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The word fibromyalgia comes from the Latin term for fibrous tissue (fibro) and the Greek ones for muscle (myo) and pain (algia). Fibromyalgia syndrome is chronic disorder which includes widespread muscle pain, fatigue, and multiple tender points that affects about 1.5 million people in the UK. For reasons that are unclear, more than 90% of those who develop fibromyalgia are women. It is not currently known whether the predominance of women who suffer from fibromyalgia is a phenomenon of the socialisation of women in the westernised culture or whether it is some combination of the female reproductive hormones and other genetic predispositions.
According to the American College of Rheumatology (ACR), fibromyalgia is defined as a history of pain in all four quadrants of the body lasting more than 3 months. Pain in all four quadrants means that you have pain in both your right and left sides, as well as above and below the waist. The ACR also described 18 characteristic tender points on the body that are associated with fibromyalgia. In order to be diagnosed with fibromyalgia, a person must have 11 or more tender points. In addition to pain and fatigue, people who have fibromyalgia may experience:
Fibromyalgia is often confused with another condition called "myofascial pain syndrome" or "myofascitis." Both fibromyalgia and myofascitis can cause pain in all four quadrants of the body and tend to have similar tender point locations, but the two conditions are worlds apart. Myofascitis is an inflammatory condition due to overuse or injury to your muscles, whereas fibromyalgia is caused by a stress-induced change in metabolism and healing. Myofascitis tend to come on rather suddenly and is usually associated with a particular activity or injury, true fibromyalgia has a slow, insidious onset, usually beginning in early adulthood. It is very important to diagnose each of these correctly, for they require very different approaches to treatment. Unfortunately, fibromyalgia is a chronic condition, meaning it lasts a long time - possibly a lifetime. However, it won't cause damage to your joints, muscles, or internal organs.
The latest research indicates that fibromyalgia is a stress-related condition that is a cousin in Systemic Lupus Erythematosis (often referred to as simply 'lupus') and Chronic Fatigue Syndrome. In all three of these conditions, there is the same predominantly female distribution, chronic fatigue, sleep disturbances, irritable bowel, as well as many other similarities. You can think about these three conditions as lying on a continuum with Fibromyalgia on one end, Lupus on the other and Chronic Fatigue Syndrome in the middle. All three of these conditions are caused by an abnormal stress response in the body, but with Lupus, the immune system is primarily affected, causing an autoimmune reaction that attacks your healthy tissues. On the other end of the spectrum is fibromyalgia, where metabolic abnormalities are primary. These metabolic changes are the result of a stress-induced decrease in blood flow to an area of the brain called the pituitary. This, in turn causes a decrease in a number of important hormones, such as the growth hormone releasing hormone (somatotropin) and the thyroid stimulating hormone. These hormonal changes lead to abnormal muscle healing, borderline or full-blown hypothyroid, as well as memory and cognitive changes.
One of the major physical abnormalities that occurs with fibromyalgia lies in the muscle itself, where there is a build up of a protein called "Ground Substance." Ground substance is normally found in muscle, bone and connective tissue all over the body and is responsible for making the tissues stronger and less susceptible to tearing. In a normal person, when a muscle is injured, the muscle tissue itself is able to regenerate and over time, completely heal itself. In a person with fibromyalgia, the muscle is unable to completely heal itself. Instead, an abnormally large amount of ground substance builds up in the injured area. It is the ground substance, coupled with local muscle spasm it creates that creates the muscle 'knots' associated with fibromyalgia.
A number of tests may be done to rule out other disorders and an examination can reveal whether a person has the characteristic tender areas on the back of the neck, shoulders, sternum, lower back, hips, shins, elbows, or knees. Unlike its cousin lupus, there are currently no diagnostic laboratory tests for fibromyalgia. Because there are no clinical tests for fibromyalgia, some doctors, unfortunately, conclude that a patient's pain is not real, or they may tell them that there is little they can do. But a combination of non-invasive spinal care, trigger point therapy, and lifestyle changes has proven to be very effective in decreasing the severity and duration of the physical pain and disability of fibromyalgia.
Fibromyalgia can be difficult to treat. Not all doctors are familiar with fibromyalgia and its treatment, however, our wellness experts are. Fibromyalgia treatment often requires a team approach, utilising spinal care, trigger point therapy, massage, dietary changes, as well as exercises and stretching.
