How To Manage Pain Flare Ups

Nature Helps Calm Stress

Pain flare ups are a common occurrence with both acute injury or chronic pain. Knowing how to manage them well can be the difference between being able to maintain a high quality of life or not.

Pain flare ups, simply put, are a normal part of being a human in pain. Sometimes, they are related to something you have or haven’t done, but many times, there is no discernable cause for a pain flare up.

Most pain flare ups are short term – be it a few days or weeks – which can, at the time, seem like they will never end, leading you to pursue options for relief that are ineffective, costly and possibly even dangerous.

Instead, with this article, I hope to show you some strategies you can use immediately, or store away for reference in the (unfortunate) event of a pain flare up.

Why do pain flare ups occur?

Biological systems are non-linear, complex systems. Whilst it is easy to think of recovery as a straight line from injury to repair, in reality, things are a lot more up and down. (2)

In fact, I wrote about this in the last newsletter (you can subscribe at the end of this post, so you won’t miss any future issues).

This fact alone means pain flare ups are an expected, yet unpredictable phenomenon, but beyond saying that flare ups are inevitable, there are more issues at play.

Sensitisation

Sensitisation is the increased sensitivity of the nervous system to stimuli, whether it is at a peripheral level (nerve endings throughout the body), a spinal level or in the brain itself (3).

Because of this process, what was once a pain free task can become painful over time.

Biologically this is designed to protect us from further harming an injured area, which works well in acute injuries, but with chronic conditions, where pain and tissue damage become poorly correlated, it’s not so useful.

Lowered tissue tolerance

Whilst similar to sensitisation, lowered tissue tolerance occurs when you do not use/load body tissues appropriately over time and they decondition.

Whereas sensitisation is purely neurological, tissue tolerance is related to structural changes as well as a heightened sensitivity. The two often go hand in hand.

An easy way to understand this is with the example of muscle wasting caused by immobilisation. There is a reduced tolerance for load, and exceeding this can cause pain.

With both acute injuries and chronic pain, often the loading on the affected area is decreased, either consciously or unconciously, which leads to decreased tolerance of the tissues to loading.

Expectation

Often people with pain, whether acute or chronic, expect certain things to hurt them.

I was wearing heels all day yesterday because I had a wedding, so I knew I’d be sore today.

What’s interesting about expectation, is that is a self-fulfilling prophecy.

If you think something will hurt, it probably will, thus confirming your thoughts.

That’s not to downplay the involvement of the activity in question, but there are studies that show simply priming  (3) someone with “old” words and thoughts causes them to walk more slowly, without even realising it.

With this in mind, if you are expecting the worst, then chances are you’ll get it. (4, 5, 6)

What to do about pain flare ups

Every strategy to manage pain needs to be individualised to the individual – no one thing works for everyone, nor does anything work the same from person to person.

Acceptance

Acceptance and Commitment Therapy (ACT) is becoming more and more popular in treating/managing pain, because it is so effective (7).

What is so powerful about ACT, is that accepting flare ups will happen, and that you will be in pain, takes away their biggest weapon – frustration and disappointment.

In ACT, thoughts and feelings are not considered to be “helpful” or “unhelpful”. This is important during pain flare ups, because pain can cause us to think negatively, painting situations into worse than they are within our minds.

In essence, ACT is a form of mindfulness.

This is probably the most challenging thing to master, but when you do, the results are profound, both in the context of pain, but also in the greater context of your life.

Modify your activities

Whilst in the long term, avoidance strategies aren’t very successful, because they simply reduce what you are capable of, in the short term, as a management strategy, modifying or even ceasing activities that hurt is a viable option.

Ideally, you will continue as best you can, with what you want/have to do, but it is completely reasonable to put things off.

This makes intuitive sense: if you have low back pain and it hurts to bend, then you will likely avoid bending when it hurts.

However, as mentioned, simply avoiding bending forever is not a solution, and actually makes things worse.

A better approach is to see if you can modify how you bend, and how much you are bending in the short term, whilst working to restore the ability to bend freely in the long term, using a graded approach.

Use pain relieving techniques that work for you

When in pain, it’s natural to want to get rid of it as soon as possible, no matter the cost.

Unfortunately, there is no one medication/therapy/product that can effectively eliminate pain in everybody, all the time.

So, instead of chasing a magic bullet that drains all your time, money and energy, it makes sense to stick with proven strategies.

Once you have found your “recipe” for relieving pain, you can seek to optimise it, with less conventional methods, if they are safe.

Things you can try, which do have effectiveness to varying degrees are:

Focus on what you can do

It’s really hard to stay positive during pain, the whole point of pain, from a biological perspective, is to over-ride our consciousness to take alternative/evasive action from our current situation.

