Living with Fibromyalgia Tender Points: Strategies for Coping and Management

Rimsha Manzoor August 20, 2023

Unraveling the Fibromyalgia Enigma

Fibromyalgia, often misunderstood due to its complex nature, is a chronic medical disorder characterized by widespread pain throughout the body, along with tenderness in specific points on the body. Fibromyalgia is often followed by other symptoms like fatigue, sleep disturbances, cognitive issues (sometimes referred to as "fibro fog"), and mood disorders such as depression and anxiety.




Tender Points: A Unique Fingerprint

One of the defining features of fibromyalgia is the presence of tender points. When pressed, they evoke discomfort or pain. Presence of pain in at least 11 of 18 specific tender points helps in diagnosing fibromyalgia. These tender points were located as follows:

  • Occiput (base of the skull)
  • Cervical area (front of the neck)
  • Trapezius (upper back and shoulder)
  • Supraspinatus (shoulder blade area)
  • Second rib (upper chest)
  • Lateral epicondyle (outer part of the elbow)
  • Gluteal (buttocks)
  • Greater trochanter (hip)
  • Knee (inner part of the knee)




Risk factors of Fibromyalgia

Central Nervous System Abnormalities:
People with fibromyalgia often experience "central sensitization." It's thought that the brain amplifies pain signals, leading to increased pain perception.

Neurochemical Imbalances:
Imbalances in certain neurotransmitters, for example, low levels of serotonin (which affects mood and pain perception) and abnormal levels of substances like substance P (which is involved in transmitting pain signals) have been observed.

Physical Trauma:
Physical injuries, accidents, or infections can trigger the onset of fibromyalgia in some individuals. It's thought that these events might trigger a heightened pain response in susceptible individuals.

Stress and Trauma:
Emotional or physical stress and traumatic events have been suggested as potential triggers for fibromyalgia. Chronic stress might lead to changes in the body's stress response systems, which could contribute to the development of the condition.

Sleep Disturbances:
Sleep disorders, such as sleep apnea or restless legs syndrome, are common in people with fibromyalgia. Sleep disturbances might contribute to the development of the condition or exacerbate its symptoms.

Differential Diagnosis of Fibromyalgia

Differential diagnosis of fibromyalgia includes various conditions that can cause widespread pain and other symptoms similar to those seen in fibromyalgia. It's important to differentiate fibromyalgia from these conditions to ensure proper treatment.

The Role of Physiotherapy

As a physiotherapist, the focus is on empowering individuals to lead activities of daily living, despite the challenges posed by fibromyalgia. Here's how physiotherapy can be your steadfast ally in this journey:

Pain Management:

Pain is a central aspect of fibromyalgia, it is important to manage it effectively. This involve various techniques such as heat or cryotherapy and transcutaneous electrical nerve stimulation (TENS) to help reduce muscle tension and alleviate pain.


Recommended Exercises for Fibromyalgia:

Developing a  exercise program is crucial in fibromyalgia, it includes low-impact aerobic exercises. Aerobic exercise can improve quality of life, pain, stiffness and overall physical function of the individual. It is associated with reduced anxiety mostly in adults. Some common exercises are:

Aquatic physiotherapy

It is practiced in water temperature maintained between 32 and 33°C. Aquatic exercises decrease the pain cycle and promotes vasodilating action, analgesia through the release of endorphins and increased capillarization. Relaxation is obtained with warm water which in turn reduces muscle contractures, helping to improve microcirculation

Other activities like walking or stationary cycling  help improve cardiovascular fitness, increase endorphin release (which can help with pain), and enhance overall stamina.


Stretching Exercises:

Stretching exercises improves flexibility which can be highly beneficial. It lengthens the muscles and enhancing joint mobility to reduce stiffness and discomfort. These exercises are prescribes as a warmup or cool-down regimens, rather than being a stand-alone treatment intervention.

Stretching exercises are also used as a part of a relaxation technique. One method is modified Pilates method, it mobilize, stretch and strengthen the muscles.


Strengthening Exercises:

Building muscle strength is essential to support your joints and improve overall functional capacity. It is important to do a progressive resistance training program using light weights or thera bands. This will help build strength without causing excessive strain on your muscles.

Fibromyalgia also occurs in post-menopausal women. One main advantage to them is that they have  neuromuscular ability to gain strength, which may help improve and maintain functional mobility and reduce the risk of falls later in life.

