From the Guidelines
Physical therapy (PT) plays a crucial role in the management of fibromyalgia, with a strong recommendation for aerobic and strengthening exercise as a first-line non-pharmacological treatment 1. The goal of PT in fibromyalgia management is to improve health-related quality of life by reducing pain, improving function, and addressing psychosocial context.
- A comprehensive PT program should include low-impact aerobic exercises, such as walking, swimming, or cycling, for 20-30 minutes, 2-3 times weekly, with gradual increases in duration and intensity as tolerated.
- Strength training with light weights or resistance bands, 2-3 times weekly, can help maintain muscle tone without triggering flare-ups.
- Stretching exercises should be performed daily to improve flexibility and reduce stiffness.
- Water-based therapy, such as hydrotherapy, is particularly effective as it provides resistance while reducing joint stress 1.
- Manual therapy techniques, such as gentle massage and myofascial release, can help alleviate trigger points and muscle tension. The PT program should be tailored to the individual patient's needs, preferences, and comorbidities, with a focus on shared decision-making and a multidisciplinary approach 1.
- Consistency is crucial, as benefits accumulate over time, typically showing improvement within 4-6 weeks of regular practice.
- PT works by gradually desensitizing the nervous system, improving blood flow to muscles, releasing endorphins, and breaking the pain-inactivity cycle that often worsens fibromyalgia symptoms. It is essential to note that the management of fibromyalgia should aim at improving health-related quality of life, balancing benefit and risk of treatment, and often requires a combination of non-pharmacological and pharmacological treatment modalities 1.
From the Research
Role of Physical Therapy in Fibromyalgia Management
The role of physical therapy (PT) in the management of fibromyalgia is multifaceted, aiming to reduce symptoms and improve quality of life. Key aspects include:
- Reducing pain and fatigue
- Improving physical function and capacity
- Enhancing sleep quality
- Addressing psychological distress
Types of Physical Therapy Interventions
Various physical therapy interventions have been studied for their effectiveness in managing fibromyalgia, including:
- Aerobic exercise training, which has been shown to improve health-related quality of life (HRQL), reduce pain intensity, and enhance physical function 2, 3
- Movement and body awareness therapies, such as tai chi, yoga, and Pilates, which can improve pain symptoms and overall well-being 4, 5
- Hydrotherapy and aquatic exercises, which may help reduce pain and improve physical function
- Manual therapy, including massage and trigger point injection, which can reduce muscle tension and pain
- Multidisciplinary therapy, combining different interventions for a comprehensive approach
Evidence for Physical Therapy Effectiveness
Studies have consistently shown that physical therapy can be an effective component of fibromyalgia management:
- A systematic review of aerobic exercise training found moderate-quality evidence for improvements in HRQL and low-quality evidence for reductions in pain intensity and fatigue 2
- A review of movement and body awareness therapies found positive results for pain symptom improvement and overall well-being 5
- Another study found that physiotherapy treatment, including active and passive approaches, had a positive effect on signs and symptoms of fibromyalgia, such as pain and physical capacity 4
Considerations for Physical Therapy Implementation
When implementing physical therapy for fibromyalgia management, considerations include:
- Individualizing treatment protocols based on patient needs and preferences
- Ensuring adequate treatment duration and frequency
- Monitoring progress and adjusting interventions as needed
- Combining physical therapy with other management strategies, such as medication and education, for a comprehensive approach 6