Friday, December 19, 2014

Functional Medicine for Digestive and Pain Disorders
Maureen Mason, MS, PT, WCS
Many patients receiving specialty Pelvic and Pain Rehab care at CTS have been diagnosed as having a Functional Gastro-Intestinal (GI) disorder. This means that medical testing has revealed that the problem presenting with pain or indigestion or other complaint is in the functioning of the system, but the condition does not represent an emergency condition, nor does it require surgery. More specifically, reference 1 states” A functional gastrointestinal disorder comprises symptoms arising in the mid or lower gastrointestinal tract that are not attributable to anatomic or biochemical defects.” It is estimated that 25 million Americans suffer from Functional GI disorders.
Medical screening by your MD is vital to review your history, signs and symptoms, and to diagnose a Functional GI disorder. Your MD may perform specialty lab tests such as scoping the tissue by viewing it directly with a camera (i.e. endoscopy, colonoscopy), potential X rays, MRI, and lab tests. If you have a Functional GI disorder, it is likely to feel frustrating as “help” may entail medication, supplements, dietary and behavioral changes, and even referral to Physical Therapy (PT). The PT referral may be to help with pain from musculoskeletal and connective tissue (fascial) restrictions, and for specialty habit and coordination training of the pelvic floor muscles (PFM). It is not unusual for patients to be surprised that they were referred to PT for a symptom such as constipation, so we provide education at the first session into the role of specialty PT for your condition. This typically involves anatomy and function training with muscle charts for the abdomen and pelvis, bladder, bowel, and genital regions.
The most common conditions presenting to MDs include irritable bowel syndrome (IBS), dyspepsia, and constipation. Functional medical disorders are quite common and range from one end of the digestive tract to the other. Upper GI problems include swallowing disorders, Gastro-Esophageal reflux (GERD), and stomach problems such as gastroparesis. Swallowing problems, reflux, and any other GI symptom may have a serious medical problem causing it, such as infection, tumor, bleeding, or restricted blood flow from a vascular problem such as a blood clot, therefore, never assume you can figure it out yourself, see your MD for assessment.
Under the heading of functional GI problems we see often, are constipation, and urinary incontinence. Constipation can include bloating, gas, and cramping, and pain. Lower GI and colon problems may be labeled as functional GI disorders, including some types of constipation, as well as the opposite problem, bowel or bladder leakage, labeled as incontinence.  Stress can be a trigger for some functional GI disorders, and the references listed explain the connection with the nervous system and the stress response in potentially aggravating a functional GI condition.
As part of helping our specialty patients, we may explore fluid and fiber management, mind-body awareness training, bladder and bowel diaries, and a physical exam of skin, scars, fascia-connective tissue-and muscle tone and strength. and respiratory patterns. Visceral mobility and motility tests may be performed, and manual therapy may be applied to balance and release tension across connective tissue planes. Spinal and local muscles may be involved in a pain, spasm, pain syndrome that has an individual “locked up” in a region surrounding an area or viscera that has a history of pain, such as upper back spasm associated with GERD, and low back and pelvic spasm associated with constipation.
Medical paperwork completion for specialty pelvic PT takes 15 minutes, up to even 30 minutes, as insurance companies and medical standards of practice dictate that we thoroughly screen for details regarding pelvic and abdominal and other pain sites, and minutia of detail regarding bladder and bowel functioning. Typically patients gain confidence and a sense of comfort from the evaluation as they learn to clarify the PT components of their problem, and set functional, measurable goals with their PT. The treatment plan will typically include exercise, respiratory and pelvic muscle coordination, manual therapy, habit training, bladder or bowel diaries, massage, mind-body skills practice, and biofeedback.
Biofeedback is a standard PT tool to help profile and understand muscle function including those in the pelvic region. Many patients are unknowingly clenching or tensing their pelvic muscles during attempted elimination, and pelvic coordination and relaxation training may be required to restore function. Weak, or slow to respond pelvic muscles may be involved in leakage. Surprisingly, pelvic muscles that are too tight are also often involved in leakage. Constipation, or incontinence, which has been diagnosed as “functional” by an MD, therefore can be referred for conservative treatment with PT.
