Fibromyalgia Syndrome - Physiotherapy Treatment

Chronic Musculoskeletal Pain Syndromes with no specific organic cause of muscle pathology have become a diagnostic and therapeutic challenge to the general population and to the medical profession. Millions of dollars are being spent in carrying out different diagnostic and therapeutic approaches to this ill- defined entity. Numerous diagnostic labels have been applied to identify this condition such as fibrositis, fibromyositis, myofascitis, interstitial myofascitis, tension myositis, primary fibromyalgia syndrome etc.

Primary Fibromyalgia Syndrome has been diagnosed by the following criteria. The two main criteria for the diagnosis are:

1. Generalised aches and pains with or without stiffness in three anatomical sites for at least 3 months.

2. Absence of traumatic injury, rheumatic diseases, infectious arthropathies, endocrine related arthropathies and abnormal blood test results.

Other major criteria that may help for the diagnosis of Primary Fibromyalgia Syndrome are

1. Change in symptoms with activity.
2. Change in symptoms with weather.
3. Change in symptoms with Anxiety or Stress.
4. Sleep Disturbances.
5. Feeling of Generalised Fatigue.
6. Psychological problems like Anxiety or Depression.
7. Frequent intermittent headaches.
8. Irritable Bowel Syndrome.
9. Subjective Swelling.
10. Non radicular or Nondermatomal numbness.

Smythe and Moldofsky postulated five criteria, which correlate with the criteria which we have already discussed, for the diagnosis of Fibromyalgia Syndrome.

1. Widespread aching for more than 3 months.
2. Local tenderness at 12 or 14 specific sites.
3. Skin – rolling tenderness over the upper scapular regions.
4. Disturbed sleep with morning stiffness and a feeling of fatigue.
5. Normal Erythrocyte Sedimentation Rate (ESR), Serum Glutamic Oxaloacetic Transminase (SGOT), Rheumatic Factor Test Result, Antinuclear Factor Test Result.

Women are more likely to develop Fibromyalgia Syndrome than men. Thorough there is no specific treatment for Fibromyalgia Syndrome, the treatment is symptomatic. Physiotherapy helps to a great extent in relieving the symptoms. Physiotherapy treatment also induces confidence in the patients. It helps in rehabilitating the patients. 20%- 30% of patients with rheumatoid arthritis may have Fibromyalgia Syndrome.

1. Widespread Ache- Constant chronic dull ache for a minimum period of 3 months. Widespread usually means, pain occurring on both sides of the body and above or below the waist.
2. Muscular Spasm and tightness of muscles-- may be present.
3. Chronic Fatigue Syndrome- A feeling of fatigue is usually present. Even after having long periods of sleep the patient may get up with the feeling of fatigue. Sleep is often disturbed as a result of pain.
4. Stiffness- Usually having a feeling of tightness while walking for a long time or sleeping in one position for longer periods.
5. Cognitive Dysfunction-Many patients have Cognitive Dysfunction. It is usually known as ‘fibro fog’. Cognitive Dysfunction is characterised by lack of concentration, inability to focus, inability to pay attention or to concentrate, and inability to carryout simple mental tasks.
6. Irritable Bowel Syndrome-Abdominal pain, bloating, nausea, constipation alternating with diarrhoea.
7. Migraine Headache and Tension
8. Sensitivity to any one or more of the following-odour, noise, bright light, certain medications, certain foods and cold.
9. Psychological Problems-Having a feeling of anxiousness and a feeling of depression.
10. Sensory Impairment-Numbness or a feeling of tingling on various parts of the body such as face, arms, hands, legs or feet.
11. Irritable Bladder-Increase in urinary urgency or frequency.
12. Inability to do exercise.
13. A feeling of swelling (without actual swelling) in the hands and feet.
14. Temporomandibular Joint Dysfunction.

1. Genetics- Genetic factors may play an important role in the development of Fibromyalgia.
2. Life Style- Stress may be a precipitating factor in the development of Fibromyalgia. Fibromyalgia usually coexist with stress related disorders such as chronic fatigue syndrome, posttraumatic stress disorders, irritable bowel syndromes and depression. Poor life style like being a smoker, obesity and lack of physical activity may increase the risk of an individual developing Fibromyalgia.
3. Sleep Disturbances- may result in developing Fibromyalgia.
4. Psychological Factors- Depression is found to be associated with Fibromyalgia.
5. Blood Tests- There is no lab test to conform a diagnosis of Fibromyalgia. But blood tests are essential to rule out any other disease conditions that may have similar symptoms as that of Fibromyalgia. ESR test and Thyroid Function Tests are essentially done.

