A Patient's Guide to Fibromyalgia Exercise

This guide to Fibromyalgia exercise starts with a how-to on minimizing stressful movements and achieving proper body alignment; then stretching/flexibility for pain; strengthening without increasing pain; and aerobics/endurance.

This material is reproduced with permission from the Oregon Health & Science University’s Fibromyalgia Information Foundation site. For information about their DVDs to help Fibromyalgia patients improve balance, flexibility, strength, and endurance, visit www.myalgia.com.*

Exercise is a crucial component for managing Fibromyalgia. There are many benefits to exercise. With exercise you can improve flexibility, endurance, strength, and the ratio of fat to muscle in your body. In order to maximize your chances at success for becoming physically better able to meet the demands of daily living you need to be as fit as possible.

Becoming fit does not necessarily mean getting to the gym, but rather may require incorporating increased activity into everyday life. If prior attempts have been disappointing, this is probably, in large part, due to the unpredictability of the symptoms of Fibromyalgia and the increased pain that can occur from overuse of your muscles.

As we begin to better understand the reasons that Fibromyalgia patients experience pain in situations that would not necessarily be interpreted as painful by others, we can use this information for Fibromyalgia treatment. The goal is “gain without increased pain.”

Many of you have noticed that your muscles have become weaker since you have had Fibromyalgia. The major reason for this is under-use, often due to pain. When usually non-painful signals from the muscles to the brain are interpreted as coming from the pain pathways, the brain sends an inhibitory signal back to the muscles which will result in under-use of the muscles.

In other words, the signals are misinterpreted, and then action to protect you from danger is put into place. Because this pain is not doing harm to the muscles themselves, well meaning but under-informed healthcare providers may have advised you to push through this pain and “just keep exercising.” The unfortunate result of this advice is that you have experienced a flare in your Fibromyalgia.

Now not only do you have the signals from the brain being interpreted as pain, but you have added the element of fear of another flare. No wonder many are reluctant to proceed with increasing activity.

How To Get Started and Know You Are Doing It Right

If you have someone available who understands Fibromyalgia and can assist you in designing an exercise program, use them. A knowledgeable person can help you learn to use different muscle groups that will lighten the burden on the more painful muscles.

Minimize the Amount of ‘Eccentric’ Work

How you use your muscles is important. You need to minimize the amount of work you do with your muscles contracted and lengthening at the same time: ‘eccentric work’. Examples in everyday activities are: drying hair with arms overhead, pushing a vacuum cleaner, putting clothes into a clothes-dryer.

Stay in the HOOP. One way to picture how to decrease eccentric work is by thinking of the hoop skirts that were worn years ago. The waist was the smallest part of the hoop and then the hoop becomes larger until the bottom.

Now picture that you have the waist of the hoop at chin level. Any activity with your arms needs to be done inside the hoop. When you are doing an activity, keep reminding yourself to stay inside the hoop. To minimize the eccentric [simultaneous contracted and extended muscle] work of your lower body you will need to take smaller steps when walking downhill and downstairs.

Avoid holding a muscle in contraction. It is also important that you not continue to hold a muscle in a contraction. There are two pointers for this:
1. Take a break from any activity every 20 minutes. This may be as much as doing a different activity, or as little as a 2-minute stretch break.
2. Pause between repetitions of the same activity. For example, if you are putting several things into a cupboard, instead of a steady 1-2-3 activity do a 1 (slight pause), 2 (slight pause), 3 (slight pause), etc.

Both of these will give the working muscles a break.

Find Your Center

How you hold your body while doing activities will be a factor in determining how quickly the muscles fatigue and how much pain is experienced with activity. Using the middle of our trunk for support will decrease neck and back pain, as the upper and lower back do not have to work so hard to compensate for posture.
1. Stand with your feet about shoulder width apart, both heels flat on the floor.
2. Gently rock forward [from the hips]. As you come forward you will get a sensation of becoming "heavier" and a bit off balance.
3. Rock back. Feel the point where you seem lighter and in balance. As you continue backward, you will notice that you become heavier and unbalanced. Now rock forward to the point where you feel balanced. This is your center.

Try keeping your posture such that you stay in the centered position. Be certain that you are centered.

Now Get Those Shoulders Down

Drop shoulders down and pretend you have a weight on the backside of your armpit.
Gently squeeze your shoulders blades together; this will keep the shoulders down and back.
Once you have the shoulders down and back, release the tension of squeezing them together while maintaining the posture. Keep your head over your trunk.

Goals with Exercise

n Set your own personal goals and share them with someone else.
n Decide if you want to do exercise alone or with someone else.
n Your goal with exercise will be to make progress, not perfection. You will have slips and slides and it is important that they not lead to a crash.
n Record keeping will help you to be certain how you are progressing in your program.