Non-invasive spinal care is critical for those who suffer from fibromyalgia in order to keep the spine and muscles from losing too much movement. Because fibromyalgia causes the muscles to tighten up and lose some of their natural pliability, it results in a global loss of movement in the spine. The loss of movement in the spine results in a neurological reflex that causes the muscles to tighten further. This vicious cycle will continue and over time will lead to increased pain, increased muscle tightness, a loss of movement, more difficulty sleeping and the development of more and more trigger points.
The only option is to continually adjust the spine and keep it moving. It is not uncommon for those with fibromyalgia to be adjusted three to four times per month to keep everything mobile and relaxed. The biggest concern in treating people with fibromyalgia is that their muscles have a diminished healing ability. For this reason, spinal adjustments are usually modified slightly to be more gentle than normal. This helps to decrease the stress on all of the small supporting muscles of the spine, which can be easily injured. It is important when seeking spinal care, to make sure that the doctor is familiar with the muscular changes that occur with fibromyalgia so that they can adjust their treatment accordingly. We make sure our wellness experts are familiar with the the changes that occur with fibromyalgia.
The overwhelming characteristic of fibromyalgia is long-standing, body-wide pain with defined tender points, and frequently, trigger points. Trigger points are often confused with "tender points." They are not the same. A trigger point needs firm pressure to elicit pain, while tender points are painful with even very light pressure. Trigger points will refer pain to other areas of the body, whereas tender points will not. Unlike tender points, trigger points can occur in isolation and represent a source of radiating pain, even in the absence of direct pressure. As discussed earlier, trigger points are purely comprised of spasmed muscle fibers, whereas tender points are knots filled with ground substance. Those with fibromyalgia almost always have a combination of the two - trigger points and tender points - and can improve dramatically with light trigger point therapy.
Trigger point therapy for fibromyalgia is much like trigger point therapy for low back pain, neck pain or headaches. The points are the same. The difference is just intensity. Since the muscles in patients with fibromyalgia are easily injured and take longer to heal, it is necessary to use less pressure on their trigger points.
Your day to day lifestyle choices have a tremendous impact on how much impact fibromyalgia will have on your life. The difference between those who take care of themselves and those who do not is tremendous. Those who make lifestyle changes to help their fibromyalgia suffer much less pain, are able to remain more active and have a much higher quality of life than those who do not. If you have fibromyalgia, here are some of the main things that you can do on a daily basis to help your body:
Getting enough sleep and the right kind of sleep can help ease the pain and fatigue of fibromyalgia, but is something that can be hard to get. Many people with fibromyalgia have problems such as pain, restless legs syndrome and brain-wave irregularities that interfere with restful sleep. Insomnia is very common. Although alcohol may help you to relax, it is not recommended before bed as it has been shown to interfere with restful sleep. Some of those with fibromyalgia have found 5-hydroxy tryptophan (5-HTP) very helpful, as well as the prescription anti-depressant amitriptyline. Typically, we don't recommend taking perscritpion drugs, but in this case, it is difficult to heal without enough sleep.
Improved fitness through exercise is recommended. Studies have shown that fibromyalgia symptoms can be relieved by aerobic exercise. Though pain and fatigue may make exercise and daily activities difficult, it's crucial to be as physically active as possible. The best way to begin a fitness program is to start with low impact exercises, like walking and swimming. Starting slowly helps stretch and mobilise tight, sore muscles. High-impact aerobics and weight lifting could cause increased discomfort, so pay attention to your body. The more you can exercise, the better off you will be.
Most people with fibromyalgia are able to continue working, but they may have to make big changes to do so. It may be necessary to reduce the number of hours at work, find a job that will allow you to have a flexible schedule, or switch to a less physically demanding job. Many people with fibromyalgia require specially designed office chairs, adjustable desks or other adaptations in order to continue working. If you face obstacles at work, such as an uncomfortable desk chair that leaves your back aching or difficulty lifting heavy boxes or files, your employer may make adaptations that will enable you to keep your job.
Foods, just like anything else, have the ability to either stress your body or to help your body heal. Foods that tend to be stressful on the body include: dairy, eggs, wheat, corn, as well as anything with monosodium glutamate (MSG), nitrates or nitrites (as are found in processed foods). Several environmental toxins may also contribute to the overall physical stress on your body, therefore fish should be avoided as well. It is important that you eat as much clean, raw, organically grown fresh foods as possible. Base your diet around live foods such as: vegetables, fruits, roots, nuts and berries.
