Fibromyalgia: A Physio's View on the Root Cause and a New Path Forward
Before we begin, a quick disclaimer. The information in this article draws from my clinical experience as a Physiotherapist actively working to solve the fibromyalgia puzzle. I sincerely hope it offers a new, helpful perspective for those suffering. Please keep an open mind—there's something important here to discuss.
Fibromyalgia is a chronic pain condition affecting an estimated 2-4% of the population, or 6 to 12 million Americans. Staggeringly, about 70% remain undiagnosed. It's a hidden struggle, often with no visible signs, which can make the journey isolating and misunderstood.
From my work in the clinic, I've come to see fibromyalgia not as a mystery, but as a condition with a logical, albeit complex, root cause. This article will explore that perspective and provide a practical action plan that goes beyond standard medication-focused care.
Key Takeaways: A New Perspective on Fibromyalgia
- It's Not "In Your Head": Fibromyalgia is a very real physical condition rooted in a sensitised nervous system.
- The Central Role of the Nervous System: The pain is a consequence of a chronically heightened "fight or flight" state, amplifying normal sensations into pain.
- A Two-Pronged Approach is Key: Effective management requires addressing both musculoskeletal stiffness/weakness and calming the nervous system.
- You Can Influence Your System: Techniques like deep breathing and cold exposure can actively down-regulate a heightened nervous system.
Understanding Fibromyalgia: The Statistics and Symptoms
Who is affected?
- ~85% of those diagnosed are women.
- Most prevalent in the 40-59 age group.
- Depression and anxiety are associated with over one-third of patients.
- Life stressors like divorce, obesity, and smoking are linked with higher rates.
Common symptoms include:
- Widespread muscular pain and tenderness
- Debilitating fatigue
- Sleep disturbances
- Cognitive dysfunction ("Fibro Fog")
- Anxiety and depression
The Current Medical Model: Gaps and Challenges
Frustratingly, the cause of fibromyalgia remains elusive in mainstream medicine. Diagnosis is a process of exclusion, often taking an average of five years. This delay, coupled with a lack of visible symptoms, can lead to patients feeling invalidated.
Physio Insight: It's Not "All In Your Head"
Telling a patient their symptoms aren't real highlights a flaw in the system. Fibromyalgia may not show up on a scan, but the pain is 100% real. It's a failure of empathy and science to dismiss what we cannot yet easily measure.
Treatment is often dominated by pharmaceuticals like Pregabalin (Lyrica), Duloxetine (Cymbalta), and Milnacipran (Savella). While these can help manage symptoms, they often foster a culture of "management" over "recovery," accompanied by potential side effects.
A Clinical Perspective: The Two Root Issues of Fibromyalgia
From treating patients, I believe fibromyalgia can be broken down into two interconnected root causes.
1. Underlying Musculoskeletal Dysfunction
The tender points associated with fibromyalgia are often the same vulnerable areas (glutes, neck, shoulders) that bother people without the condition. The difference is in the volume of the pain signal.
In someone without fibromyalgia, poking a tight glute muscle might be a 3/10 on the pain scale. For someone with fibromyalgia, the same pressure can feel like a 9/10, or the pain may be present without any touch at all. This is where the nervous system comes in.
2. A Chronically Heightened Nervous System
This is, in my clinical opinion, the most important part of the equation. To understand why, we need a modern understanding of pain.
What Is Pain, Really?
Thanks to pain scientists like Professor Lorimer Moseley, we now know pain is not a direct signal from damaged tissue. Instead, pain is your brain's interpretation of threat. It's a protective output based on the context.
If your nervous system is already in a heightened state, its perception of threat is skewed, and it can amplify normal or mild sensations into significant pain.
The Modern Stress Response: Always "On"
Our autonomic nervous system (ANS) has two main parts:
- Sympathetic Nervous System (SNS): The "Fight or Flight" system, designed for short-term threats.
- Parasympathetic Nervous System (PNS): The "Rest and Digest" system, which brings us back to baseline.
In our modern world, the SNS is constantly activated by chronic stressors: financial pressure, work deadlines, relationship issues, and past trauma. There's often no endpoint, no chance for the PNS to switch on.
