A Simple Mind Hack To Reduce Pain

Neurons

Neurons

Pain is the conscious correlate of perceived threat. – Lorimer Moseley, Professor of Clinical Neurosciences and Chair in Physiotherapy, Uni SA

Pain is only pain if we are consciously aware of it, if you aren’t aware of pain, you don’t have pain!

Knowing this, if we can shift our awareness away from pain, we can reduce it.

In medical terminology, this is described as distraction therapy.

Distraction therapy is an effective pain management strategy, and it’s something you’re likely to be familiar with.

If you’ve ever spent any time with children, you’ll have seen them hurt themselves. Sometimes, after a minor fall/scratch/scrape children make a bigger fuss than warranted (tears and tantrums), mostly for attention. Many clever parents use simple distraction techniques to take a child’s mind off the pain they are experiencing. It usually works a treat.

This is distraction therapy.

How Does It Work

There are 2 inter-related but separate mechanisms that are at play.

The first, and probably the coolest, is that distraction therapy leads to the secretion of pain relieving opoids by the brain (1).

These opioids, termed endogenous, as opposed to exogenous opioids that you consume (codeine, oxycodone etc) act within the central nervous system to reduce pain.

The second involves competition for attention between an important sensation and consciously directed focus (2).

This is because the conscious mind can only focus on one thing at a time.

Sure, we can rapidly alternate our attention between two or more things, but at any given moment our attention can only be on one thing.

And going back to the opening quote, “pain is the conscious correlate of perceived threat”, if our consciousness is focused elsewhere, then it cannot focus on pain.

How Do You Use It?

The great thing about this, just like with children, you can use this to help reduce your pain.

It’s important to understand that distraction therapy is not magical. It is simply a pain management technique that is free, easy to implement and accessible to all.

Distraction therapy can work with pain of all different causes, but you can’t ignore the underlying issue:

  • If your pain is caused by a medical condition, see a doctor!
  • If you are suffering pain due to injury, the injury must heal first before the pain goes away.
  • Likewise if you have pain related to movement issues, they must be resolved.
  • Finally, please understand, that persistent or chronic pain is considered a disease in its own right, it’s also not considered to be curable, instead, focus on finding effective management strategies.

 

So how do you do it? The beauty of distraction therapy is that there is no one way.

The most important thing is to use an activity that is interesting and meaningful to you. One that is comfortable and immersive.

You can’t think to yourself “I’m doing to distract myself from the pain by doing this” while you are doing it, because that means your attention is on your pain and not on the activity.

Doing this causes you to engage in a state of flow, and given that your brain will want to remain in this state, it will secrete opioids to modulate your pain.

That’s a win-win. You get to do something that is important to you and reduce your pain at the same time!

There is no limit to how long this will work for, it depends on how strong your concentration is.

Intention and Distraction: The Next Level?

Whilst the research on distraction therapy focuses on the immediacy of performing a task and the subsequent physiological response, here at Integrative Osteopathy we have used similar principles to help patients throughout their entire day.

This is not, strictly speaking, distraction therapy, but the principles are similar – namely that the conscious mind can only give attention to one thing at a time.

Not only does this technique help with pain management, but it can improve your mood and even your life.

The technique is called setting your intention.

It simply involves a short period of quiet contemplation in which you focus your attention on your intention.

What is your intention? It is another way of describing your focus.

If you look back through time, pretty much all cultures had periods of quiet contemplation built into their lives.

Whether it was prayer, meditation or spiritual rituals, these practices allowed people to process events that had happened and the associated thoughts and emotions, and find a place of comfort, if not clarity.

It is part of the reason mindfulness/meditation is gaining such traction in recent years – our attention is being attacked from every direction, distracting us – mindfulness helps with finding clarity again.

To add in quiet contemplation to your life, it need not be complex. In fact, it’s better if it’s not.

How To Set Your Intention

Setting your intention starts with quiet contemplation. A great time to implement it is in the morning, as it sets you up for the day ahead.

Pick something you habitually do, like taking a shower or brushing your teeth, and immediately before/after, close your eyes, slow your breathing and spend a few minutes alone with your thoughts and feelings.

Focus on the one thing, above all else, that you want for the day. This is your intention.

 

Your intention needs to be framed in a positive way. Your brain doesn’t recognise negative words. To illustrate, make sure you don’t think of dancing elephants while you’re reading this sentence.

Once you have the elephants out of your mind, get back to setting an intention.

This focus will govern all your actions for the day, both consciously and unconsciously.

