Fibromyalgia (FM) is a complex condition that can limit all facets of life for a person with it. The exact cause of FM is not fully understood and therefore medical treatments have been slow to develop and those available have varying levels of success.30 Pharmacological treatment is common for FM, however literature is beginning to surface that suggests the effects of physical therapy (PT) management may be as effective or perhaps more effective at reducing the symptoms.31 The effectiveness of PT management is based in large part upon the person with FM buying into the plan of care that unfortunately at times may make symptoms worse.
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Pogatzki-Zahn EM, Englbrecht JS, Schug SA. Acute pain management in patients with fibromyalgia and other diffuse chronic pain syndromes. Curr Opin Anaesthesiol. 2009;22(5):627-33.
Rossy LA, Buckelew SP, Dorr N, Hagglund KJ, Thayer JF, McIntosh MJ, Hewett JE, Johnson JC. A meta-analysis of fibromyalgia treatment interventions. Ann Behav Med. 1999;21(2):180-91
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Brief overview of the episode:
As a PT, it is important to realize that FM causes chronic pain and fatigue and that many patients will not be able to tolerate as many interventions or treatments as we would like to provide. However, treatment tolerance will improve with gradual exercise progression. 19 It is paramount that in the beginning, the PT works at a pace that the person with FM is comfortable with. As the person with FM starts to see and feel benefits from PT management, the difficulty and level of the interventions can be increased to levels that may be beyond the patient’s comfort to reach a therapeutic dose.
The positive effect of aerobic exercise, specifically aquatic exercise, described by Assis et al and Munguía-Izquierdo et al, on the symptoms of FM is profound. 8,14 Many times people with FM, as was the case with PF, come to PT as a last resort. Being able to show them evidence that supports PT management for FM will help relieve the feelings of hopelessness that are common in the FM community and instantly build some level of trust in the physical therapist. For PF, deep water running or aquatic therapy are treatments that will improve aerobic capacity and decrease pain and fatigue thus improving her quality of life.
Assis MR. Silva LE, Alves AMB. A randomized controlled trial of deep water running: clinical effectiveness of aquatic exercise to treat fibromyalgia. Arthritis & Rheumatism. 2006; 55, (1):57-65
Munguía-Izquierdo D, Legaz-Arrese A. Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89(12):2250-7.
Busch AJ, Barber KA, Overend TJ, Peloso PM, Schachter CL. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst Rev. 2007;(4):CD0037
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