Living with fibromyalgia can be challenging. Your pain and other symptoms might take different forms from day-to-day. If you avoid activity because of pain, your overall physical fitness might be decreased.

Extensive research supports the use of education, aerobic exercise, and strengthening exercise to help improve fibromyalgia. But fear of pain often keeps people from beginning an exercise program. Your physical therapist will teach you how to interpret pain signals—and how to manage and decrease your symptoms—through a customized exercise program.

Help You Take Control Through Information

Research shows that people who are knowledgeable about their health condition have more confidence, can cope better with their condition, and are more likely to get "back in the swing." Your physical therapist can explain how fibromyalgia affects the way your body perceives and responds to pain and how you can start to take control of the pain, rather than the pain controlling you. We also have evidence to support that knowledge is power, as it pertains to managing pain. There are several books, such as Why Do I Hurt, that have helped people in pain.

Your therapist also can provide information on local support groups, exercise programs, and self-help programs. 

Manage Your Symptoms Through Exercise

Regular, moderate exercise is an important part of managing fibromyalgia. Reducing body mass index can actually reduce the risk of developing fibromyalgia.

Research has shown that the following treatments can decrease pain and improve function, general health, and sleep in people with fibromyalgia:

• Aerobic conditioning

• Aquatic exercise

• Stretching

• Strengthening exercise

• Yoga

• Tai chi

• Deep breathing

• Recreational activities

• Manual therapy

Your physical therapist will design an exercise program that’s right for you. To ensure your success, the therapist will show you how to:

• Start slow.

• Pace yourself.

• Set realistic goals for exercise and physical activity.

• Modify your program in times of stress.

Your physical therapist can help you improve not only your fitness, but your quality of life by designing a program of aerobic exercise, which trains your heart and lungs as well as your muscles. Aerobic exercises include walking briskly (you can talk but you need to take deep breaths), bicycling, swimming, and using a stair-climbing or elliptical device.

If you have severe symptoms, your physical therapist will work with you to gradually increase your overall activity level and your tolerance for exercise, starting you off with exercises that you are able to perform for short periods (eg, 10 minutes), and then gradually building up your tolerance for longer exercise. Even short, 10-minute exercise sessions done 2 or 3 times per day can improve your strength and increase your endurance. If you have milder symptoms, the therapist might focus on strengthening your muscles or increasing your cardiovascular fitness. The therapist might recommend aquatic exercise in a pool to help reduce stiffness and pain while you exercise.

Even if you start out slowly, you are likely to have more pain as a result of increasing your activity. Your physical therapist will prepare you by teaching you techniques that you can use at home, such as relaxation techniques and stretching exercises.

You might have other conditions in addition to fibromyalgia, such as tendinitis, arthritis, or heart disease. These conditions can make exercise more difficult for you. Your physical therapist is uniquely trained to individualize treatment for those conditions, taking into consideration the effect that they might have on your fibromyalgia symptoms and on your exercise ability.

You may be prescribed medications that target brain chemicals that are responsible for the way your body deals with pain. Physical therapists also take into account the effects that medications may have on your movement and exercise ability.

Improve Your Range of Motion

Your therapist may use manual therapy techniques to move your joints while you are relaxed to help improve your joint motion. These techniques are combined with exercise, stretching, and movements that you control.

Use Special Techniques

Research indicates that the best results are likely to come from combining a variety of treatments. Appropriate medications, exercise, and "mind-body techniques" can work together to help you manage your symptoms.

Some techniques, such as meditation and cognitive behavioral therapy, can change your responses to pain and promote relaxation. Physical therapists also are educated and experienced in how to recognize behaviors that may interfere with recovery of function, and often refer patients to other health care professionals who can help them overcome these barriers.

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To reduce your pain, your physical therapist may select from a number of treatments:

• Your therapist may use pressure on specific areas of the muscle, followed by stretching or contracting your muscles, to relieve pain and make the muscles more flexible. Your therapist also might use manual therapy techniques to help relieve pain in your muscles and other connective tissues (the material between the cells of the body that support the organs and other tissues).

• In states where it is allowed by the physical therapist practice act, your therapist might use an approach called "dry needling" to relieve your pain by inserting very fine wire-like needles into the painful areas of the muscle.

• Massage therapy can be used to increase blood flow to the tissues and promote muscle relaxation to decrease muscle pain and stiffness, and break up scar tissue.

• Depending on the severity of your pain, your therapist might decide to use electrical stimulation to help relieve pain. Some people find that portable electrical stimulation devices help them manage severe pain independently. Your physical therapist will work with you to help determine if this type of treatment makes sense for you.