Fibromyalgia and Chronic - Fatigue Syndrome (CFS), By: Brad Walker

Fibromyalgia and Chronic Fatigue Syndrome (CFS) are thought by many to be separate manifestations of the same disorder, the main difference being the major symptom associated with each of the disorders.

Fibromyalgia is a chronic disorder in which the sufferer complains of severe pain throughout their body. This pain can affect the muscles, joints and soft tissues i.e. tendons and ligaments, to the extent that any movement is a struggle. This particular disorder affects the female gender in 90% of cases and is commonly diagnosed between the ages of 25 and 40 although the symptoms can begin to show at any age. Other symptoms that are used to diagnose fibromyalgia include:

• Tenderness in 11 of the 18 pre-determined sensitive spots of the body

• Chronic fatigue

• Sleep disorders

• Headaches

• Stiffness of the joints

Many individuals diagnosed with the condition suffer with all or the vast majority of these symptoms however because fibromyalgia is a relatively new disorder many physicians mistake it for other, more common disorders. One such disorder is CFS.

CFS is another life long illness that is characterized by the above symptoms however in this case the major diagnostic symptom is fatigue, as apposed to widespread pain. The fatigue associated with the condition is often debilitating and is described by many as like "having concrete arms and legs." Muscle and joint pain is also common in CFS and so it is understandable that many experts get the two disorders confused.

The cause of fibromyalgia and CFS is still unknown although many research papers commonly refer to four possible aetiologies:

• Toxicity - due to long term exposure to chemicals, pesticides, insecticides etc.

• Traumatic experiences and life long stress, possibly from a pre-existing medical condition or illness.

• Genetic susceptibility.

• Immunological breakdown - due to prior bacterial or viral infection.

Whatever the underlying causes of the two disorders they are both as yet incurable and so treatment and management of the symptoms is seen as the key to relief. Surprisingly exercise has been found to be very beneficial with regards to reducing the pain and fatigue associated with fibromyalgia and CFS and so a regular exercise regimen needs to be tailored to each individual sufferers needs.

Precautions, limitations and dangers
As with any exercise plan, an exercise plan for people diagnosed with fibromyalgia or CFS needs to cater for the individual's level of fitness, mobility and experience. Extra precautions need to be taken to allow for the persons disability and so only certain types of exercise should be included.

Because many of the joints, muscles, ligaments and tendons will be affected by fibromyalgia and CFS only low impact or non-impact exercise routines should be practiced. This acts to reduce any additional stress that would normally be placed on already tender and painful spots.

Each case of fibromyalgia is different i.e. one person may only have pain in their leg muscles and joints whereas a second person may have all over pain, and this will inevitably affect the type and intensity of the exercises performed. All people with fibromyalgia or CFS should know their limitations and should thus try to stick to exercises that they know won't exacerbate their main symptoms.

Over exercising will often cause pain and soreness in even the healthiest of people and so in those already suffering with chronic pain, the intensity can effectively double making any subsequent movements absolute torture. It is important for sufferers of fibromyalgia and CFS to increase their levels of exercise very slowly and only push themselves as far as is comfortable. By overexerting themselves and causing their pain to become more intense, many sufferers of fibromyalgia will enter a period in which they refrain from all activity and effectively become inactive. This then causes de-conditioning and as a consequence, more pain.

Individuals diagnosed with either fibromyalgia or CFS need to break the above cycle by becoming active and keeping their bodies conditioned and strong.

The best types of exercise for fibromyalgia and CFS
Non-impact and low impact aerobic exercise has been found to be very beneficial for sufferers of fibromyalgia and CFS. The cardiovascular training involved with aerobic exercise has been shown to significantly reduce the degree of pain and stiffness experienced by sufferers.

Light aerobics
For those who can manage it, low impact aerobics sessions, which can include activities such as brisk walking, cycling, using a Stairmaster etc. can be very good for reducing all levels of pain. Aerobic exercise should be performed for around 30 minutes per day, 3-4 time per week for it to have a significant effect however it is very important not to rush into things and stress the muscles and joints unnecessarily.

It is advised that people with fibromyalgia or CFS start with a simple 5 minute walk and build up gradually until they reach the 30 minute target. Pre-exercise stretching is also highly recommended as this helps to make the exercise session more comfortable and reduces the risk of injury. Regular stretching will also help with posture and flexibility while reducing the amount of muscle and joint stiffness experienced during and after the workout.