First Comes Stretching/Flexibility; Then
Strengthening; Then Aerobics/Endurance

Becoming more flexible through a regular stretching program may well result in a decrease in your pain. Improving muscle strength and increasing activity probably will not result in decreasing your pain: The aim is to improve your level of fitness without increasing your pain.

Always start your journey to fitness with a regular stretching program. The goal is to release some the muscle tightness, which in turn will decrease the signals going to the brain.

The next phase is to get the muscles stronger.

After you are more flexible and stronger, you will be ready to begin aerobic or endurance activities.

Toning Exercises. Using the proper technique - pause between each repetition and do fewer repetitions than you are able. Pausing between each repetition will allow the muscle to relax, a response that appears to be delayed in persons with Fibromyalgia. If the muscles are not relaxed before starting the next repetition, you are increasing the probability of experiencing increased post-exercise soreness. Improving fitness includes not only increased flexibility and improving muscle tone but also improving ‘aerobic’ or endurance capacity.

Thigh and buttocks. In order to be able to increase your "aerobic" daily activities, muscles that need to be strong are the quadriceps (thigh) muscles and the gluteus maximus [buttocks].

A good exercise for this muscle is to stand facing a table or chair. Place your hands gently on the table, as if you are using them only for balance and not doing a ‘death grip.’ Keeping the leg straight, contract the gluteal muscle and raise your foot about one inch off the floor, lower the foot back to floor, count to four as you rest and then repeat with the other leg. Do 2 or 3 per leg and build up over the next 2 weeks to doing 8 each leg. Do this twice a week. This will allow you to start to increase other activities such as walking.

Abdominal muscles. Another area that is very important in order to hold the body in proper position is the abdominal region. The muscles in this area easily become lax. When they do, the upper and lower back is put under increased strain, leading to more neck, shoulder, and low back pain. Potbellies become more prominent.
n Sitting. Without moving from ‘sit bones,’ scoop the abdominal so it makes a C curve [navel toward spine].
n Standing. Back against wall, gluteal inserts against wall; without moving from the wall, press your navel to your spine.
n Lying. Keep ‘sit bones’ on mat and move the lower abdomen by scooping, pressing navel to spine.

We are all familiar with sit-ups for abdominal strength training. Unfortunately these result in increased neck strain; a ‘forbidden’ activity for Fibromyalgia patients. The now-popular machines for abdominal work can help alleviate this if used properly. If not used properly, you get an arm workout but nothing, or little, for the abdominals.

You can safely work your abdominals without straining the neck with the [back strengthening] exercises listed below. Guidelines are to:
n Always curve the abdominal muscles so that the belly button goes toward the spine and not the other way around; this will take pressure off the lower back.
n Remember to breathe. Inhale before you start the exercise, then blow the air out as you contract the abdominal muscles. By doing this, you will also know how long to do the exercise. At the end of the blowing out, relax the muscle. Count to 10 before repeating. Repeat each one 2 to 3 times and build up to 5 to 6 times.
n When you are lying on your back, both of your shoulders should be in contact with the floor. If they are not, then you are too tight in the pectoralis [chest] muscles and need to do the stretching for that area described below.

Back strengthening. The muscles on the back need their work too in order to provide you with good support.
n Lie on your back, knees bent, and put the soles of your feet on the floor. Put the back of your arms on floor, palms up, and then bend at the elbows so only the area from your elbow to your shoulder is in contact with the floor. Now push down on your triceps (muscles in back of arm) and lift your chest/breasts. The movement is coming from the back muscles alongside the spine. Do not hold, but release immediately, count to 10 and repeat 2 to 3 times. Remember to breathe: Inhale before you start the exercise, then blow the air out as you contract the muscles.
n Lie on your back, legs extended in front, arms stretched overhead with palms up and resting on the floor. Press your spine into the floor so that you can feel each vertebra in touch with the floor. If this is too difficult with your legs straight, then bend your knees slightly. Caution: Do not arch your back. Remember to breathe. Inhale before you start the exercise, then blow the air out as you contract the muscles.

Now is the time to get started.

* Dr. Sharon Clark, PhD, FNP, is an exercise physiologist and researcher/therapist who has worked with Fibromyalgia patients since 1989. She is a founder and officer of the Oregon Fibromyalgia Foundation http://www.myalgia.com and a former associate professor of nursing at the Oregon Health & Science University in Portland. Dr. Clark has participated in decades of Fibromyalgia-related clinical research, including studies that helped shape the National Fibromyalgia Impact Questionnaire. The FIQ is now translated into 11 languages and “is considered the ‘gold standard’ for measuring change in Fibromyalgia research."