This means a stress response, and a stress response, physiologically, is designed for action, black/white thinking.

What this can do, is cause you to focus on negative thoughts and emotions, setting of a vicious cycle making things worse over time.

If you focus on what you can do – with both a macro and micro perspective – then you completely shift the way you are living.

After all, if you can’t control whether you experience a pain flare up, wouldn’t you at least want to control your thoughts and activities?

BONUS TIP: Spend time in nature to calm stress

Just as I was editing this, I realised it was hard to find pictures of “pain flare ups”, so instead I went for a calming picture of nature, because spending time in nature is quite beneficial for a multitude of reasons, but simply put, time in nature calms our bodies and our minds, which is a massive key for anyone in pain.

Conclusions

Pain flare ups are a massive challenge for patients and practitioners alike, for many reasons.

As with most things, there is no quick fix, but you can definitely improve your experience of pain flare ups in the short term, whilst in the long term, a tailored pain management strategy can help reduce or even eliminate them.

 

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) Complex systems theory

(2) Neurobiology of pain

(3) Priming

(4) How expectations shape pain

(5) The subjective experience of pain

(6) Expectation of pain enhances response to non-painful stimuli

(7) ACT

How Your Mindset Impacts Your Pain

Mind

Most people think pain is a physical problem, because we feel it in our body.

Whilst this is not wrong, it is not completely right either.

This is because all pain has 3 components:

  1. “Bio” (biological – aka what is going on in the body)
  2. “Psycho” (psychological – what’s going on in the mind)
  3. “Social” (what’s going on in our environment)

You might be thinking, that doesn’t apply to me, “I strained my back shifting the couch, there’s nothing going on in my head or around me”.

That might be so, but, even if we strain out back moving furniture (an obvious physical cause to pain), by the time we experience pain, our brains have done a magnificent job of filtering the sensory information from our body via all our existing biases and preconceptions (“psycho” and “social”).

This simply means, if you’ve heard your grandfather complain about how getting old sucks because his back hurts, and if you’ve heard people talk about “wear and tear” or anything else about back pain, you brain, cool as it is, will consider this when deciding whether to produce pain that you feel “in your back”.

The fancy name to describe this, is a neurotag.

I like to think of it as a filing system in our brains.

When you see, hear, or read something about low back pain for instance, it goes in your “file” titled “low back pain”.

It doesn’t stop there. Neurotags, I mean, the filing cabinet in our brain, also cross reference.

So when your grandfather complains about being old and having low back pain, your brain files “low back pain” into the “old” file, and “old” into the “low back pain file”.

So, when you strain your back, causing the sensory nerves to start firing rapidly and bombard the spinal cord with messages of danger, your brain is pulling up all these files:

  • Danger is coming from the body
  • The danger seems to be around the low back
  • Low back pain
  • Old
  • Wear and tear
  • Can’t move
  • Never be the same

Or whatever else is stored in there. As you can imagine, over time, this could get pretty full.

All this means that even a “simple” low back strain is not so simple.

Some people are at a high risk of developing chronic pain, even from a relatively benign back strain. All because of the psycho-social factors involved. This is why it is important to always address all factors involved in your pain. After all, all chronic pain was acute at some stage. 

When it comes to treating pain, your mindset matters.

In general, there are two types mindsets that we can possess.  One can lead to a better recovery, while the other can actually impair your recovery.

The Two Types of Mindset

When it comes to our mindset, we either have a fixed mindset, or a growth mindset.

This concept was first described by a psychologist, Carol Dweck, who once had a teacher who arranged the seating order of the class by IQ. Whilst Dweck was actually in the number one position, she felt enormous pressure to maintain that position, whilst those lower in the order became resigned to their fate.

This teacher inspired Carol to conduct her own research, which lead her to conclude:

People with fixed mindsets believe that they were born with all the intelligence and talent they will ever have, and that this cannot change.

People with growth mindsets, as you might guess, believe that their abilities can expand and improve over time.

The vast majority of people who have had success in life, especially those who have had to overcome adversity, display characteristics of a growth mindset.

How Your Mindset Affects Pain

If you search for articles on “fixed vs growth mindset”, most of the results will be about personal development and business, but this concept can also apply to pain.

The easiest way to demonstrate this is with an example.

Let’s imagine two completely fictitious people, Danny and Danielle.

Danny

Danny, 30, is a rising star in the corporate world. He works his ass off every day to improve at his job – networking, learning persuasion and sales techniques, studying his field so he is on top of his game. He goes to the gym 5 times per week and ensures he eats well most of the time so he looks and feels good. On top of this, Danny has a daily ritual of visualising his success.

