Jill Murphy, DPT, LAT, CSCS
Fibromyalgia. I hear the fear and dread in my patients’ voices when they share this one of several diagnoses that has landed them in physical therapy yet again. These patients surrender this information accompanied by a hopeless shrug of the shoulders. It’s the burden of a death sentence that seems impossible to overcome and interruptive of every aspect of patients’ lives. It has made scores of patients give up in despair as they try to manage this overwhelming disease process on their own, since typically they are not sent to physical therapy until something else is also wrong and their life has become unmanageable.
What is fibromyalgia? It is simply a syndrome with a concrete set of symptoms that patients have, that when other diagnoses are ruled out, becomes the new problem label. While telltale signs of fibromyalgia are multiple tender points around the body, as well as disrupted sleep, these numerous symptoms tell me very little. Fibromyalgia is actually your nervous system running wild, wired too hot for your body to handle, ramping up pain sensations by amplifying pain signals once they reach the brain, and even changing non-painful sensations into painful ones.
When patients come in with a diagnosis of fibromyalgia, what tells me far more than the diagnosis is to figure out just how hot your nervous system is. How much neural tension is present? Is it in the head and neck and creating daily headaches? It is present in the thoracic spine, and was it precipitated all along by a long history of low back pain? Does the pain extend into one or both legs as well? The more areas affected with daily pain and symptoms, and the more sleep and function that is lost, the hotter the nervous system tends to be and the more amplified the signals of the sympathetic nervous system are in your central nervous system.
It didn’t start out this way. Typically fibromyalgia starts with an insult or trauma to the nervous system somewhere, although sometimes a poor immune system, surgery, or a long illness can trigger it. Genetics also may play a role. Sometimes it comes on for no apparent reason. Frequently it starts as untreated or poorly treated low back pain, that then extends to the hip, and then down the leg. Next it moves up into the thoracic spine, whether or not pain is present, the neural tension and spine hypomobility is typically present. Finally the upper thoracic spine, neck, and headaches with or without TMJ involvement become involved. This can work the opposite way as well, starting in the head and neck and moving down into the back and lower extremities. The particular starting point is of little consequence, since the result of a reduced play now available in the nervous system is now present regardless of symptom origin. Less play and more stress in the nervous system along with the presence of chronic pain increases neural tension, which is the tension that each peripheral nerve and the central nervous system (the brain and the spinal cord) feel with day to day movements of the body. Every time you bend over, your spinal cord must lengthen. Punt a football, and you will create a large stretch on your spinal cord and your sciatic nerve distribution. Perform a backhand in tennis, and you will have lengthened your peripheral nerves in your arm. Look down to text and you have lengthened the upper portion of your spinal cord all the way down to the low back. Having chronic pain and increased neural tension comes hand in hand with anyone with a fibro diagnosis.
By now, no doubt the muscles are very tight in 2 or 4 of the extremities, and exercise only increases the dead limb feeling. Fibro can make people feel ill, nauseous, heavy, and/or just not right; it is difficult to describe the weighed down feeling a hyperactive nervous system can bring. Sleep becomes very difficult, because the hyperactive nervous system boosting adrenaline at night can keep the mind and body active throughout the night, and the pain can make patients feel very fatigued during the day. This leads to the fibro fog many patients describe from pure fatigue and constant pain. Patients are encouraged to perform more activity and exercise, but are frustrated by the flares this can bring.
What can be done once fibro is present? What is the best approach to address all of the symptoms and issues that come with it? Can physical therapy help, and how? I will address a successful, comprehensive approach to fibromyalgia that I tailor to each individual patient to help each person address their symptoms, their pain, and their nervous system to face the challenge of fibro head-on, and gain control over their fibro and life again in next month’s newsletter. Remember that fibro does not come on overnight, and the approach is not as easy as a snap of the fingers. But hope is ahead…