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¾ What fibromyalgia (FM) is ¾ Symptoms and theories of FM ¾ How to decrease symptoms with physical
therapy ¾ How to apply interventions appropriately
Facts ¾ FM has no known ¾ ¾ Theories of causes ¾ ¾ ¾ ¾ ¾ ¾ ¾ cause There is no known cure at this time Over 12 million people will be diagnosed with fibromyalgia Majority affected are women. however men and children also can be affected Physical therapy can decrease symptoms (Quote1) Trauma Infection Environmental factors Hereditary Anti-polymer antibodies .
FM is a syndrome A syndrome is a group of symptoms that are characteristic to the condition FM has overlapping symptoms of other syndromes .
What are the symptoms of FM? Picture3Symptoms .
Unique to the patient Specialized assessments on: Pain Biomechanical systems Ergonomics Education Energy conservation techniques Physical Therapist (PT) role in FM care: Develops individualized programs to meet the goals of the FM patient Evaluates biomechanics and formulates specialized programs to improve dysfunction Advises on ergonomics to adapt to their condition and environment to decrease fatigue and discomfort Educates the patient on their condition and the importance of lifelong care to control their symptoms Educates the patient on energy conservation techniques .
11-18 specific painful Triggerpoints (TrPs) are the main symptoms of FM .
TrPs almost always refer pain to other areas Symptoms of TrP pain in joint capsules and ligaments include sweating. and blanching which are autonomic reactions from the periosteal pain. . nausea.What are TrPs? Descriptions Symptoms These are hyperirritable areas on the body located at specific parts of the body in FM patients located in skeletal muscles They are banded up into a knot-like consistency and are especially painful to the touch.
.Theories & Types of TrPs Calcium and adenosine triphosphate (ATP) interactions from stresses placed on muscles result in tight bands of contracted muscles. TrP types include active and latent Active: doesn·t affect other parts of the body and Latent does. jabs of pain. Microfilament damage can occur causing cutaneous scars that consist of burning. Blood circulation is decreased and metabolic activity increases toxic buildup releasing substances that irritate nerves causing hyperirritability resulting in pain.
How can Physical therapy help with the pain associated with trigger points (TrPs)in FM? .
Ice massage including Spray and stretch followed by re-warming Neuromuscular electrical stimulation (NMES) and ultrasound (US) followed by passive stretch Precautions: Emphasis must be placed on applying gentle passive stretching to avoid exacerbating pain Care must be taken with hypermoble joints Obstacles include patient apprehension to increased pain . TrPs are released by applying pressure Interventions Include: Trigger-point massage followed by gentle stretching Gentle passive stretching with the muscle extended to the full length.
Cool & Stretch Inhibits pain Restores ROM Can be applied several times a day as needed Technique for spray and stretch: Prepare the body part for stretch Patient should breath out as spray is applied Patient should relax into the stretch and hold for 15-20 seconds Avoid overstretching Re-warm the area afterwards Massage Neuromuscular therapy = Apply pressure to TrPs with static pressure. light or deep TrP Therapy=Apply increasing pressure to hyper-irritable TrPs .
How can Exercise help with pain in FM? .
Conditions Benefits of Exercising maintains a muscular and cardiovascular balance reduces loss of function tender points muscle spasm back pain Postural imbalances Flexibility Strength Endurance Range of motion Sleep Fatigue decreases pain of Improves Decreases Types of Exercises Pool Exercises Yoga Aerobics Taichi Strengthening .
How does Hydrotherapy help Increases aerobic capacity Increases endurance Improves lung capacity Buoyancy decreases weight bearing placed on the spine and joints Decreases pain Improves sleep through relaxation Improves circulation Decreases stiffness and fatigue Water temp matters ¾ 85-92 degrees Fahrenheit Hydrotherapy Exercises Types of exercises recommended: ¾ Stretching: x x x x x x x x x Hamstring Hip extension Cross arms over chest Overhead triceps stretch Neck flexion/rotation Biceps stretch Hands clasped behind back stretch Gentle non-impact Walking Press for Video ¾ Aerobics Press to continue .
fibro fog (memory). Yoga improves symptoms and function ¾ ¾ ¾ Pain relief ¾ Decreases stiffness Decreases fatigue Decreases pain Helps to improve poor balance. anxiety. depression. environmental sensitivity. and tenderness Press for video Improves symptoms and function Press to continue .
or double stance poses due to balance issues and symptoms of dizziness associated with FM Low-impact exercises are recommended Energy conservation is recommended (i. don·t do grocery shopping and aerobics) Aerobics Taichi is a gentle form of exercise Taichi incorporates meditation which is recommended for FM sufferers for calming effects Increases mobility Taichi .e. floor reclining.Exercise must be done in moderation to prevent exacerbation of symptoms Include exercises consisting of sitting.
