Fibromyalgia (FM) is a syndrome of unknown cause in which widespread pain, persistent fatigue, and muscle weakness are common symptoms. This discussion will focus on the use of non-drug methods to treat FM and in particular, the use of physical exercise approaches. Studies have shown that FM patients who participate in aerobic exercise programs experience reductions in pain, fatigue, and the number of tender points. Progressive strength training has been shown to decrease FM’s impact on the nervous and muscular systems, perceived symptoms, as well as functional capacity. Therefore, exercise programs that include aerobic activity and strength training may offer great benefit to the FM patient.

But what about flexibility exercises? What, if any, are the positive benefits that stretching has for those with FM? Because this information is scarce, a February 2009 study compared two different stretching programs that continued for 12 weeks, at 2 times per week, for 150 minutes/week in duration. The study included a 6-month follow-up after the stretching programs ended to determine if any long-term benefits could be achieved by either method if the exercises were discontinued. The study reported a significant reduction in both symptom severity and an increase in flexibility at the end of the 12 week treatment period. However, there were no significant differences at the 6-month time point compared with the start of the program. The authors concluded that both flexibility methods were equally helpful in achieving a reduction in symptom severity and improved flexibility by the program’s conclusion, but no significant long-term (6-month) benefit persisted if the patients stopped exercising.

This study emphasizes the importance of continuing an exercise program in order to maintain the beneficial effects of exercise in FM patients. It also adds to the collection of data that shows flexibility is effective in the treatment of FM, as are aerobic and progressive strength training. However, it remains unclear if all three in combination vs. any one of the three exercise methods alone would be equally effective in reducing the symptoms associated with FM. This study looked at the quality of life, the psychological aspects of FM, the measurement of pain, and the measured physical performance using a sit and reach test. The researchers reported that all of the FM patients were less flexible compared to norms gathered from the general population without FM. When comparing younger vs. older patients with FM, higher/worse scores were found in the older patient group. Regarding quality of life, the average score placed the patients in both groups in the “moderately” affected quality of life category. Re-gaining flexibility is important for both feeling less pain and improving function. However, perhaps most important benefit for adding a stretching routine to a FM patient’s treatment plan is that it reduces the fear associated with movement that many FM patients experience. Because most FM patients have had their condition for extended lengths of time, it is common to become fear avoidant and sedentary. Lack of activity over time then leads to further deconditioning, which only perpetuates the vicious cycle of worsening symptoms. Therefore, a supervised program of exercise is almost always needed to achieve meaningful and satisfying results.

Doctors of Chiropractic treat patients with FM using a variety of methods. Since every patient is unique, various approaches and techniques may be employed. These may include chiropractic spinal and extremity adjustments, physical therapy modalities such as electrical stimulation, light therapy and/or others, as well as advice on diet and nutrition, supervising exercises, and discussing work station modifications.