What is Fibromyalgia? Where are the 18 tender points of fibromyalgia?

Fibromyalgia is a disorder that causes muscle pain and fatigue (feeling tired). People with fibromyalgia have “tender points” on the body.

These tender points tend to occur in specific places on the neck, shoulders, back, hips, arms, and legs. The points can be quite painful when pressure is placed upon them.

Fibromyalgia is difficult to diagnose, but it is estimated to affect about 5% of the population. It tends to occur in women much more than men, and generally starts in middle age.

What Causes Fibromyalgia?

Unfortunately the cause of fibromyalgia is unknown. It has been linked to:

traumatic/ stressful events such as a car accident
repetitive injuries
illness
certain diseases, such as lupus, rheumatoid arthritis, and ankylosing spondylitis.

What are the Symptoms of Fibromyalgia?

Pain, stiffness, tiredness and tenderness of the muscles, tendons, and joints.
Restless sleep, awakening feeling tired, chronic fatigue, anxiety, depression, and disturbances in bowel function.

These symptoms ‘feed’ of each other, as demonstrated in the following diagram:

Source: http://www.arthritisireland.ie/assets/FCKeditor/Image/Pain-Cycle-infographic.jpg

How is Fibromyalgia Diagnosed?

The symptoms of fibromyalgia can be associated with many conditions or diseases, making it difficult to diagnose. There is no blood test, finding on imaging such as MRI or other diagnostic procedure that doctors can use to definitively tell a patient that they have fibromyalgia.

Generally then, diagnosis is made by your doctor or physiotherapist ruling out other diagnoses, as well as findings on physical testing of the body. One test that your health practitioner can do is to palpate a number of points around your body.

If a large portion of these points are tender to touch, it may help support a diagnosis of fibromyalgia.

You may be referred by your GP to a rheumatologist to help with the diagnosing process.

Conditions that can mimic the features of fibromyalgia include an underactive thyroid (hypothyroidism), vitamin D deficiency causing the bone disease osteomalacia, rheumatoid arthritis and even sleep apnoea.

How is Fibromyalgia Treated?

The management of fibromyalgia is complex, but can be broken down into a number of parts. Treatment tries to help you slowly break the fibromyalgia cycle by addressing each of the points shown in the diagram above.

Relief of your muscle and joint stiffness, tenderness and pain

The first part of helping you manage fibromyalgia is to help provide some pain relief. This may involve soft tissue massage, acupuncture or joint mobilisation to improve muscle tightness, tenderness and joint stiffness.

Managing your fatigue and limited activity

The best way to help treat fibromyalgia in the long term is through exercise. It is important, however, that this exercise is slowly progressed to allow your body to cope with increased activity levels.

There are three types of exercise that may be given to you:

stretching and mobility exercises to help improve pain, stiffness and tightness.
specific strengthening exercises to help build strength and endurance in the ‘posture’ muscles of the body, and take the load off other overactive, achy muscles.
general exercise, such as going for a gentle walk or bike ride, yoga, tai chi or pilates.

Fibromyalgia symptoms can fluctuate, meaning that you can have both good and bad days. Sometimes overdoing it one day can lead to increased symptoms the next day, so being able to manage your effort important.

Improve your ability to cope with daily stress and depression

Daily stresses from work or home can increase your fibromyalgia symptoms. You and your physiotherapist can work with your GP to help you develop strategies to manage these stresses.

In some cases your GP may prescribe medications such as an antidepressant to help normalise chemical imbalances and also improve pain. Referral to a psychologist can also help in developing strategies to cope with stressful situations.

General exercise, is an excellent way to help deal with stress and depression. Exercise, amongst other things, releases ‘happy’ chemicals such as endorphins that help to provide relief of your symptoms. Regular exercise also helps to improve eating and sleeping habits, which will lead to better general health and less sleep deprivation.

Have a Treatment Goal

Some people find it beneficial to have a goal to strive for. Your physiotherapist will tailor your rehabilitation to help you achieve your own functional goals. During this stage of your rehabilitation is aimed at returning you to your desired activities.

Everyone has different demands for their bodies that will determine what specific treatment goals you need to achieve. For some it be simply to walk around the block. Others may wish to run a marathon or return to a labour-intensive activity.

Surgery

Surgery is generally not recommended for isolated fibromyalgia. Where another condition is leading to fibromyalgia symptoms, your GP can advise you if this is an option for you.

Massage for Fibromyalgia

Many patients find that soft tissue massage therapy is beneficial in the early stages of their rehabilitation to assist your pain relief, muscle relaxation and swelling reduction. Please ask your physiotherapist, health practitioner or massage therapist if you would benefit from a massage.

Acupuncture for Fibromyalgia

Acupuncture can be helpful in the relief of your fibromyalgia pain and restoration of your energy levels. If you are interested in trying some acupuncture, many of our therapists are trained in acupuncture. Please ask for their advice.

Weight-Loss

Carrying excessive body weight can predispose you injury or pain. If you have had difficulty in the past losing weight, the professional help and support of a dietitianor your doctor may be beneficial.

General Exercise

General exercises are important to keeping your body fit. If you have a specific activity that enjoy, please ask your physiotherapist if that activity will be beneficial to your long-term health.

For fibromyalgia, other patients have benefited from the following activities: hydrotherapy, pilates, yoga, walking, swimming or cycling. Please ask for guidance as to what we feel will help you the most.

Products That May Help Fibromyalgia

Whilst exercise is very important to help manage your symptoms, sometimes your body can feel quite fatigued. At times like this you may benefit from short term use of a supportive brace, such as a low back or upper back support.

It is important that your brace is used as a training tool. Too much use can lead to over-reliance on the brace and de-conditioning or your muscles. Please consult your physiotherapist about how best to utilise a brace for fibromyalgia.

TENS machines and heat packs can also help to provide relief for tired, achy muscles.