1. Medications-Usually symptomatic.
   1. Pain Relievers.
   2. Muscle Relaxants.
   3. Antidepressants.
   4. Anti -seizure Drugs.
2. Psychological Treatment- Stress must be avoided at any cost. Care should be taken to avoid or limit over exertion or physical and mental stress or strain. Daily activities must be carried out in such a way that enough time to relax in between is also to be incorporated. But one need not do away with the activities of daily routine completely as it may worsen the condition. One must avoid activities which demand stress.
3. Reassurance to the patient- Psychologically the morale of the patient must be boosted up. The patient must be well explained of the nature of the disease condition and also about the expected prognosis. One must reassure the patient that the relief can be expected, disability diminished and recurrence avoided.
4. Proper Sleep- As we have already discussed, fatigue is one of the characteristics of Fibromyalgia. Hence one must have sufficient and uninterrupted sound sleep. Sticking to and following good sleeping habits is very important. One must practice the habit of going to bed and getting up at the same time each day. Try to avoid day time napping.
5. Exercise Programme- Before resorting to the exercise programme, it is advisable to seek the advice of a qualified physiotherapist. He may evaluate the patient thoroughly and provide advice regarding the exercise programme. He may chart out a regime of exercise programme to be followed and may give advice regarding the way in which they have to be done. Avoid stressful and tedious exercises. But to start with, most of the exercises may cause or increase pain. But if the exercises are continued regularly, it helps to relieve the symptoms to a great extent. Resorting to simple exercises like walking, swimming, cycling, water aerobics e. t. c. is advisable. Exercises must be done regularly.
6. Regularise the activities- While undertaking the routine activities a self-discipline must be maintained. All the activities must be done within the limits of tolerance and comfort.
7. Maintenance of Healthy Life Habits. Sticking to and following good food habits is very important. One must practice the habit of taking food at the same time each day. Take food items which are gastric friendly so that constipation and other bowel problems may be avoided. Intake of fluid must also be increased so that the bladder problems may also be avoided to a great extent.

8. Physiotherapy Management- Physiotherapy plays an important role in relieving the symptoms. Superficial heating modalities like Moist Heat, Hot Water Fomentation and Infrared Radiation are very beneficial in minimizing the severity of the symptoms. Deep heating modalities like Short Wave Diathermy (SWD), Ultra Sound Therapy (UST) and LAZER Therapy are also very effective in dealing with Fibromyalgia. Transcutaneous Electrical Nerve Stimulater (TENS) is also helpful in treating Fibromyalgia.

a. Mobilization Exercises to the Cervical Spine and Shoulder girdles. Please refer my earlier articles on Cervical Spondylosis.

b. Strengthening Exercises to the muscles of the Cervical Spine and Shoulder girdles. Please refer my earlier articles on Cervical Spondylosis.

c. Postural Correction Exercises to the Cervical Spine. Please refer my earlier articles on Cervical Spondylosis.

d. Re -education of correct posture. Please refer my earlier articles on Cervical Spondylosis and Low Back Pain.

e. Guidance on the correct way of carrying out the Activities of Daily Living. Please refer my earlier articles on Cervical Spondylosis and Low Back Pain.

f. Mobilization Exercises to the Spine and Low Back. Please refer my earlier articles on Low Back Pain.

g. Stretching Exercises to the tight muscles of the lower limbs especially the Hamstrings and the Calf Muscles. Please refer my earlier articles on the same subjects.

Selection of exercises is very important. May seek the advice of a physiotherapist. He may evaluate and advice a regime of exercises that may be suitable for the patient. To start with the patient may do the exercises in the presence of the physiotherapist so that he may supervise and may help in bringing about necessary variations in the exercise pattern. Always select pain free simple exercises rather than tedious, tiresome and complicated exercises. Do the exercises within the limits of pain. Active exercises (the patient does the exercises on his own) are preferred. While doing the exercises rest must be incorporated in between at regular intervals. Breathing Exercises must also be incorporated in between to instill a feeling of relaxation.

These are very helpful in inducing relaxation. Thus breathing exercises help in stress management. Please refer my earlier article on ‘Thoracic Outlet Syndrome 4-Treatment 2 ‘which deals with the ‘Breathing Exercises’.

The remaining set of exercises for Thoracic Outlet Syndrome will be dealt with in my next article.

I hope this article was useful for you all. If you have any questions, feel free to post them below or contact me on

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