The Result: A nervous system that resembles a dog barking constantly at the front door, never able to relax. This chronically sensitized state lowers the pain threshold, turning everyday aches into debilitating pain.
Example: Think of how frustrating it is to get stuck behind a slow car when you're late. Now, imagine if you weren't late—the same car wouldn't bother you. The car isn't the problem; your pre-existing stressed state is. For fibromyalgia, the "slow car" is a stiff joint or a tight muscle, and the "lateness" is a perpetually heightened nervous system.
A New Treatment Framework: 5 Strategies to Calm the System and Restore Function
Based on this understanding, here is the two-pronged approach I use with my patients, focusing on what we can influence.
Strategy 1: Optimise Musculoskeletal Function
The goal is to give a sensitized nervous system as little to react to as possible. This means building a resilient, well-functioning body.
a) Build Foundational Strength: Focus on areas weakened by modern life:
- Gluteals
- Core and Trunk
- Scapular Stabilizers
b) Improve Key Mobility: Target areas prone to stiffness:
- Ankles
- Hips
- Thoracic Spine (Mid-Back)
Strategy 2: Down-Regulate the Nervous System with Deep Breathing
This is your most powerful tool. The body links slow, deep breathing with a state of safety. We can use this to consciously calm the SNS.
Technique: Box Breathing
Breathe in for 4 seconds → Hold for 4 seconds → Breathe out for 4 seconds → Hold for 4 seconds. Repeat.
Commitment is key: Don't judge this by immediate pain relief. The goal is to consistently practice creating a calmer baseline state. Do this daily for 5-15 minutes.
Strategy 3: Use Cold Exposure to Build Resilience
While many with fibromyalgia are sensitive to cold, it can be a powerful tool for "resetting" the nervous system when introduced gradually.
How to start safely:
- Finish your regular warm shower by turning the temperature to cool (not cold) for the final 15-30 seconds.
- Focus on maintaining deep, calm breaths.
- Gradually increase the coldness and duration over weeks and months.
Strategy 4: Incorporate Gentle Somatic Practices
These techniques provide direct feedback to the nervous system that it is safe.
- Gentle Massage: Using a lacrosse or tennis ball to gently press into tight tissue.
- Vagus Nerve Stimulation: Techniques like Jill Miller's "Gut Smash" can directly stimulate the parasympathetic system.
Strategy 5: Leverage Foundational Health
Never underestimate the basics.
- Get Sunlight and Nature Exposure: Time in nature has a proven calming effect on the nervous system.
- Prioritise Sleep: Poor sleep dramatically lowers pain thresholds.
- Move Consistently: Gentle exercise like walking provides mental and physical benefits without over-stressing the system.
Frequently Asked Questions About Fibromyalgia
Is fibromyalgia a progressive disease?
No, it is not considered progressive. Symptoms can flare up and go into remission, but the condition itself does not progressively damage tissues or organs.
Is there a cure for fibromyalgia?
There is no official "cure." However, the perspective outlined here suggests that by systematically addressing the underlying nervous system dysregulation and musculoskeletal issues, many can find significant, lasting relief and improved quality of life.
Does exercise help or hurt fibromyalgia?
Exercise is profoundly helpful, but the type and dose are critical. Gentle, graded exercise like walking, swimming, or light strength training can build resilience and improve mood. The key is to start slowly and avoid pushing into a pain flare.
Should I see a chiropractor or a Physiotherapist for fibromyalgia?
As a Physio, I'm biased, but I believe Physiotherapy is the better fit. While a chiropractor may offer short-term pain relief, fibromyalgia requires a comprehensive approach to retrain the nervous system and build lasting strength and mobility—the core focus of physiotherapy.
Conclusion: A Path Forward Based on Function, Not Just Feelings
Fibromyalgia is a multi-faceted condition, but it is not a life sentence of mysterious pain. By understanding it as a state of nervous system sensitization, we open the door to logical, active strategies.
The path forward involves a dual commitment: to build a strong, mobile body that gives your system little to complain about, and to diligently practice techniques that teach your nervous system it can finally stand down from its constant state of alert.
This isn't just theory; it's what I see working in the clinic. It requires patience and consistency, but it offers a sense of control and a genuine path toward reducing pain and reclaiming your life.
- Grant
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