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 modality 1. The goal of PT in fibromyalgia management is to improve health-related quality of life by reducing pain, improving function, and addressing associated features such as depression, fatigue, and sleep disturbance.
Key Components of Physical Therapy for Fibromyalgia
- Aerobic exercise, such as walking, swimming, or cycling, for 10-15 minutes daily, gradually increasing to 30 minutes 3-5 times weekly as tolerated
- Strengthening exercises to improve muscle function and reduce pain
- Gentle stretching exercises for 5-10 minutes daily to improve flexibility and reduce muscle tension
- Specific techniques like myofascial release to relieve pain points
- Heat therapy (warm baths, heating pads) and cold therapy (ice packs) for temporary pain relief
- Water-based exercises in warm pools to reduce joint stress while providing resistance
- Tai chi and gentle yoga to improve balance, body awareness, and reduce stress
Importance of Tailored Approach
Working with a physiotherapist experienced in treating fibromyalgia is essential to ensure exercises are appropriately tailored to the individual's specific needs and limitations 1.
Evidence-Based Recommendations
The 2017 EULAR revised recommendations for the management of fibromyalgia emphasize the importance of a multidisciplinary approach, including non-pharmacological and pharmacological treatment modalities, with a strong recommendation for aerobic and strengthening exercise 1.
Prioritizing Patient Needs
The management of fibromyalgia should aim at improving health-related quality of life, balancing benefit and risk of treatment, and considering patient preferences and comorbidities 1.
Ongoing Research and Updates
The committee recommended an update after 5 years to determine whether new therapies have emerged and whether further trials have been conducted for therapies with relatively little current evidence 1.
From the Research
Role of Physical Therapy in Fibromyalgia Management
- Physical therapy (PT) plays a crucial role in the management of fibromyalgia, with various studies highlighting its effectiveness in reducing pain and improving quality of life 2, 3, 4.
- Aerobic exercise, strength training, and movement therapies such as yoga and tai chi have been shown to be beneficial in improving pain intensity and quality of life in patients with fibromyalgia 2, 3, 4.
- The optimal dose of aerobic exercise for pain reduction in fibromyalgia has been found to be 2-3 times per week, for 25-40 minutes per session, with a gradual increase in intensity over 6-12 weeks 4.
- Multidisciplinary rehabilitation programs, which include physical therapy, have been shown to improve self-efficacy and ability to cope with the illness in patients with fibromyalgia 5.
- Physical therapy can be used in conjunction with other treatment modalities, such as cognitive behavioral therapy (CBT), to provide a comprehensive management plan for fibromyalgia 6.
Types of Physical Therapy
- Aerobic exercise: walking, swimming, cycling 2, 4
- Strength training: resistance exercises to improve muscle strength 2
- Movement therapies: yoga, tai chi, belly dance 3
- Body awareness therapies: affective self-awareness, Resseguier method 3