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The Pitfalls and Pearls of Resistance Training in Fibromyalgia Patients with Myofascial Pain Syndrome

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By Celeste Cooper, RN

A gathering of evidence(1) suggests resistance training is helpful for pain associated with fibromyalgia. And this is true but only when we avoid certain pitfalls.

What is Microtrauma?

Microtrauma is a term used to describe microscopic tears in muscle fibers, muscle covering (myofascia), and connective tissue. The minute any injury occurs, the body begins to heal. Microtrauma needs to be addressed before beginning any resistance training.

The Fibromyalgia Brain

The pain of fibromyalgia is thought to be due to centralization. What this means is there is a problem within the central nervous system (CNS), the brain and spinal cord. It shares this distinction with other problems, such as a brain injury or a disease, like multiple sclerosis.

Microtrauma — a Pitfall of Resistance

Muscle microtrauma occurs in the peripheral nervous system (the nervous system that is outside the CNS). Things like repetitive motion and muscle overload, poor posture, vitamin deficiencies, hormonal imbalance, sleep disturbances, or joint problems may predispose us to microtrauma. Likewise, microtrauma to muscles, their covering and connective tissue predisposes us to the development of myofascial trigger points (MTrPs) associated with myofascial pain syndrome (MPS).(2)

Trigger points (TrPs) are knotted up pieces of muscle fiber in a taut band of muscle that causes restriction of movement, shortening of the muscle involved, local pain, and pain in a referral pattern of the TrP.

Some believe that the centralization of pain, like that seen in fibromyalgia, may cause a taut band of muscle to develop due to emotional stress or even a slight chill when MPS co-exists. We are not sure why this occurs. But, we do know strength-building exercise performed on a dysfunctional muscle will only make the problem and the pain worse.

What Happens to Pain

When we experience more pain as the result of a treatment or activity, it is human nature to avoid it. The good news is that if TrPs are treated:

  • Muscle fibers are returned to their normal resting state.
  • Healing takes place.
  • Muscle function is restored.

This is important to understanding your pain. Once the trigger points of MPS are treated successfully, you can begin resistance training. Having healthy muscles minimizes the risk of injury, microtrauma, and negative feedback that hypersensitizes the CNS of people living with FM.

What is Resistance Training?

Researcher, Jones (2015), found “a growing body of evidence” indicates resistance training is beneficial and can improve fibromyalgia severity. So, what are some resistance exercises that might help you?

  • Using your own body weight, as with Yoga.
  • Using your extremities to create resistance. An example would be putting your palms together and pushing. This activates and engages muscles in your hands, arms, neck, shoulders, and even your chest. Any muscles you feel tighten as a result are doing so because they are being activated by resistance. Wall pushups or leaning against a wall is another example.
  • Yoga or therapy ball exercises. (These put less stress on your joints when done properly.)
  • Weight lifting. (You can use a can of vegetables or fill up a used gallon water bottle to a weight that works best for you. You don’t need to buy expensive equipment.)
  • Theraband (rubber tubing) exercises.

Anytime you feel your muscle tighten, even gently, you are providing resistance. You may be doing some of this already, for instance, carrying a bag of groceries. Some things to consider are:

  • Engage the joint involved for stability.
  • Don’t try to lift more weight or provide for more resistance than you can handle.
  • Use large muscles. Think about this—when you hang a full plastic bag by the handle, what happens to the handles? If the handles are representative of the small muscles in our hands and fingers, you can see they would be stressed. Larger muscles in our arms and shoulders are better equipped to handle the load. This same principle applies to lifting large objects. The muscles between vertebrae (bones in the spine) are very tiny. And, while muscles in our mid area are certainly larger, their main purpose is to provide protection for the spine and internal organs. They help us twist, not lift. So, when lifting larger objects, first engage the core muscles (the abdomen and pelvis), then use your arms and hands to grasp the object, and use leg muscles to lift safely.
  • Use caution with repetitive movements or sustaining muscle flexion.

Exercise your safety brain. Wobbly joints are not safe joints. When we build muscle safely, we also improve joint stability.  And don’t forget to stretch. Stretching helps maintain the normal resting state of muscle fibers. So, warm up with stretches, shake your hands and feet, and walk around a bit. This will improve important blood flow. And, cool down with stretches to prevent muscle recoil.

Start low and go slow. Listen to your body. If an exercise increases your pain, reduce resistance by 40-50% effort or eliminate it all together. If you suspect TrPs are present or you know you have MPS, respect it. Take care of those knotted up pieces of muscle fibers before beginning.

When we minimize peripheral pain stimulus, we also decrease our brain’s hypersensitivity to peripheral input. This helps minimize the body-wide pain, cognitive disturbances, and inefficient sleep associated with fibromyalgia.

This type of training is contraindicated in some health conditions, so be sure to check with your physician first. Learn the precautions and proper techniques necessary to prevent further injury.


1. K.D. Jones. Recommendations for resistance training in patients with fibromyalgia. Arthritis Res Ther. 2015 Sep 17;17(1):258. doi: 10.1186/s13075-015-0782-3.

2. Han SC, Harrison P. Myofascial pain syndrome and trigger-point management. Reg Anesth. 1997;22:89–101.

Celeste Cooper, RN is an advocate, writer and published author, and she is a person living with chronic pain. She is lead author of Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain and Broken Body, Wounded Spirit, Balancing the See Saw of Chronic Pain (a four book series). She spends her past time enjoying her family and the rewards she receives from interacting with nature through her writing and photography. You can learn more about Celeste’s writing, advocacy work, helpful tips, and social network connections at http://CelesteCooper.com

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3 thoughts on “The Pitfalls and Pearls of Resistance Training in Fibromyalgia Patients with Myofascial Pain Syndrome”

  1. ldylarke says:

    This information is very timely for me. Having recently become T2 diabetic, I am extremely motivated in finally getting off this extra weight. Though a third of it is from the side effects of most of the medication I’m on.

    However, wanting to exercise when you are in pain (and some days extreme pain), is right up there with wanting to be hit by a bus – because that’s how you feel anyway. I’m starting with walking. So far I’ve gotten one city block’s worth.

    When I am ready to start thinking about resistant training like exercise, I will be better able to decide what I should or should not attempt. Thanks to this article.

    So thank you, Celeste Cooper, for writing this article!

    Shannon from LivingWithFibromyalgia.ca

  2. CCoop says:

    I am so glad you were able to find information that will help you move forward in your journey, and with less pain. Knowing the pitfalls is helpful so we don’t become discouraged. Best of luck. In healing and hope, Celeste Cooper

  3. cihnjdh1 says:

    I was wondering how can you find out that you have this? Is there a test that I should ask about?

    Thank you


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