People with FM have balance issues that increase their risk of falls The average amount of falls of the FM is more than 23 times that of a healthy individual. ¾ These results are from a study completed by the Oregon Health and Science University (OHSU) which found that over a six month study of more than 50 people of middle age. 25 with FM and 28 were healthy Scores of the FM patients were worse than the controlled group and poorer than a 7080 year old in good health. Side to side lean Swiss ball exercies x Wall squats x Marching x Walkouts Balance testing ¾ Exercises improve balance ¾ ¾ ¾ ¾ ¾ Tandem walking Wobble board Single leg standing one foot on ball or wobble board .
Body mechanics: Maintain a neutral spine. Flexed or extended wrist increases chances of carpal tunnel syndrome. hands. wrists. and forearms in a straight line Take frequent breaks to avoid stiffness and look away from the computer every 30 minutes for 30 seconds Use anti-fatigue matting if standing for prolonged periods Workstation .Physical Therapists and Physical therapy assistants can identify ergonomic issues that can contribute to the discomfort of FM sufferers Educating the patient their work environment: Home ¾ ¾ ¾ ¾ ¾ ¾ Proper seating: feet touch floor. knees level or slightly lower than hips Computer monitors: 18-25 inches from eyes and the top of the screen at eye level Keyboard position: wrists should remain in neutral when typing. shoulders relaxed. Mouse should be positioned near your keyboard to decrease strain in the shoulder.
ex. Organized your activities: If you have multiple things you need to do. Do heavier work every other day such as laundry. Break tasks down: Do tasks a little at a time over several days.What does a PT know about energy conservation anyway? A PT can evaluate your routine and advise the adjustments and general techniques to conserve energy Prioritize your activities: Decide what is important to get done and let other activities wait. Alternate between heavy duty tasks and light duty tasks: If you stand to do one task. sit to do the next Remember to breath calmly: calm Breathing should be even and deep Use core strength as opposed to body extremity or smaller muscles Use gravity Use wheeled carts to transport items Pace yourself . Set time limits on how long you do tasks. decide how many things you can take care of without causing flare-ups in order to avoid having to climb up and down. in your house where you must climb stairs.
Fatigue Irritability Brain Fog Restless Legs Overlapping Syndromes Muscle & Joint Pain You Never Feel Good Anxiety & Depression Loss of Control Grief & Worry Immune Dysfunction A Lifetime Fight .
blogspot.html (quote1) Fibromyalgia Treatment by Modality. J. (n.com/aquatics. Retrieved October 30. May 12.). 2011. from Undulation Exercises: http://undulationexercise. (2008. 2011.fibromyalgiaadvisor. 2011. Fibromyalgia Exercises.html Deactivation of Trigger Points.autoimmune.php (aerobics pic) Fibromyalgia Stats N' Facts.com/FMLetterMay99. Retrieved October 30.physrehab. Fibromyalgia Second Edition.com/html/4_. Retrieved October 30. (1999).com/2008_05_01_archive.menwithfibro.com/MOREDEACTIVATIONOFTRIGGER#coolstretch Fatigue and Exercises. May Friday). Retrieved from ProHealth Commerce With Compassion: http://www. (2010).cfm A Review of Recent Research for Fibromyalgia Awareness day.Aquatic Center. from Physical Rehab & Aquatic Center: http://www.d. from Men With Fibro: http://www. Retrieved from Wellnomics Workpace: http://www. (2009). Lobo: Phoenix Publishing Co. (1997). (2004-2011).com/fibromyalgia_exercise.workpace.html (Balance Pic) Hulme. Retrieved October 27. 2011.pdf . (2011). from Autoimmune Technologies Applied Biomedical Science: http://www.com/fibromyalgia/modalities. Retrieved from Fibromyalgia Advisor: http://www. 1999.prohealth.
html Robert Bennett.). from My Squirrel Bait: http://www. from Fibromyalgia and Chronic Myofascial Pain Patient Information: http://homepages. Retrieved October 27.htm (picture1) The Painful Truth About Fibromyalgia. M.com/The_Painful_Truth_About_Fibromyalgia(picture3 Symptoms) Trigger Point Therapy. Fibromyalgia (FM) and Chronic Myofascial Pain (CMP) Information for Patients and Supporters. D.mysquirrelbait. Retrieved from FMS Community: http://www. (2011.net/~devstar/define. Principles of Treating Fibromyalgia.net/exercise-forfibromyalgia.htm Starlanyl. (n. 2011.sover.com/trigger-point-therapy/ .myalgia. Retrieved from Exercise for Fibromyalgia.htm Mangosteen Source. (2011. (2009).).fmscommunity.d.d.org/worktips. 2011. April 11).mangosteensource. (n. Retrieved October 27.infobarrel. What's Recommended and What's Not: http://www. Retrieved from Infobarrel: http://www.d. Retrieved October 27.). from Fibromyalgia Information Foundation: http://www. 2011. October 11).Managing Tasks When You Live With Chronic Pain.com/Treatment/treatment%20overview. (n.
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