Fibromyalgia (FM) is a condition characterized by generalized pain distributed in a non-anatomical pattern. That is, the pain is widespread, possibly in all four limbs, the trunk, and/or head. It can be either primary (not associated with another/different condition) or secondary (a specific condition like irritable bowel syndrome, trauma, post-surgical, etc. gives rise to FM). Some studies suggest a central nervous system origin to the condition exists that may explain why the symptoms seem so random and unrelated. Some common symptoms shared by most FM patients include non-restorative sleep with frequent interruptions, extreme fatigue, as well as the widespread pain pattern.

Exercise has long been recommended as part of the treatment approach to FM. When choosing an exercise approach, it is important to START OUT SLOWLY so as to not overdo the initial few sessions. This can minimize the normal post-exercise soreness that usually occurs in everyone (with or without FM) due to lactic acid and other metabolites build up that occurs when muscles are utilized in a way that they are not used to. In the FM patient, post-exercise pain is usually 2-4 times more intense that non-FM subjects so in order to not scare the FM patient away from exercising, DON’T OVERDO IT! The second important point is BE CONSISTENT! After 2 to 4 workouts, the muscles become acclimated to exercising and the post-exercise soreness will become a non-issue. In order to avoid this, be consistent with your exercise routine. Start with a frequency of 3 times per week and after a few weeks, progress to daily or 5 out of 7 days. The intensity of the exercise process can be gradually increased so starting out with a 15-minute session and gradually building to 30 minutes (and later up to an hour) is appropriate.

There are many types of exercises to choose from. Some good choices include yoga, Pilates, biking, and walking. Since the FM patient may also have depression and anxiety issues, yoga is a good choice given its emphasis on breathing and mental concentration. Mixing up several types of exercises is a good idea as well. For example, one could do yoga for 15 minutes followed by biking or walking for 15 minutes, gradually increasing the duration, frequency, and intensity over time. Specific exercises for a certain activity, such as simulating a movement that is performed while working or playing a sport, performed in both the “normal” direction as well as in the opposite direction is very helpful. For example, if golf is a sport you enjoy, try holding a medicine ball cradled in the arms next to the chest and simulate a golf swing both forwards AND backwards in the opposite directions (as if twisting for a normal right-handed shot followed by a left-handed shot). This helps build motor control and coordination, as well as strength and flexibility. Incorporating balance during the exercise process is very important as well.

Try a test: Stand on one foot with the eyes open for up to 30 seconds and then switch legs. This should not be too difficult. If it is, you REALLY need balance-retraining exercises. If this is easy, next, try it again but with the eyes closed and count,  “…1001, 1002, 1003, etc.,” until you have to put your foot down. This really challenges your “proprioception” (motor control) system! If you are under 60 years old, you should be able to stand on one foot with the eyes closed for 25 seconds. How did you do? It’s very common to fail with the eyes closed. The good news is that you can regain your balance by performing balance-challenging exercises. Performing this test daily is a simple approach. Learning different exercises on a rocker or wobble board and gym/exercise ball also speeds up the process.