by Dr. Timothy J. Maggs, © 2000
For 30 years, Dr. Pat Belcher suffered with an unexplainable muscular pain that was difficult to both diagnose and treat. Thousands of dollars and a lifetime of emotions searched for successful answers, but nothing proved beneficial.
In 1986, Mary S. underwent a total hysterectomy. Immediately following surgery, her symptomatic picture exploded into excruciating muscle pain in her entire back. These symptoms were new, and help and explanations were limited.
Today, we know the diagnosis in both cases--- fibromyalgia. Despite the fact that these two athletically oriented people were in great shape, this condition showed no mercy and selected them as subjects for suffering. For those of us not afflicted, it's difficult to appreciate the intensity and constancy of this pain. Only through detailed dialogue can any of us begin to understand what these people are going through.
Fibromyalgia is a condition of the muscles. Although no one is completely sure of the cause, people involved in traumatic situations, both physical and psychological, are most prone to it. 88% of all diagnosed cases are of woman and people in their 40's. For some unexplained reason, the involved muscles don't store glycogen as well as healthy muscles, and simulate muscles undergoing extremely stressful situations. This results in extreme pain and contracture of the muscles. A medical research team from Finland has reported that the pain intensity from FMS is twice that of rheumatoid arthritis. Obviously, this can severely limit activity and future happiness.
According to the American College of Rheumatology, the 1990 criteria for diagnosis requires a history of widespread pain [minimum 3 months]. The pain pattern must include both right and left sides of the body, be located above and below the waist and also include the axial skeletal region. On digital examination, pain must be noted in at least 11 of 18 characteristic tender point sites.
The condition produces a shortening and tightening of muscle fibers. Cold weather, due to it's contractive influence on a muscle, makes the symptoms worse. Likewise, warmth can make them feel better. Although activity may seem painful to the afflicted, exercise and motion are strongly encouraged, as dis-use of the muscles is the beginning of the end. Blood flow to a muscle will provide improved flexibility and reduced tightness.
Sleep deprivation is common in fibromyalgia patients, as the pain of the muscles during sleep will oftentimes cause the person to wake, never allowing them to fully reach the deep sleep level that is critical for an enjoyable life. This also reduces normal recovery of the body.
Although testing can be rather subjective, there are several tests that can help point to an accurate diagnosis. The most important test consists of the 18 designated points along the upper and lower back and gluteal regions that will be more tender upon palpation. For a conclusive diagnosis, 11 of the 18 points have to be rendered as "painful". The amount of pressure needed at each of these points is approximately 10kg of pressure. This is the amount of pressure needed to change color of the thumbnail when pressing the thumb down on a hard surface. Many people suffer with pain in some of these points, but for a conclusive diagnosis of fibromyalgia, 11 of the 18 established points must be painful with at least 10kgs of pressure.
Testing can extend beyond the criteria needed to establish a diagnosis. A biomechanical exam is important, as balance and normal muscle function can only help those involved. Testing medial arches of the feet for pronation, supination and unequal arches (right vs. left foot) is important. Leg length measurements are important. Normal range of motion in the joints of the pelvis and spine are also important. Any other tests that locate imbalances and restricted motion should be done in an effort to increase balance and mobility.
Standing x-rays should be done of the low back and neck to determine disc heights, pelvic symmetry, gravity line, lordotic curves and the pelvic angle. Any abnormalities will produce an abnormal stress on one or more muscle groups, increasing the demand, potential tightening and pain of that group.
Contrary to popular belief, all massage may not be beneficial to fibromyalgia patients. Recent research has shown that light massage is more beneficial than heavy massage. "Less dosage and high frequency has proven to be far more beneficial in my self-treatment of my condition", states Dr. Belcher.
Structural corrections, including the use of orthotics, rehabilitative exercises, corrective structural treatment and an improvement of life's habits, will help provide long-term benefits. Objective x-ray and examination findings should be the criteria used when designing a rehabilitative program. Since every person has a structure that is unique (your Structural Fingerprint), a rehabilitative program should also be unique based on the specific needs of the involved patient.
Nutritionally, some minerals have been shown to produce beneficial results. The list includes CO-Q-10, Magnesium and Malic Acid.
Although no universal treatment protocol has yet been established, the athlete with fibromyalgia has to approach the condition as they would the marathon. It's a long journey with unknown results, but a strong positive attitude, a good physical program and quality nutritional support will make the journey easier. The key, once again, is to never give up.