Aqua aerobics
Water makes the body weightless and so any form of swimming or aerobic activity in water greatly benefits people with painful muscles and joints. This non-impact form of exercise takes all of the strain off the joints meaning that for a time they don't have to bear the weight of the body. This is perfect for fibromyalgia sufferers with very tender body areas who get excruciating waves of pain with every jolt. It is important however that the swimming water is warm because cold water can cause the muscles and joints to seize up and become infinitely more painful.

Stretching
Apart from the pre-exercise stretching that will be discussed in more detail as part of the following section; there are a number of exercise forms that involve specific types of stretching.

Stretching, as it relates to physical health and fitness, is the process of placing particular parts of the body into a position that will lengthen the muscles and associated soft tissues. Stretching is a simple and effective activity that helps to enhance athletic performance, decrease the likelihood of injury and minimize muscle and joint soreness.

Stretching can be practiced in the privacy of the home or at the gym where a qualified instructor can demonstrate the correct way to stretch so that the maximum benefit is achieved.

As with most activities there are rules and guidelines to ensure that they are safe. Stretching is no exception. Stretching can be extremely dangerous and harmful if done incorrectly. It is vitally important that the following guidelines be adhered to, both for safety and for maximizing the potential benefits of stretching.

Stretching Guidelines
It is incredibly important to stretch correctly as an incorrect stretch can do more harm than good, especially with regards to a fibromyalgia sufferer. There are five main things to remember when stretching which will help to keep the body in great shape and injury free.

1. Warm up the muscles prior to stretching
Cold muscles can injure very easily and so it is vitally important to warm up the body before strenuous stretching and before an exercise session. Bringing the body's core temperature up by performing a warm-up will ultimately increase the temperature of the muscles, so making them more supple and loose i.e. in the condition needed to stretch safely.

A warm up will also act to increase the heart rate and therefore the blood flow and nutrients reaching the muscles. As the breathing rate also increases, the amount of essential oxygen reaching the muscles rises dramatically, again creating the perfect internal environment for safe stretching.

A safe warm up for a fibromyalgia or a CFS sufferer might consist of a brisk walk or a short swim. The warm up should not last more than 10 minutes and it shouldn't be overly strenuous, especially if the individual's level of fitness is relatively low or severe pain is experienced.

2. Stretch slowly with gentle movements
Slow gentle stretching helps to relax the muscles of the body, which is often highly beneficial to the fibromyalgia sufferer. Jerky movements or over-stretching can lead to increased pain, muscle strain and even muscle tears and so all stretches should be done as if in slow motion and as smoothly as possible.

3. Stretch only as far as is comfortable
Over stretching is one of the major causes of muscle strains and tears and so it is important that individual muscles are only stretched as far as is comfortable. The idea of stretching is to relax the muscles and make the body generally more flexible which, in the case of fibromyalgia and CFS, can reduce the amount of pain felt in specific areas of the body. Over stretching a muscle can cause the tendons and ligaments attached to the muscle to spontaneously contract and this can cause major problems if the stretch is then forced beyond the comfort level. Stretching should never be painful and if it is then it is a sure bet that the muscle concerned is being greatly over stretched.

4. Control of breathing while stretching
It is important to concentrate on breathing while stretching as many individuals have a tendency to hold their breath and often they don't even realize they are doing it. Unfortunately holding the breath can cause the muscles to tense up and trying to stretch tensed muscles will, more often than not, lead to injury, especially in fibromyalgia sufferers who already have tense and painful muscles. Holding the breath also limits the amount of oxygen and nutrients reaching the muscles and if this anaerobic state continues for any significant length of time, the muscles will build up lactic acid and become highly painful, which is the opposite of what stretching is supposed to achieve.

5. Stretching correctly
Each stretch should ideally be held for around 30 seconds for the maximum beneficial effect. Anything less than this will not provide a sufficient length of time for the muscle to relax and lengthen. In addition each muscle group needs to be stretched two or three times in rotation and this is considered the bare minimum. Fibromyalgia sufferers may initially have trouble stretching to this extent and so should only stretch until they begin to feel uncomfortable. Any form of stretching is better than no stretching at all and so even a few minutes is worth doing.

People diagnosed with fibromyalgia or CFS will benefit from stretching on a daily basis but it is vitally important that they don't overexert themselves on a particular day as the following day may be more painful than the person can bare, in which case the beneficial cycle will be broken i.e. the pain causes inactivity which continues for a number of days or even weeks and this eventually causes even more pain.

Stretching is one of the most under-utilized techniques for improving athletic performance, preventing sports injury and properly rehabilitating sprain and strain injury. Don't make the mistake of thinking that something as simple as stretching won't be effective.