After you have set your intention, you can create an intention card (3). Write your intention down on the front of small card, in one word. Then, on the back of that card, write out a prompt question.

Usually, you would frame it like this:

A. Statement of the intention
B. A question prompting the action which leads to the intention

Here’s an example:

Imagine someone who always feels stiff.

They might set their statement of intention as this: Fluid movement.

Then their question might read: what do I have to do to experience more fluid movement?

Instead of thinking about how stiff they feel, this question prompts somebody to get up and move, to stretch, to avoid prolonged positions and a whole heap of other things, all from a positive outlook. In essence, it’s distracting them from the problem whilst prompting a solution.

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

References

(1) Attention Modulates Spinal Cord Response To Pain – http://www.sciencedirect.com/science/article/pii/S0960982212003934

(2) How Does Distraction Therapy Work – http://www.ncbi.nlm.nih.gov/pubmed/15745617

(3) Intention Cards – http://www.authenticeducation.com.au/intention-cards/

Exercise For Low Back Pain

Fit girl lift weights at fitness gym center. Deadlift workout.

Any article about exercise for pain needs to cover one important fact before it goes on:

The body will tend towards self-correction/health/resolution, if, and that’s a big if, the right conditions are present.

The biggest challenge facing an osteopath, or any other therapist, is finding, or more likely, stumbling upon, the right conditions for the individual seeking help.

Whilst there are general guidelines to abide by, every one of us has a unique set of experiences, thus different stories, explanations, treatment techniques and movements are required to facilitate a recovery; not to mention all the environmental factors that come into play.

This article intends to discuss the general principles that should underpin your actions when exercising for/with low back pain.

Where Most Back Pain Exercise Programs “Go Wrong”

Most back pain exercises or exercise programs are based on the notion that pain is the result of specific factors, and that these factors can be specifically identified and then specifically addressed.

There are a variety of factors that can contribute to low back pain, but aside from a history of previous episodes of low back pain, nothing drastically stands out as being identifiable. (1)

As an aside, this perhaps points the finger at us, therapists and rehab professionals, who are not doing a good enough job in the first place (on a population, not individual level).

It is also highly important for sufferers of low back pain to understand, as many people decide to cease treatment/rehab as soon as their pain is gone, rather than concluding the full course of treatment and restoring “lost” function.

Unfortunately, it is very difficult to specifically assess and as a result, address them with targeted exercises.

So knowing that specific factors may be hard to identify and treat, it seems more important to build resilience with a complete mobility, strength and conditioning program.

Take home point number 1: exercise programs for low back pain should not attempt to be specific, but rather improve all physical qualities.

There Are No ‘Good’ And ‘Bad’ Exercises

Another misconception surrounding exercise for low back pain is the concept of ‘good’ and ‘bad’ exercises.

Generally, if you are reading a fitness article, the concept of “neutral spine” is mentioned quite a lot. Lifting should always take place with a neutral spine, regardless.

If you are reading a rehab article, limits might be imposed on external loading, as in, any lifting above 10 kg is bad, and must be avoided.

Or you might read a medical article which mentions you should simply avoid things that hurt.

All of these comments have a place, and are neither right or wrong without any context to define them.

A ‘good’ exercise is one that you can do safely, is suitable for your current ability, is able to be gradually progressed and fits in with your needs and wants (aka your goals).

Take home point number 2: blanket statements and absolutes do more harm than good. There are times when a moderate approach doesn’t work and more extreme action needs to be taken, but it is rarely either or. Exercise selection is based on your needs and wants, not an arbitrary definition of good and bad.

Self-Limiting Movements

This is a concept that was popularised by American physical therapist Gray Cook, in his book Movement.

Self limiting movements/exercises are those that have an inbuilt “coaching mechanism”, meaning doing them forces you to increase your awareness with movement, and often times with these type of movements you can only perform them correctly, or not at all.

Utilising self limiting movements as part of an exercise program for low back pain allows you to safely challenge your body and brain, leading to improvements, without the risk of overdoing it.

There are many different examples of self-limiting exercises. The specifics are not as important as being able to move with increased awareness and a low risk. This is a big focus of our exercise programming for low back pain, especially in the early stages.

Take home point number 3: a good exercise program will provide both a challenge and the option to “fail safely” – thus reducing the fear associated with facing more demanding movement challenges.

Our Approach To Programming

There is no one way to program exercise for low back pain. As long as the programming is underpinned by sound principles, and not “technique based”, then it should be sufficient.

We strive for more than sufficient, we strive for optimal.

