by Betsy Timmerman
Fibromyalgia is a chronic pain syndrome that has reached epidemic proportions today. Once believed to affect 2 to 4 percent of the population, that estimate has climbed in recent years. Chronic pain in all four quadrants of the body for more than three months is the leading definition of the illness, but it has more than 50 known symptoms, ranging from non-refreshing sleep, memory and cognitive issues, irritable bowel and bladder sensitivity, to severe muscle pain and stiffness.
Many approaches to recovering from fibromyalgia are available, including (but not limited to) dietary changes, supplementation, IV nutrients, medications, 5-hydroxytryptophan, thyroid medications and cognitive behavioral therapy. One crucial element of recovery, however, is getting the body’s muscles back into balance. Strength and flexibility are extremely important if a patient is to feel truly well.
With the constant overactivity of the central nervous system, a fibromyalgia sufferer’s muscles are contracted inappropriately most of the day, even when no true “fight or flight” event is evident. The constant peripheral nerve activity and feedback loop to the brain cause trigger points to become active in the muscles and tendons when the involved muscles are used.
The continued shortening of muscles causes deep, aching pain symptoms; reduced work ability; difficulty getting comfortable while sleeping or sitting; and oxygen-starved muscles. When cell energy (ATP) is not produced in large enough quantities, the muscles become tired quickly. Energy reserves are limited for people with fibromyalgia, which is why they fatigue easily and must pace themselves. Determining what they will accomplish in a day is important, because they cannot live a normal life without paying the high price of more pain.
Most of us can wake up, shower, dry our hair, dress, prepare breakfast and get out the door to work without too much stress, effort or pain. But for fibromyalgia patients, a simple task, such as just blow drying their hair with their arms held above their head for a few minutes, can be exhausting. This is why relaxing and strengthening the muscles is so important for recovery.
Trigger points are also laid down through injury and are activated by psychological stressors, anxiety, cold, overuse of muscles and postural imbalances. Muscle weakness is perpetuated by disuse and often coupled with the fear of creating more pain by taking up an activity the body is not used to. Recovering from trigger point overload is a dance — a give-and-take event. A program of progressive stretching and strengthening done over time will help restore full muscle function without excessive discomfort.
What is a trigger point?
How does one start the muscle recovery process? Let us first look at what trigger points are and why defusing them through stretching is so important in chronic pain syndromes.
A trigger point is a small area of muscle or tendon (loci) that is in an energy crisis, resulting from overuse, repetitive injuries or accidents. Ninety-five percent of pain patients have trigger points as the origin of their pain. Factors that predispose one to trigger points are vitamin and mineral deficiencies, poor sleep, poor posture from muscle weakness and deconditioning.
Before you begin stretching
To begin a program of stretching and strengthening, look at your vitamin/mineral intake first. You must get enough magnesium (most people with fibromyalgia need between 400 and 1,000 mg) to help relax the muscles; B vitamins are needed for energy production and nerve health; amino acids to build muscle properly; and vitamin D for relieving muscle pain. Supplementation may be necessary.
You must exercise to increase the number of mitochondria (organelles where energy production happens) in your cells. The more mitochondria, the better your energy and the better your muscles will perform. After you begin taking the correct supplements, the next important step is to work on getting an extended amount of stage-four or delta sleep. Initially, aim for 5 to 7 hours of uninterrupted sleep. Do not get discouraged, as this can take time, but it can be accomplished with patience.
Promote good sleep by taking melatonin (start at the lowest milligram dosage, as some people get relief at .1 mg, others at 3 mg), or 5-htp (50 mg to 400 mg a day is the usual dosage). Herbal formulas are also available that can help. Traditional medications that promote stage-four sleep work well for many patients. An older remedy for fibromyalgia sleep issues is Benadryl®, which for most is a benign yet helpful sleep aid. (A small population is stimulated by it.)
Realize that many drugs and over-the-counter medicines can disrupt sleep. Advil® is a stage-four sleep disruptor, as are some statins, pain-relief medications containing caffeine and some blood pressure drugs, as well as Prednisone and asthma drugs that stimulate bronchodilation. Getting enough stage-four or delta sleep is crucial to recovery, because that is the stage of sleep in which the growth hormone is released and muscle repair occurs.
Once you get enough sleep and take the right supplements, you will feel better, gain more energy and experience less pain. At this point, you can exercise and stretch without hurting yourself.
Where to find the proper stretching exercises
The best resource for proper stretching and strengthening exercises (that will not hurt your muscles) is the book Pain Erasure by Bonnie Prudden. The book is about myotherapy and exercise, so there is much discussion about the location and removal of trigger points. You can do a lot of the work yourself or with the aid of a companion.
When you start a mild stretching program and do it several times a day, you will find that as the muscles are stretched out, they will stay that way. You can often get to a point where stretching will keep your pain from returning.
Pain Erasure includes simple and safe exercises for strengthening and lengthening the muscles. If you have active trigger points, I do not recommend that you hold a stretch initially. You may go too far, which can cause rebound pain. Make sure you are warmed up before you begin the stretching — walk in place or around the house, move your arms and legs to some music, take a hot shower or bath, and then begin the stretching. It can take a couple of weeks of stretching two to three times a day to reduce the stiffness.
When you are stretched out sufficiently, you are then ready to gently use a Dyna Band® or a resistance band with handles. Do not strengthen with light weights until you are unwound. Putting a mechanical load on a muscle in spasm (with trigger points in them) will only make the pain worse. The goal is to reeducate the brain and the muscles so they let go of the inappropriate holding pattern that has been set up over the years. Over time, re-patterning is the safest way to release muscles.
Begin with simple back exercises from the book, such as the Side Lying Stretch and the Knee to Chest. Remember that you do not hold these stretches — they are fluid, moving motions which put your joints and muscles through the whole range of motion for that particular body part. It should only take 7 to 10 minutes to do upper and lower back stretches, some leg, arm and neck stretches and doorway stretches for the chest. Do them several times a day for two weeks so that a new pattern is established, and you will be on your way to pain-free living.
Betsy Timmerman is a certified Bonnie Prudden Myotherapy (trigger point therapy) and exercise therapist, fibromyalgia educator and a First Line® Therapy educator. She offers workshops and one-on-one consultations to help people recover from fibromyalgia. eastwestpainsolutions.com. firstname.lastname@example.org or