There are dozens of nutritional products that claim to be 'the answer' for fibromyalgia. To date, none of them have proven to be of much long-term benefit for anyone. However, there are some people who have used magnesium malate with good results, some people who have used ginkgo biloba with good results and others with various herbals. The bottom line with nutritional supplements is that, do date, there is nothing that works for everyone. If you come across something that you would like to try, by all means do so, as long as you check it out with our wellness experts first to ensure that it won't interfere with any of your other treatment.
At the Atlas Wellness Centre in Bedford we have many experts that specialise in natural interventions for a variety of conditions. Our team is made up of two former doctors of chiropractic who have gone on to specialise in advanced techniques to rehabilitate spinal abnormalities/injuries, nerve damage, and offer first class education in nutrition and exercise science all of which can help with fibromyalgia. We also have one chiropractor, one sports therapist and three massage therapists on the team, all of whom work as a team to reverse the root cause of fibromyalgia. Contact our clinic today!
Effects of resistance training and chiropractic treatment in women with fibromyalgia. L. Panton, et. al. J Altern Complement Med. 2009 Mar;15(3):321-8.
Chiropractic management of fibromyalgia syndrome: a systematic review of the literature. Michael Schneider, DC, PhD, Howard Vernon, DC, PhD, Gordon Ko, MD, Gordon Lawson, MSc, DC, and Jerome Perera. J Manipulative Physiol Ther. 2009 Jan;32(1):25-40.
Movement and massage therapy reduce fibromyalgia pain. Field T., Delage J., Hernandez-Reif M. Journal of Bodywork and Movement Therapies (2003) 7(1),49-52.
A combined ischemic compression and spinal manipulation in the treatment of fibromyalgia: a preliminary estimate of dose and efficacy. Hains G., Hains F. J Manipulative Physiol Ther. 2000 May;23(4):225-30.
The effectiveness of chiropractic management of fibromyalgia patients: a pilot study. Blunt KL, Rajwani MH, Guerriero RC. J Manipulative Physiol Ther. 1997 Jul-Aug;20(6):389-99.
Effects of aerobic exercise on pain perception, affect, and level of disability in individuals with fibromyalgia. D. Nichols, T. Glenn. Physical Therapy, Vol.74, No.4, April 1994.
Diagnosis and treatment of fibromyalgia syndrome. S. St.Claire. Journal of the Neuromusculoskeletal System, 2:101-111,1994.
Dependence of tender points upon posture - a key to the understanding of fibromyalgia syndrome. K. Hiemeyer, R. Lutz and H. Menninger. Journal of Manual Medicine (1990) 5:169-174.
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" ... it's just amazing!"
Malcolm & Pat Pete
Atlas Wellness Centre (Atlas): Can you tell me your names, please?
Malcolm: Yes, Malcolm James Pete.
Pat: Pat Pete.
Atlas: And what made you want to come and see us in the first place.
Malcolm: Well, I’ve been suffering with severe pain in lower back and legs for two, three years really. I had several hip operations which supposedly were designed to cure the problem. But they had absolutely no effect and I would say in desperation, I saw your advertisement in the local paper. It sounded very good. So I thought, “Let’s give this a try.”
Atlas: And how would you say that having the health problems affected your life before you came in?
Malcolm: It stopped me doing most things that I enjoy doing. I couldn’t walk. I couldn’t go for walks. I couldn’t garden. Found it extremely difficult to do any jobs around the house and was virtually confined to a wheelchair.
Atlas: And how would you say things have changed since you started having the care here?
Malcolm: Since I’ve had the care, I’ve lost 95 percent of all the pain that I was suffering with. I rarely use the wheelchair now unless in fact I’m – got a lot of walking to do and I can rely on a walking frame and now I can get about comfortably with a walking frame. My only problem now is that it has been so long since I’ve walked that I’ve got to build up my stamina and balance before I can really try to walk without any support at all.
Atlas: And Pat, would you say you noticed changes with Malcolm?
Pat: Definitely. He’s not taking any painkillers now. He was on quite a lot of painkillers. Within about three weeks to a month, he had dispensed with all the painkillers. It’s so good for both of us. He’s much more independent. I don’t have to push him around in a wheelchair, so it has made a lot of difference to my life too. Yeah, it’s just amazing!
Atlas: Excellent. What would you say to someone who’s maybe a bit worried, a bit – about coming here for the first time?
Malcolm: I would tell them to come along without any concerns at all. I found the people – all of the people I’ve come in contact with to be very helpful. They explain what’s going to happen and there’s absolutely nothing to worry about. But the benefits can be immense.