As such, over the years our approach to exercise programming for low back pain has been refined to what it currently is. Chances are, in another 5 years it will be further refined, but the vast majority will be consistent, as it is all principle based.

First, we consider the body as a whole. We don’t only do “low back” or “core” exercises, but rather we devise a total body program. This is the underpinning principle of osteopathy, and is also applicable to exercise programming.

Second, we ensure that of physical qualities are developed in the right sequence.

If we start with osteopathic manual treatment in the consultation room, we then progress to mobility and flexibility exercises.

These will usually start on the ground, as this provides the most stable environment, thus is the least threatening.

Considering pain occurs when there is a perception of threat by the brain (if you haven’t already, have a read of Pain Basics), this is one of the best ways to regain movement and avoid inefficient compensation patterns taking over.

From there you are looking to build “motor control” – this is simply the ability to control movement well.

We can call this stability, but that implies static positions and discounts the movement component. This is actually achieved simultaneously with improving movement/mobility/flexibility.

We can consider mobility as “end range strength”, and we are simply progressively challenging you so that both qualities improve.

Once you have achieved adequate movement and control (adequate is based on your individual needs), if you want and/or need, we would add load. This might be in the form of external resistance, increased leverage challenge or even changing the tempo.

Only when you are moving competently under load do we add a conditioning component – that is, more volume of work. This is the challenge of fatigue to your new found movement abilities, and if done correctly, is the difference between breaking down when the going gets tough and being able to withstand (almost) anything.

Take home point number 4: whole body, principle based programming that utilises appropriate methods of progression yield the best long term outcomes (based on clinical experience and research) (2) for sufferers of low back pain.

Conclusions

There is a well worn quote:

Methods are many, principles are few. Methods always change but principles never do.

This served as inspiration for this post – there is no point showing you how to do an exercise with no context as to whether it is appropriate for you or not.

Rather, it is important to have an understanding of why you are doing something – even if you only care about the “what”.

This understanding means you will not chop and change based on the latest article in your newsfeed.

It means you will take the time to get things right, knowing that making progress is all the matters, even if it is “slow”.

It also means that you have a better chance at a good outcome and are less likely to become a statistic of low back pain recurrence.

Reducing the article to four sentences, we would end up with something like this:

  1. Do something you enjoy doing, that has intrinsic reward – there are no “good” or “bad” exercises.
  2. Ensure you take a “whole body” approach to exercise. Don’t simply focus on “low back exercises”.
  3. Start slowly, progress gradually.
  4. Vary the stimulus over time, but not too much or too often (or you won’t elicit adaptations).

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



 

References

(1) Incidence and risk factors for low back pain: http://www.ncbi.nlm.nih.gov/pubmed/24462537

(2) Resistance training and low back pain in active males: http://www.ncbi.nlm.nih.gov/pubmed/20093971

Rethink Pain: Moving Beyond Muscles and Bones

Classical Anatomy

This is the first post in what will be a series about “re-thinking pain”, or rather, re-conceptualising it.

The aim of the series is to help you move from a tissue based understanding of pain to one based in neuroscience, which is more accurate and more correct (although a better term would probably be “less wrong”, as there is still so much to learn).

Why is this necessary?

  • The language we use around pain shapes the way we think about, and experience pain. Using tissue based descriptors of pain reinforces the idea of a “bottoms up” model of pain, which is wrong, and can often make things worse in the long term. Moving towards a neuroscience approach helps move away from this model.
  • Chronic pain is a massive problem in Australia (and around the world), affecting millions, costing billions and growing worse every year. Chronic pain often starts as poorly managed acute pain. One of the most important management strategies of any painful condition is education.

The Problem

To begin to understand how we have ended up with such a problem regarding pain requires tracing back through the centuries of medical and philosophical history.

In short, we used to describe pain as “coming from the tissues” up to our brains, where we felt it.

What is now understood, is that pain is a brain output, with many different “filters”, that are unique to each and every one of us, being applied before we are consciously aware of it.

Despite having this knowledge, we can see that even within the official definition of pain, the problem exists.

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

The definition of pain above has been put together by a group of highly intelligent people (International Association for the Study of Pain), who have spent a large portion of their lives studying pain, it’s effects and how to treat it.

Unfortunately, there is one small problem, and it has nothing to do with the definition itself, but rather, the fact that pain is “described in terms of such damage”.

When we explain all pain in terms of tissue damage we paint a picture in people’s minds. Unfortunately, when it comes to pain, this picture is not only incorrect, but harmful.

