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Fibromyalgia Pain vs. Muscle Soreness: Monitoring Pain During Exercise

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By Colleen Black-Brown, M.S. • • March 27, 2002

Editor's Note: The following information was developed as a guide for health care professionals to assist their FM patients in an exercise program, and contains useful information for patients. We recommend that you consult with your health care professional before beginning any exercise program.

Monitoring Pain

Each fibro (fibromyalgia patient) responds to exercise differently and will progress at his/her own rate. So you may have a beginner progress rapidly to the next level or they may start out at a low level and progress very slowly and not seem to be making much progress. Good communication with your client is essential so that you can track their progress.

I have my clients fill out a daily monitor of how they feel each day, what they ate, water they drank, what the weather was like, how well they slept the night before and what exercises they performed that day. This helps to identify activities or behaviors that aggravate pain.

Sleep and stress, nutrition, fatigue levels, the weather, and environmental and chemical sensitivities can have severe effects on fibros.

In the area of sleep, Moldofsky reported sleep disturbances in 90% of fibros. (75% every night) In fact Hudson and Poe stated that the more problematic the sleep pattern, the more likely the person is to have other physical symptoms. Lack of phase 4 deep sleep results in decreased growth hormone release, which is critical for muscle tissue repair and fat metabolism. This also results in low serotonin levels that can cause less deep sleep. This cycle leads to increasing fatigue and pain.

Stress worsens FM symptoms. The greater degree of stress an individual perceives the more likely the person is to have other physical complaints.

Sleep and their perceived stress levels may be pretty good indicators of how well they are going to tolerate exercise.

Differentiating FM Pain from Muscle Soreness

Each fibro is unique because we differ in symptoms and severity of pain. Keeping a record can help you identify muscle soreness versus pain from FM. Fibro symptoms can include general stiffness and achiness or flu like symptoms, fatigue, and tension (58%) headaches. Fibro pain can manifest itself by burning, throbbing, shooting, stabbing numbness, tenderness, and muscle twitches. Pain can occur simultaneously in different parts of the body and may be felt everyday. Because of increased substance P in the spinal cord fibros perceive pain 3 times to the degree of that of a normal individual.

Whereas; muscle soreness is localized and can occur 24-48 hours following their workout.

The goals of a fibro are to improve the quality of sleep, reduce pain, increase neurotransmitter production and help the person regain control of her life. We find that exercise address’s all these areas.

When to Increase - or Decrease Exercise

Should your clients progress with exercise if they are hurting? If your client only has tiredness or muscle soreness encourage them to continue with the normal progression, increasing intensity and duration.

If they complain of a shaky or quivering muscle stop the movement and continue the following day. A quivering muscle can mean that the firing circuits are overloaded but in time their muscle will adapt. A shaky muscle could mean a state of contracture. In order for the muscle to relax and stop contracting you have to release calcium that’s bound to troponin and bring it back into the lateral sacs of the sarcoplasmic reticulum. This requires ATP and sarcoplasmic ATPase. If the ATP is used up (or the sarcoplasmic ATPase isn’t available) the muscle cannot relax because calcium remains bound to the troponin, and the myosin head remains attached to the active site on the actin myofilament.

If the client experiences sharp pain during the workout stop the movement and continue the following day.

If your client feels nauseated while exercising rest a few min. then continue. This may be due to a parasympathetic response, the sensory feedback through the CNS, digestive problems or a pain response.

However, chronic fatigue, no sleep at night, or tension headaches that occur the same or the following day is a sign to regress or cut back to ROM and stretching until symptoms cease. These symptoms may or may not be accompanied by a flare-up. Usually in this condition the body is already stressed to the limit and just responds to exercise as yet an added stressor.

Summary of When to Increase or Decrease Exercise

--Minimal muscle soreness and fatigue = progress with intensity and duration
--Shaky or quivering muscle = stop the movement, and continue the following day
--Sharp pain = stop the movement, and continue the following day
--Chronic fatigue, no sleep at night, tension headaches or a flare up = regress to ROM, stretching, & relaxation until symptoms cease

In time your FM clients will learn the difference between muscle soreness and fibro pain and how to monitor themselves. And eventually they will be able to tell when to increase or decrease exercise.

It is difficult for FM patients to get started on an exercise program because of the pain and fatigue experienced at first with repetitive movements.

However, those who do exercise experience worthwhile improvement and are reluctant to give it up. A little muscle soreness and fatigue should be expected the first week or two of exercise and that is normal. Exercise may exacerbate the pain response initially. Even though they are hurting it is essential to exercise. Normally pain is an indication that you need to stop exercising. But in the case of the FM client it is the motivation they need to begin exercising.

The symptoms of FM can be devastating but with your help fibro clients can experience a better quality of life.

Happy Health,

Colleen Black-Brown

This information was developed and written by Colleen Black-Brown. If you wish to use this information please contact me at:

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