I remember as a child when people would tell me about someone with fibromyalgia. It was a diagnosis that they felt meant nothing, and they often treated that person as if what was happening was their own fault, something entirely in their head. I would not argue that even today we have a perfect understanding of how this process works on the human body, or that every doctor is off the blame game bandwagon, but I think sharing what we know and how different things can help is a great weapon for patients trying to overcome!
I have seen a variety of theories for the cause of fibromyalgia, we seem to know more about what it is now, but I have yet to hear a consensus to why. We know that fibromyalgia causes a hyper-reactivity in our nervous system, that what should feel like a small amount of pressure or strain sends the signal to the brain of a far greater amount. We know that this can cause the body to guard these areas heavily as well in a protective response, resulting in active points of tissue that have difficulty downgrading their threat level and creating further tender points. We know that this combination in any individual injury would cause a lot of pain, and we understand that this is happening at a systemic level in these patients.
A traditional response to this systemic response has been medication, attempting to decrease global nerve sensitivity by slowing down the entire system. It’s not a bad approach at all, but it’s far from the only thing we can do to help, and understanding a little about the nervous system can go a long way in understanding why your doctor wants you to exercise when it REALLY does not want to.
Our nervous system is described as “highly plastic,” which means that it is wonderfully adaptable, even in the face of a pathology like fibromyalgia. When I have patients with hypersensitive single regions after an injury, I apply very light load over that area so that the brain learns that this level is safe, down-regulating threat response and in turn decreasing the amount of pain felt in that region. I also work with patients to slowly load joints and tissues in non threatening ways with specific exercises so that the local nerves allow more force and strength in the area, using that plasticity to allow the body to adapt a little at a time to accepting more and more work while it feels less and less pain and threat.
So if that works at an individual injury level, why wouldn’t this work on the global level with fibromyalgia? We have a nervous system perceiving threats at a higher level (check), tissue loading protected to prevent higher pain (check), the only difference is that this is happening all over, not just locally. So can the nervous system still adapt? You’re darn right it can!
This process, known as a progressive loading protocol, works at utilizing pressures and exercises beginning at a low load and adding to them as the body learns that they are non threatening. It’s a process that takes good communication between both your healthcare practitioners and you as everyone needs to be on the same page in regards to how much is too much, and what is tolerable. You as a patient should feel listened to and respected, and you should in turn work hard to understand the ways that your body is changing so that you can give the best feedback possible, learning to differentiate the normal post-exercise soreness that we all feel from the heightened level of threat your body perceives from what it considers overuse. Every human body has limits, and this protocol works in steps to increase yours until it matches the “average,” and hopefully going beyond!
Sound exciting? I certainly think so! By learning to utilize the adaptability of the body, we can take control of our situation! Plus, now that there is legitimate scientific understanding, the voodoo of “exercise is medicine” becomes far more, a real and evidence based treatment!
- Written by: Alec Martinez, DPT