Thursday, September 29, 2011

Fibromyalgia and Pilates

This weekend, Saturday October 1, 2011, I will be the leadoff presenter at a workshop that deals with Pilates for Fibromyalgia Syndrome.  The workshop will first look at the background of Fibromyalgia (that is my part) and then focus on how Pilates can be an effective tool in the management of this chronic pain syndrome.  After my introduction, the heart of the workshop will be presented by Kathryn Russell and Marilyn Koval of Viva Pilates Studio. The workshop will be held at Body Arts and Sciences International (BASI) in Costa Mesa, California. 

Research has shown that Fibromyalgia is best managed through an inter-disciplinary approach focusing on exercise. The Pilates method, with its emphasis on breath, core strength and joint stability, is particularly successful for those suffering from Fibromyalgia. Due to potential physical limitations due to pain and stiffness, people with Fibromyalgia may need to exercise with special modifications and strategies necessary.

A full description of Fibromyalgia Syndrome would fill pages and pages but a brief summary of this disorder and its control follows:

When I first started in practice (way back in 1982) most doctors scoffed at Fibromyalgia and it was usually dismissed as a psychological condition rather than a physical, pain condition.  Gradually, it became more widely accepted as a true pain condition but there are still many physicians who still do not accept Fibromyalgia as a “real” condition.

Fibromyalgia is considered a syndrome rather than a disease.  A disease can usually be attributed to a specific problem where patients have consistent symptoms.  For example, a particular disease may have several classic, cardinal symptoms or abnormalities.  A diagnosis of the disease may be made if a patient has, for instance, three of five of these cardinal symptoms, signs or exam findings.   A syndrome, on the other hand, is a broader word (supposedly coming from the Greek, "run together") denoting a collection of signs or symptoms that tend to occur together, possibly but not necessarily disease related.  In the case of Fibromyalgia, there are many symptoms but some people suffer only from a few.  
The exact cause of Fibromyalgia is unknown however recent basic science and clinical investigation have led to its new classification as a central nervous system sensitivity syndrome, specifically a neurosensory disorder associated with abnormal pain processing. 
We know that females are more likely than males to have Fibromyalgia.  There may be a history of abuse or traumatic experiences during childhood (when the nervous system is still developing).  Fibromyalgia is more likely to develop in people under persistent stress.  Physical injury does not appear to cause Fibromyalgia.  
Once someone has Fibromyalgia it can interferes with daily life but it might not.  Some people work and live relatively normal lives. Others are disabled and quite ill.  Some people experience frequent  flu-like symptoms, depressed mood, fatigue, digestive problems, wide spread muscle and joint pain, cognitive difficulties (Fibro Fog) and poor sleep.  
One of the most frustrating things people with Fibromyalgia face is going from doctor to doctor, trying to figure out what is causing symptoms.  A family physician may assume the patient has suffered a muscle strain and recommend rest and ibuprofen. A psychiatrist might diagnosis an anxiety or depressive disorder and a gastroenterologist may diagnose irritable bowel syndrome. To make things more complicated, Fibromyalgia often occurs in illnesses characterized by systemic inflammation, such as rheumatoid arthritis (RA), Lupus and chronic hepatitis C infection. In fact, an important emerging consideration is what inflammation itself.  There is some evidence that inflammatory cytokines and C-Reactive Protein are elevated in Fibromyalgia.  
Except for painful tender points and maybe signs of being out of shape, there are no abnormal physical examination findings in people with Fibromyalgia. Pain and tenderness are usually felt at multiple points when pressure is applied but most people feel pain virtually everywhere. 
In my experience, persistent pain and stiffness along with a history or poor sleep (what is called non-restorative sleep) are the most common shared symptoms in people with this condition.  In adults, growth-hormone helps repair normal daily wear and tear but disturbed sleep impairs the production of growth hormone.  This may contribute to symptoms of Fibromyalgia. Often sufferers will report improved symptoms on days following a good night of sleep. interestingly, an anti-inflammatory substance, called Interlukin-10, may increase in Fibromyalgia during the night but it hinders sleep.  
A so-called anti-inflammatory diet may be helpful in promoting relief.  Some nutritional supplements can help (but there are no miracle pills to cure the problem).  Weight reduction may be needed as obesity is also associated with Fibromyalgia (and obesity is also associated with increased inflammation as well).  Low vitamin D levels are common in patients with chronic pain of various causes.  It may be an independent cause of pain but it is worth considering that low vitamin D levels are often associated with increased evidence of inflammation. I have treated patients who have improved dramatically over time with a reduction in pain by combining chiropractic treatment (which usually results in good but temporary relief) and vitamin D supplements. Increasing blood levels of vitamin D, whether by supplements or with sun exposure, does not always improve pain, however. 
Exercise is probably the most important tool in the management of Fibromyalgia. While it is best to avoid prolonged, overly strenuous physical exercise, especially in people who are severely out of shape once better conditioning is achieved, there are no blanket limitations on activity.  Each person with Fibromyalgia has to exercise or be coached in activities that suit his or her particular situation as it can change from day to day.
As the Pilates for Fibromyalgia workshop will emphasize, Pilates is an excellent form of exercise that can help manage this difficult problem.

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