One can assume this became part of the definition because of what takes place in the real world:

  • Your back hurts, people say you have strained a ligament/joint.
  • Your knee hurts, people say it must be arthritis.
  • You have a headache, must be wear and tear of the head. No, that last one doesn’t sound quite right.

So how exactly is this harmful?

When pain is described in terms of body tissues alone and combined with the type of language typically used (words like torn, strained, scarred, degenerative) to describe tissue based pain, irreversible damage in the form of nocebo* can be caused.

This can lead you to think that something is wrong with your body that needs to be fixed, when things are in actual fact, completely normal.

Additionally, thinking in terms of body tissues leads to a mechanistic view of the body, one that wears out over time and the association of this “wear” with pain. The body is a biologic organism, one that is always adapting as best it can, it doesn’t “wear out”, but rather fails to adapt. There are lots of reasons for this failed adaptation though, it’s not just the result of “getting older”.

Check out this Facebook post on from September:

"It's probably just WEAR AND TEAR"My oh my, does that saying get tossed about. Usually, it goes something like this:…

Posted by Integrative Osteopathy on Wednesday, 30 September 2015

*Nocebo, is basically the opposite of placebo, ie causing harm when no harm has been done.

The Solution

We need to rethink pain, to conceptualise it as a dynamic process, arising in the nervous system and governed by our brains.

Yes, pain is often a result of tissue damage. However, there are many cases of severe tissue damage with no pain experienced at all and vice versa.

Additionally, the intensity of pain is very poorly correlated with the severity of any tissue damage.

Finally, when tissue damage has occurred, there are three scenarios.

  1. It is quite severe and needs medical intervention at a hospital. Think of compound fractures, 3rd degree burns, deep cuts etc.
  2. It is not severe enough to require medical intervention beyond basic first aid.
  3. It is somewhere in the middle.

In all 3 cases, with time, the body will heal as best it can.

As long as there is adequate rest, nutrition and then re-loading of the tissues in a progressive manner as governed by the condition and individual requirements, you’ll get as full a recovery as possible.

So initially, once the need for medical intervention is ruled out, the important thing to do is treat the pain.

This goes against almost all manual therapy and allied health advertising to “treat the cause of your symptoms”.

Alleviating pain will, in many cases, sort out a lot of associated “findings”, the so called causes of your pain, and then beyond that, allow your body to heal.

If you came to us for treatment, here’s how we might do that:

  • Explain all of this information about pain, in a way that makes sense to you, so that you aren’t as stressed or anxious about it anymore.
  • Have a look at you stand and move and suggest ways that might make standing and moving less painful.
  • Get hands on and apply some really pleasurable manual techniques. There is no need to dig in deep for the sake of it. The goal isn’t to change the tissue, it’s to change the perception and get the brain releasing pain relieving chemicals.
  • Do some breathing techniques to help you relax. You’d be surprised at how poorly most people breathe, even when they are concentrating on doing it properly.

All of these techniques are based on the same principle – once the threat is reduced to an acceptable level, the brain will stop protective behaviours, which include pain and altered movement.

So to summarise a blog post in a sentence:

Pain is all about threat perception, it doesn’t mean damage and body tissues can’t produce pain, only the nervous system can**, so we must focus on the nervous system, including the brain, when describing and treating pain, so as to not cause further complications via nocebo.

 

 

**Yes, the nervous system is a body tissue, but for the sake of the argument we are using simple language.

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

Integrative Osteopathy is an osteopathic practice located in the heart of Fitzroy North, within the reputable Healthy Fit gym. For all inquiries, call 0448 052 754, or to make an appointment online, click here.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

Pain Is A Verb, Not A Noun

Brain
When you seek treatment for pain, part of that process should be a thorough education about pain.

This education should cover the basics:

So that you understand the physiological process, at least at a basic level.

Many people think pain is only a marker of tissue damage. It’s not. It is a multi-factorial sensory and emotional experience.

To help people change their understanding of pain, I like to describe pain as a verb, not a noun.

For those of you who can’t remember primary school English (or never learnt it in the first place):

  • Verb = doing word
  • Noun = thing

Thinking about pain as something you experience, instead of something you have is empowering.

It gives you an active role in your pain experience. This means you can influence your experience, for better and worse

How? With your thoughts, feelings and actions.

Pain Is A Body and Brain Experience

All pain has three major components:

  1. Physical
  2. Cognitive (thoughts)
  3. Emotional

The relative contribution of each component varies.

