Physical Therapy for Fibromyalgia

Fibromyalgia, a condition that about 3 to 6 percent of people experience, is associated with widespread pain throughout the body. It is often accompanied by trouble sleeping, focusing, depressed mood and fatigue. The condition is believed to be linked to “sensitization” where nerve pathways in the brain, spinal cord and body function in a sensitized neurochemical state. Previously, it was believed to be a local problem with the health of the muscles and soft tissues of the body. Now, the focus is on the systemic neurological, hormonal and inflammatory processes of sensitization.

Like all health conditions, the factors that influence it are complex. Examples include diet, stress, genetics and epigenetics (how genes interact with the environment and experiences of life). In the biopsychosocial model of care, which is recognized as an important approach to improving health and well-being, addressing symptoms from the whole-person approach is critical. This necessitates exploring factors that may have contributed to the onset of the symptoms. Subsequently working with exercise, hands-on therapy, mind-body skills training (meditation, relaxation, biofeedback) and yoga practices are considerations. Additionally, exploring one’s relationship to food, eating and gut health; stress; and emotional awareness and expression may be useful.

One important link in the body’s integrated systems that is being researched is the “autonomic nervous system” which regulates many of the body’s functions, mostly below our awareness. This includes examples such as heart rate, sweating, digestion and temperature. The sympathetic nervous system can be likened to a gas pedal. It mobilizes our body’s resources to respond to any demand such as exercise, and even psychological stress. If we get too much of this, it is known as the “fight or flight” response. The other division is called parasympathetic and represents a counterbalancing “brake pedal”. In healthy levels, this is known as “rest and digest” and is associated with safety and relaxation. If this system becomes excessive, especially in response to stress, it is known as the “freeze” response where the system shuts down.

Imbalance in this delicate dance is increasingly understood to be involved in some way in nearly all health problems. Restoring balance, which can be achieved through approaches that teach “self-regulation”, is useful for management of all health problems. At the least, we can learn improved self-care to manage and improve our relationship to our health experience. At the best, sustained transformation to our health is possible.

Traditionally, physical therapy has been seen as exercise focused. Exercise, or perhaps a better word, movement, is essential for health. Discovering our relationship to movement and what works for us is an important goal. Exploring some of the other levels in an integrative physical therapy approach, will contribute to our sense of self-efficacy in the experience of fibromyalgia.

Matt Erb is a physical therapist at Simons Physical Therapy, located at 8703 E. Golf Links Rd., in Tucson. Connect at 520-514-1114 or

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