Fibromyalgia Part III: The Role of Physical Therapy in Managing Fibromyalgia

FibroThe past two articles on fibromyalgia reviewed the signs and symptoms of this phenomenon, as well as the need for a multi-faceted treatment approach. In the last article we reviewed the everyday ways we can affect the central nervous system, as well as medications that can help calm down the hypersensitive nervous system. In this article, we will discuss the way we can reduce CNS hyper-sensitivity by interacting with the peripheral nervous system.

The peripheral nervous system is the part of our nervous system that communicates from the brain and spinal cord to the muscles, joints, and ligaments. There are both motor and sensory components to each peripheral nerve, as well as local nerves that communicate things like temperature, pain, pressure, and even tickle to the spinal cord, where receptors determine if the information is important enough to make its way to the brain and register an actual perception.

To start, the nervous system is not the bad guy in fibromyalgia. Its job is incredibly important to human survival. If we did not feel pain, temperature, and sensations like touch, we would burn ourselves on a hot stove, touch sharp objects and cut ourselves, and miss out on the most important sensations of feeling your newborn’s pudgy baby cheek right next to yours. People born without pain sensations and other alterations of a hyposensitive nervous system have serious problems traversing daily life safely.

So while we need this system, what do we do when the nervous system is too wound up? Review our last article for some very important ways to directly impact the central nervous system. There are also very important ways to affect the peripheral nervous system, and this system is what we directly impact when you attend physical therapy and experience manual physical therapy.

Manual TherapyManual therapy to your sore muscles like soft tissue mobilization can reduce the tone in local areas, reduce local tissue waste, and relieves the tension and heavy feeling patients with fibromyalgia experience in their limbs. Joint mobilization, muscle energy techniques, and other approaches to improve the motion at the small facet joints in your spine help relieve tension where the nerve root exits the spinal cord, freeing the area of mechanical and/or chemical irritation that can occur when there is inadequate space present for a nerve to exist in its normal state. Excess tightness in the thoracic spine region especially is a common irritant for the vagus nerve, which can cause a variety of problems including altering heart rate variability. Tension in this area of the spine also contributes to migraines and tension headaches. So addressing this area to improve the mobility of the joints of the spine can help relieve pain, symptoms, and decrease neural tension and the overall unwell flu-like symptoms and/or chest pain you may be experiencing.

Exercises prescribed to floss or mobilize the nerve within its sheath is another way to directly impact each peripheral nerve by reducing adhesions that occur with abnormal nerve function, adverse tension, and nerve irritation. Other exercises prescribed by a physical therapist to stretch tense muscles and joints send signals to the central nervous system that induce relaxation of the local muscle fibers, reduce excess nerve flow, and promote general relaxation and reduced tone to the muscle even after the stretch is complete. Improved muscle and tendon extensibility is extremely important in patients with fibromyalgia who are avid exercisers and weekend warriors, since this extra tight muscle holding can directly lead to muscle tears, strains, and tendon tears such as the Achilles tendon, resulting in major surgery. Even upper extremity ailments such as carpal tunnel syndrome, lateral epicondylitis or tennis elbow, and medial epicondylitis or golfer’s elbow are frequently found in patients with fibro who perform repetitive tasks involving their upper extremities since all of their muscles have excess tone. For these patients especially, physical therapy to address all of the problems related to fibro is of utmost importance before any surgery is considered, due to the high risk of fibro flare after surgery.

While the items listed above are a very important reason to participate in physical therapy if you have fibromyalgia, one of the most important reasons is to have someone on your side who understands your symptoms, your pain, your sleep challenges, your fears, and can help you address them head-on. A physical therapist who specializes in the treatment of fibromyalgia plays the role of coach, encouraging and challenging you to set attainable goals and then to follow through until you reach them. As evidenced by the hundreds of research articles in recent years on the syndrome, fibromyalgia is one of the most challenging diagnoses physical therapists treat. So don’t go it alone, because you think no one is available who understands and can help guide you on the path to true quality of life. Take charge and control of your life with proactive steps designed specifically to you by your physical therapist.