One day Danny starts to experience neck and shoulder pain. The onset wasn’t caused by anything in particular, but he did recall training extra hard that month.

Not wanting the pain to interrupt his life more than necessary, Danny seeks the help of an osteopath named Nick.

His osteopath formulates a treatment plan designed to get him back to full training in 4 weeks. In the mean time, Danny reads some articles Nick sent him and does some extra research on the topic from some trusted health sites he frequents.

At 4 weeks, Danny is not only pain free, but he has learnt about injury management and knows how to improve his gym workouts so that the issue doesn’t recur. In essence, he has come back stronger than ever.

Danielle

Now, let’s have a look at Danielle, 35, who is a public servant. Danielle enjoys her life – she works from Monday to Friday and enjoys exploring galleries and cafes on the weekends with her partner. At work she does what she has to do, but no more, thinking “if I’m not paid to do it, it’s not my responsibility”. Danielle feels like her life is pretty good, but she has one eye on retirement.

One day at work, Danielle starts experiencing neck and shoulder pain, and she recalls her mother having something similar due to her work as a seamstress and thinks to herself that it “must be genetic”. After talking to a colleague whose partner, Danny, had a similar problem and was able to resolve it after consulting an osteopath, she books an appointment with the same osteopath.

When she arrives for her consult, they discuss a treatment plan and get started. After a few days, there has been no change and Danielle loses motivation to do her home based exercises. She continues treatment for a few more weeks, as she enjoys the way manual therapy feels, but she is disengaged. After 6 weeks there is no change, and she is convinced her original thoughts were correct, and that her pain is “genetic” and “there is nothing she can do”.

Your Mindset Affects Your Behaviour

It should be obvious who has the growth mindset, and who has the fixed mindset, and as you can see, your mindset permeates every aspect of your life, including pain.

Having a growth mindset meant that Danny saw his pain as something that could be changed, if he changed what he was doing and improved (his knowledge, his body etc).

Having a fixed mindset limited Danielle’s recovery, as she saw her pain as her destiny (genetic), and thus was not inclined to try and change or help herself.

While pain is never simple, there are so many unseen factors, we can control much of our reaction to pain and what we do in the future. If you have the belief that you can grow and improve throughout your life, that it is likely this will extend to your beliefs around pain.

Can You Change Your Mindset?

This is the trickiest question to answer. People with a growth mindset will believe so, but people with a fixed mindset may not.

The science is unequivocal – our brains are plastic and can continue to change as long as we are alive.

As we change our thoughts and behaviours, our brain structure changes too.

If you want to change your mindset (wanting to change is key), then the best way is via actions.

You see, our brains are funny.

When we sit idle and think, especially about the future, our brains can get very creative. This can be a positive if you start thinking about where you want to be in 5 years and what you have to do to get there, but not so much if all this thinking does is keep you idling in place for another 1/2/5/oh-shit-where-did-my-life-go years.

It’s even worse if you start getting into negative thought spirals.

However, if we take action, any action, then our brains can’t get carried away. And, if we are smart, and start small, then we achieve a little success, we build confidence and momentum. Repeat this process long enough and you become a different person.

This, in essence, is mindfulness, but let’s call it something else – let’s call it momentum. Create momentum by starting small and before you know it, you have changed.

Really, My Back Hurts, How Does This Help Me?

In essence, it all boils down to this: are you resigned to having pain or looking for someone else to solve your problem (fixed mindset), or, are you willing to adapt, change and do what it takes to help yourself?

Some conditions are very easy to recover from, others very hard. What doesn’t change though, is that if you have no doubt in your mind you will improve, no matter what it takes, then you probably will*.

 

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) Wikipedia – Carol Dweck: https://en.wikipedia.org/wiki/Carol_Dweck

(2) Stanford News Service – Fixed versus growth intelligencehttp://news.stanford.edu/pr/2007/pr-dweck-020707.html

(3) NY Times – If You’re Open To Growth, You Tend To Grow: http://www.nytimes.com/2008/07/06/business/06unbox.html

(4) Brain Plasticity and Behaviour – https://www.psychologicalscience.org/journals/cd/12_1/Kolb.cfm

 

*Please don’t take this the wrong way if you suffer from chronic pain. This isn’t meant to belittle your pain or say you are not trying. The recovery rate for chronic pain is quite low, but many people learn to live fulfilling lives and manage their pain quite well. In part this comes from re-shaping their thoughts, emotions and behaviours around pain. Cognitive Behavioural Therapy (CBT) is quite helpful in this regard.

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?