Often we can determine which factor is likely to be the primary driver of each pain experience, but we can’t measure by how much.

Even though were aren’t always aware of each component, they are always there.

If the primary driver of your pain is physical, then physical treatment approaches tend to work best.

This is the same for psycho-emotional pain, which response best to psycho-emotional treatments.

Kind of obvious yeah?

Where it gets tricky, is that even physical approaches have cognitive and emotional aspects.

There is no separation.

Get Involved In Your Treatment

The best outcomes in pain treatment occur when you and your practitioner are working together.

This maximises the effects of treatment.

The more effective your treatment, the faster your resolution of pain. Again, kind of obvious yeah?

You are probably more involved in your treatment than you think.

First, you chose your practitioner (hopefully). The act of choosing is both psychological and emotional. You want to choose someone who is good at what they do, and who you like.

Second, you are probably already doing things to help your recovery. They may or may not be the best things, but you’re already changing your behaviour.

A good practitioner will point you in the right direction of what change is best, but you’ve made a start.

How To Change Your Pain Experience

Our mental and emotional state influences our perception.

Think about watching a movie. If you are on a first date, it’s a very different experience to watching the same movie with your long term partner after you’ve had a fight.

Same stimulus, different psycho-emotional status and thus different perception/response.

This principle can be applied to factors affecting pain:

  • Take control of your emotions. First, identify your thoughts and emotions around pain. Commonly these include fear, anxiety, overwhelm and frustration, among others. Then you can change them. A good practitioner will help you with this.
  • Improving your stress management. Stress is dictated by the way we frame an experience. Any event has the potential to be stressful. By learning to change your framing of stressful scenarios, you can minimise your stress load.
  • Change your environment. Our environments shape us, for better and worse. Sometimes, as hard as it is, the best thing you can do for your pain is change or leave aggravating environments.

Conclusions

It might be strange to consider pain as a verb, not a noun. But as I outlined, it can make a massive difference to both your pain and suffering.

Taking a different view on things is the first step to changing your outcomes.

And while different views can be quite confronting, it is the only way to grow.

Hopefully, this growth means improving or eliminating your pain.
Nick Efthimiou Osteopath

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 


 

 

Exercise For Fibromyalgia

 

Couple walking on the beachFibromyalgia is a common and debilitating condition.

It affects around 2-5% of the population. (1)

It is under-diagnosed, because of the vagueness of many of the symptoms. For those who do get a correct diagnosis, it can take years.

Fibryomyalgia was originally though of as a rheumatic (joint) condition.

Now, research has shown it is mainly a problem with the central nervous system (the brain and spinal cord).

Due to the lack of understanding of the condition, there aren’t many treatments that provide good, long term, results.

Currently, the best treatments for fibromyalgia are (2):

  • Exercise
  • Stress management and relaxation techniques
  • Cognitive behavioural therapy
  • Manual and physical therapies
  • Certain medications

The Benefits of Exercise for Fibromyalgia

Of the treatments above, exercise is low cost, available to all and has minimal side effects. This makes it an excellent primary management strategy for chronic pain.

Exercise has the potential to improve fibromyalgia. It works by a combination of both specific and non-specific effects.

Some of those effects are:

Decreased Pain

We don’t know exactly how exercise helps pain. We do know there are probably a few different effects involved.

One of the main ones is descending modulation. This occurs when the brain secretes natural pain relieving chemicals. Commonly known as endorphins, they target different nerve receptors, inhibiting potentially painful messages.

 Improved Cellular Energy Production

Suffers of fibromyalgia often report increased fatigue. To make matters worse, many have difficulty getting restful sleep.

Exercise can help increase mitochondrial density (3). Mitochondria are the cellular power plants. They convert glucose into ATP, which cells use to fuel their activity.

In theory, increasing mitochondrial density should improve cellular energy production.

In practice it’s kind of like installing a bigger engine in your car. It has the potential to make it go faster, but everything else need to work well too.

Better Hormonal Balance

Regular exercise improves hormonal balance. It decreases catabolic stress hormones and increases anabolic sex hormones.

This balance is thrown off in people with fibromyalgia.

Better hormone balance leads to a more positive psychological state, improved emotions and healthier physiology.

It’s not hard to see how this could benefit a chronic pain condition like fibromyalgia.

Stimulates the Lymphatic System

Many people are aware that exercise improves blood flow. But, few know that exercise also improves function of the lymphatic system.

The lymphatic system is the body’s “waste management system”. It has a network of vessels all around the body, like arteries and veins. These vessels remove cellular and immune system “waste” from the local area.