 

Kinesio Taping Technique:

In fibromyalgia, kinesio taping is often used to provide support, reduce pain, and enhance the body's awareness of movement and posture. It can be used for the following purpose:

Localized Pain Relief:

  1. Identify the areas of localized pain or discomfort.
  2. Apply the tape over these areas using an "I" or "Y" strip technique, depending on the size and shape of the area.
  3. Apply gentle tension to the tape as you apply it, creating a slight lift in the skin.


Muscle Support:

  1. Identify the muscles that are experiencing weakness or fatigue.
  2. Apply the tape along the length of the muscle, using a "muscle facilitation" or "muscle inhibition" technique.
  3. For muscle facilitation, apply the tape with light tension to provide support and encourage muscle activation.
  4. For muscle inhibition, apply the tape with less tension to reduce excessive muscle activity.


Lymphatic Drainage and Swelling:

  1. If swelling or localized fluid retention is an issue, apply the tape using a "fan" or "web" technique to encourage lymphatic drainage.
  2. Ensure that the tape is applied with a slight stretch, creating space between the skin and underlying tissues. 


Tension Relief:

  1. For areas with tension or tightness, apply the tape using techniques that help release tension and provide a sense of relief.
  2. Use a "space correction" or "fascia" technique to create a lifting effect on the skin.

 

Education and Self-Management:

Incorporating relaxation and stress-reduction techniques into daily routine reduces chances of fibromyalgia. Improving posture and body mechanics also help in decreased occurrence rate. Sleep Improvement Strategies help in fibromyalgia. Individual should practice sleep hygiene and relaxation techniques that can help you achieve more restful sleep.


Clinical scenario involving a patient with fibromyalgia:

Meet Sarah, a 35-year-old woman who comes to a physiotherapy clinic with a history of widespread pain, fatigue, and sleep disturbances. As a physiotherapist, the primary goal is to assess her condition and develop a personalized treatment plan to address her symptoms.


Assessment:

During the initial assessment, Sarah explains that she has been experiencing persistent pain for several months. She describes the pain as a constant dull ache that affects various parts of her body, including her neck, shoulders, lower back, hips, and knees. She also mentions tenderness at specific points when pressure is applied. These points align with the classic tender points associated with fibromyalgia.


Functional Limitations:

Sarah's pain is significantly impacting her daily life. She mentions that she's finding it increasingly difficult to engage in her usual activities, such as going for walks, doing household chores, and even enjoying hobbies she used to love. She often wakes up feeling unrefreshed despite having slept through the night.


Medical History:

The physiotherapist inquires about Sarah's medical history and any potential triggers. She recalls that the symptoms began after a period of high stress at work and a minor car accident that left her with neck and back discomfort.

 

Physical Examination:

During the physical examination, physiotherapist performs gentle palpation on the tender points to confirm their sensitivity. Sarah confirms that these points indeed cause discomfort when touched. Her range of motion is slightly limited due to muscle stiffness, and she demonstrates poor posture, particularly in her neck and shoulders.


Treatment Plan:

Based on the assessment findings, the physiotherapist develops a comprehensive treatment plan for Sarah:

 

  1. Pain Management: He explains the importance of pacing herself and avoiding overexertion. He uses hot pack and gentle massage techniques to alleviate muscle tension.
  2. Exercise Program: A tailored exercise routine is designed that includes low-impact aerobic activities like swimming and guided stretching exercises to improve flexibility and joint mobility.
  3. Strength Training: To address her muscle weakness, physiotherapist integrates resistance training using light weights and thera band to gradually build strength.
  4. Posture Correction: He provides guidance on maintaining proper posture during daily activities to reduce strain on her muscles.
  5. Sleep Hygiene: He discusses strategies for improving sleep quality, including setting a consistent sleep schedule and creating a calming bedtime routine.
  6. Stress Management: The physiotherapist introduces relaxation techniques such as deep breathing, meditation, and mindfulness to help Sarah manage stress and reduce its impact on her symptoms.
  7. Education: Throughout the sessions, he educate Sarah about fibromyalgia, its triggers, and self-management strategies to empower her in her journey.


In fibromyalgia, the goal is to gradually improve pain levels, enhance functional abilities, and equip with tools to manage symptoms effectively.

 

 

 

 

 

 

 

 

 

 

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