physio on the internet, but keep an open mind.
All of this is free and safe to do, so test it for yourself and go from there.
From what I see day-to-day, there's something important here.
Please let me know how you go. I'm genuinely interested.
I want to keep evolving my thinking so I can get the best results for my patients.
I'm all ears.
Best of luck!