When you are sick, your lymphatic system becomes more active, and you can often feel your lymph nodes.

Of interest to fibromyalgia sufferers, the brain, hormonal and immune systems are connected. One of the ways they communicate during an immune response is via the sympathetic nervous system (SNS). (4)

It’s a complex relationship, but the stress hormones can both improve or inhibit immune functions.

With fibromyalgia, one of the mechanisms involved is an overactive SNS.

By stimulating the lymphatic system, we can influence the SNS. However, we have to do it in a way that does not cause a flare up.

How To Exercise With Fibromyalgia

Exercise with fibromyalgia is often challenging for two main reasons:

1. Pain (both during and/or after)

Pain is an obvious barrier to exercise for someone with a chronic pain condition. Sometimes though, you need to endure the early pain to get a bigger benefit in the long term.

To deal with this, research on chronic pain suggests a pacing approach. Pacing means doing a little at a time, within your limits, and increasing that amount at a gradual pace.

A good exercise program for fibromyalgia should have pacing built in. It will also have a “plan B” for those days when you feel terrible, and don’t want to do anything, but know you should.

2. Fatigue

Fatigue is the second big issue associated with fibromyalgia.

As mentioned, exercise can potentially help reduce fatigue in the long term.

In the short term, focus on pacing during exercise. In pain management terms, pacing is where you work within yourself and gradually increase the amount over time.

Then afterwards, look to enhance your recovery as much as possible to help minimise accumulated fatigue.

If you avoid common exercise mistakes, you can get the benefits of exercise for fibromyalgia whilst minimising flare ups.

What Type of Exercise Is Best?

There are many types of exercise, which can be organised into 4 broad categories: flexibility training, motor control/skill training, cardiovascular/endurance training and strength/power training.

Each of these has potential benefits for sufferers of fibromyalgia, but overall, there is no clear consensus on which is best, so it is safe to say that the best exercise is the type that gets done and is enjoyable, while producing the least negative effects.

Cardiovascular Exercise

Cardiovascular exercise is a great place to start with fibromyalgia. The majority of research looking at exercise for fibromyalgia has studied various forms of cardiovascular exercise.

One of the downsides of cardiovascular exercise is the potential fatigue it creates. That can be minimised with careful planning and paying attention to biofeedback during and after sessions.

This allows appropriate scaling of volume and intensity, as well as an optimal rate of progression.

The beauty of cardiovascular exercise is that there are a variety of ways to perform it.

Some include:

  • Walking
  • Running
  • Cycling
  • Swimming
  • Rowing
  • Elliptical machines
  • Skipping
  • Rebounding

Remember, always start well within yourself, and progress slowly. It takes patience, but it is the best way to avoid flare ups.

Resistance Training

Resistance training offers complementary benefits for fibromyalgia. Increased strength helps to maintain function throughout your life.

Resistance training is also very scalable, making a pacing approach easy to implement.

Recent (2017) research showed that strength training is both safe and effective for people with fibromyalgia.

Strength training is safe and effective in treating people with fibromyalgia, and a significant decrease in sleep disturbances occurs after 8 wks of intervention.

Strength training can be performed at home, with body weight exercises or using home based equipment, in a gym or at a clinic. There are many forms of strength training, but the principles are the same: progressively load the muscles with increasing resistance over time.

Flexibility Training

Flexibility training is another good option for suffers of fibromyalgia.

It has a myriad of benefits, most relevant to fibromyalgia are decreased stress and increased cellular energy production.

Stretching is requires no equipment and can be performed anywhere, at any time, to varying intensities. This makes it a fantastic intervention for people with limited access to transport or those who live in unsafe environments which prohibits outdoor activity (extreme weather, crime etc).

Conclusions

A good approach, depending on your personal preferences, would be to incorporate a variety of exercise activities. This gives you benefits in multiple areas of health and function, increases enjoyment (variety) and minimises potential overloading issues.

The most important factor, is to apply pacing principles to your chosen activity.

If you do that, with activities that you enjoy, you can’t go wrong. While you may have the occasional flare ups, over the long term, the benefits are much greater.

 

 

Nick Efthimiou Osteopath

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 


 

 

 References

(1) RACGP – Fibromyalgia

(2) Fibromyalgia – Treatments and Drugs

(3) Exercise and mitochondria

(4) The Sympathetic Nerve – an integrative interface between two supersystems: the brain and the immune system

(5) What Is the Effect of Strength Training on Pain and Sleep in Patients With Fibromyalgia?