Physical therapists at Manning Physical Therapy and Sports Medicine in Pittsburgh, PA, help fibromyalgia patients shift their focus to lifestyle changes rather than on the chronic problems of pain, stiffness and fatigue.
Learning proper posture techniques allows efficient muscle function and helps patients avoid undue fatigue and pain. Slow stretching exercises help improve muscle flexibility. Relaxation exercises help reduce muscle tension.
Those with the condition tend to suffer from sleep deprivation and depression, often complain of difficulty carrying out activities of daily living, and have difficulty working and doing housework. In fact, 80 percent of the patients who comprise this population report serious problems sleeping.
Even though the cause of fibromyalgia is unknown, it's a real diagnosis. Many sufferers have been told by family members or other doctors that they are imagining or making up the pain and other symptoms associated with fibromyalgia.
Beginning with the Right Diagnosis
"It's extremely important that these patients are diagnosed by the right practitioner," said Patrick M. Manning, MPT, ATC, owner of Manning Physical Therapy and Sports Medicine. "A rheumatologist is the best person to diagnose the condition. If a patient hasn't seen a rheumatologist, then we recommend making an appointment."
According to Manning, fibromyalgia is a diagnosis of exclusion, and therefore, is based on gathering a subjective history of the patient. There is no diagnostic test that shows a patient has fibromyalgia.
"Society is so accustomed to having the results of an X-ray, MRI, or blood work to reveal a diagnosis," shared Manning. "But with fibromyalgia, we have to delve into the patient's history to determine the diagnosis."
Most tests show nothing out of the ordinary in the anatomy of people with fibromyalgia. However, health care providers may perform these tests to rule out other conditions. Chronic fatigue syndrome (CFS) and fibromyalgia share many symptoms, especially the severe exhaustion, and may need to be ruled out. The major difference is that CFS causes flu-like symptoms, such as low-grade fevers, sore throats and swollen lymph nodes.
"It's most common that the patient is female and her pain usually presents in the neck, shoulder and back regions," explained Mark J. Orsi, MS, MPT, Manning Physical Therapy and Sports Medicine. "A recent patient I had appeared to be depressed, had a flat affect, and a lot going on with stress, anxiety and lack of sleep. There were numerous tender points in her neck and back. I knew her diagnosis right away." 
The symptoms of fibromyalgia are long lasting and intense but can vary from day to day. Symptoms include pain and stiffness throughout the body, with especially tender points near certain joints; a feeling of exhaustion that sleep often does not remedy; tension headaches; numbness or tingling in the arms, hands and/or feet; irritable bowel syndrome; intense PMS pains in women; depression; morning stiffness; swelling sensation; bothered by light, odors and/or noise; poor concentration and memory loss; changes in vision and sore glands.
"We look at the whole scope of a patient and then design a treatment plan based on what is uncovered," explained Orsi. "Getting the patient to self-manage is the most important tactic."
Fibromyalgia often occurs along with other conditions, such as other forms of arthritis, Lyme disease or thyroid problems, and can develop after a serious injury.
The telltale signs and symptoms of fibromyalgia are depression, sleep deprivation and pain. Pain is present in soft tissues throughout the body and tends to concentrate in spots such as the neck and lower back. The tender spots don't seem to be inflamed.
The PTs often recommend that their patients consider a support group because fibromyalgia can be a devastating diagnosis. It's important for fibromyalgia patients to talk to someone else who has the same diagnosis.
"We treat aggressively and then make sure they are getting care somewhere else, if needed," Manning shared.
Managing Pain
The first step at Manning Physical Therapy and Sports Medicine is to help fibromyalgia patients understand the complex and frustrating disease. Many patients are relieved to learn that the disease is not all in their heads, and that the PTs are able to develop a program to help manage pain and combat exhaustion.
According to Manning, the best treatment for fibromyalgia is arming his patients with education. "We need to educate these patients because they have a chronic condition," he said. "I can't treat them forever so they need to learn to exercise to maintain mobility."
These patients are often hesitant to exercise for a variety of reasons. The patient population tends to be noncompliant because of the depression and lack of sleep commonly associated with the condition. Some are afraid of exacerbating the pain they are experiencing and others simply feel too tired to exercise.
"These patients need to manage their disease aggressively and get on an exercise program or fibromyalgia is going to take hold of their lives," Manning observed. "We educate about the likely prognosis and show them how to manage it and get the help they need."
The PTs teach patients that aerobic exercise helps patients sleep by increasing serotonin in the brain and that gentle stretching can effectively help with limited range of motion issues. The PTs also instruct the patients how to do gentle strengthening exercises with light weights and high repetition to build strength.
The PTs create an individualized caring treatment plan for each patient and make recommendations aimed at improving a person's ability to carry out activities of daily living. According to Orsi, the main focus is on relieving symptoms and improving function.
"We educate our patients on self-management techniques," Orsi explained. "Patients need to be mindful of reducing stress, doing physical activity, monitoring exertion rates and making nutrition improvements."
The diagnosis is one that is not well understood. "We have to take a multifaceted approach," Orsi said. "All other causes of a patient's symptoms should be ruled out before this diagnosis is made."
In the case of a patient who has shoulder impingement, for example, the PTs might discover the patient has weakness of the rotator cuff. "It's easy to identify those cases and perform specific interventions to treat and improve the condition," Orsi explained. "But with fibromyalgia, we must figure out what is contributing to the tender points in the patient's joints."
Self-stretching, gentle strengthening and being compliant are the most important factors with this patient population. "We believe in providing positive reinforcement, identifying contributing factors or triggers to a patient's problem, educating them appropriately and making the patient believe in us as clinicians," Orsi explained.
Pathway to Compliance
The plan of care for fibromyalgia patients has a wide base, according to Manning. Patients may require as little as four to six visits or as many as 16 to 20 visits depending on the patient's impairments, cardiovascular endurance, range of motion, strength and ability to carry out ADLs.
"We focus on transitioning our patients to a home exercise program," Manning explained. "Massage is helpful but we cannot do that for the patients forever. Improving range of motion, strength and cardio endurance needs an active approach." Patients must be willing to make lifestyle changes as well as pay attention to their psychological health to help control the symptoms. The PTs recommend incorporating more walking, parking far away from the entrance of a store while running errands, sleeping on one firm pillow (not two), and flipping their mattress once a month.
According to Orsi, certain times of the year can trigger symptoms. Seasonal mood disorder, for example, may affect some patients in the winter because they are less active and daylight is shorter. "I educate patients on coping techniques to combat shortened daylight hours such as going for a walk at the mall or joining a gym," he explained.
Other treatments or lifestyle changes recommended include exercise, biofeedback, meditation, acupuncture, pain medication, anti-inflammatory drugs, cortisone injected into painful points, ultrasound treatments, massage, heat for temporary pain relief and counseling to help deal with the symptoms.
The PTs stress that these patients must be active participants for at least three months before they will see significant improvements. "We need our patients to make the commitment," Orsi said. "There is no magic cure but with commitment, they should be feeling somewhat better in 12 weeks. They need to establish healthy habits and continue the program."
Recent studies show that about 25 percent of patients treated for fibromyalgia were in remission at the end of two years. Many others have reduced their pain to tolerable levels.
Rebecca Mayer is senior regional editor at ADVANCE and can be reached at rmayer@advanceweb.com