Advance magazine seems to always be in the my mailbox alongside local, small town coupons. Unlike the latter, this magazine is usually pretty good. The articles are usually clinically based and easy reading for hot, new topics and events.
Dawn Westfall, PT, MPT recently wrote a good column on Fibromyalgia, the Invisible Pain. She went through diagnosis, physiology, therapeutic interventions and modality usage with what available evidence supports it. I’m not going over that now, but you can read the article here.
I know most of us “sigh” in disgust and wonder how bad the evaluation will be with the Dx of Fibromyalgia walks in the door. Its true…unfortunately. I think these patients can be some of the most deserving of what we have to offer. At times, I have us (meaning healthcare professionals) to blame for patients getting into this state. Maybe we should start blaming ourselves instead of blaming the painful patient.
They are usually over-medicated and under-educated about their condition. We can be of considerable service.
Each patient can and will present differently just like any other condition so prescribing the correct treatment will always vary. Some points I look into:
-Graded pain-free ROM of the proximal joints and especially the spine are the most direct to start obtaining mobility and decreasing pain.
-Aquatic therapy can also be of benefit if it is available but still rare in most clinics.
-Exercise is absolutely necessary but not always the best route initially.
-Fibromyalgic syndromes typically have changing symptoms over short period of time. These type of symptoms and individuals are usually resistive to exercise. We need more to offer them than just modalities until we can obtain the critical proper pain-free range of motion.
-Manual therapy (of course, the main reason for this blog!) in my opinion, can really separate you from not only other physical therapists, but other professions. It can give great results with this subset of patients.
Manual therapy hasn’t been conclusively stated in research to be greatly beneficial (but really, what has?).
Pain relief through manual means followed by low level exercise = results and increased function.
Considering pain is “wide-spread” (11 of 18 designated areas), where do we start?? Everywhere hurts!
I find it not only time-efficient but effective in addressing the spine; in particular, the junctions. Meaning cervicothoracic & thoracolumbar junctions. I address this with exercise and manual therapy. But from my knowledge, there is no evidence to back this claim. Its evidenced-informed…but not evidenced-based. Meaning, nothing confirms or invalidates it.
P.S. After looking at the pictures, the techniques may seem brutal but really is more comfortable than it looks!
What are your thoughts on treating Fibromyalgia? Do you think it is a scientific syndrome or just psychological? Do you find most relief from modalities, exercise &/or manual therapy?