Infections are often a trigger for starting GI symptoms, yet after an infective agent is discovered and “eradicated”, symptoms may persist. Genetic testing is demonstrating patterns to levels of susceptibility for things like celiac disease (gluten intolerance), chrons disease (ulcerative colitis), and other conditions.
The GI microbiome, or “gut health”, is a growing area of medical interest, as our gut bacteria composes a critical part of our immune system. The national institute of health recently analyzed the microbiomes of 200 healthy people, and mapped out over 80% of the organisms present in health individuals. The human microbiome is an acquired system based on birth type, and environment.
The human biome changes somewhat day to day, depending on what we ingest, and are exposed to via our airways, and skin. A common change agent in the microbiome results from antibiotics. Many doctors now advise that following a course of antibiotics, individuals take probiotics, to re-establish the “healthy bacteria” of our gut. There does not appear to be a current consensus on which probiotics are best to restore health gut bacteria. Medical research is currently expanding rapidly into the field of nutrition, gut health, and probiotics, as pharmaceutical management certainly does not resolve all problems, but may help reduce symptoms. A functional MD who practices “holistic and integrative medicine” will strive to discern the root cause of the GI symptom, and this may involve extensive dietary and lifestyle analysis. Adopting positive lifestyle habits, and the optimum use of medication and/or supplements, can help to turn down, or even turn off functional GI problems. However the field of integrative, holistic medicine has it’s critics, who look for more research and studies to back up and support the use of the toolkit of supplements, mind body approaches, and other non-traditional medical approaches.
Reference 4 reviews many areas where the writer critiques holistic medicine and it’s practitioners. When one delves further into the writer critiquing holistic practitioners, one sees he indirectly receives funding from the pharmaceutical industry for his research. Any person touting a holistic approach, or a pharmaceutical approach, or a specific dietary or exercise approach, may receive financial benefit from your use of the products sold. Consumers have to be careful to not fall under the care of someone who is promoting unsound or even dangerous supplements, herbs, or pharmaceuticals. The best method is to work with a medical practitioner who uses a research base for prescribing your treatment.
GI symptoms from the use of over the counter items such as non-steroidal anti inflammatories (NSAIDS) can cause GI bleeding, and Tylenol has been in the news recently for being found to irritate the liver at lower levels than had been prescribed in the recent years. Alcohol consumption can exacerbate the effects of GI irritation associated with NSAID or Tylenol use. Be sure to discuss your med and supplement use with your MD, as things like an ulcer from NSAIDS may appear to be back or abdominal region pain that is not appropriate for PT treatment. Reference 5 includes information on liver toxicity from Tylenol.
There is an increasing incidence of auto-immune disorders, many of which include functional GI symptoms. Identifying lifestyle triggers including stress, dietary habits, as well as having a complete medical workup is the safest and most logical process. Reference 6 describes the common autoimmune GI disorders, and provides an example of a combined medical approach of diet, lifestyle, and medication management of a medical condition.
In summary, if you have GI symptoms, discuss these with your MD, and look to your diet and stress level and antibiotic use as potential aggravators. Perhaps you have had genetic testing and know you are susceptible to specific problems, yet it often requires a trigger to turn on a GI disorder, and functional GI disorders are often improved with medical care and healthy habits. Most of our patients significantly reduce constipation and incontinence while receiving comprehensive PT. Listen to the signals or symptoms you are receiving from your body, and take care.

Thursday, November 20, 2014

We here at Comprehensive Therapy Services are wishing you a happy and healthy Thanksgiving! We’ve put together a local San Diego list of all of the Turkey Trots happening next weekend. It’s not too late to sign up.

  1. Coronado 5K Turkey Trot in Coronado, CA
  2. Father Joe’s Villages Thanksgiving Day 5K in San Diego, CA
  3. Run for the Hungry 10K and 5K in San Diego, CA
  4. Running of the Turkeys 10K Trail Run in San Diego, CA

Take your pick, and enjoy the start of this holiday season! Gobble, gobble, gobble!!

Friday, November 7, 2014

Whoa, I’m Pregnant!
April Douglas, PT, DPT, MTC, OCS
I treat pregnant women on a daily basis, teach a course with a pregnancy section and go to continuing education courses on pregnancy, so when I got pregnant, I thought I would be overly prepared (yes, my ego, I know). Here’s what I didn’t realize:

1. In your first trimester, everything’s a secret. You cannot tell anyone anything.
2. My first trimester was my personal hell. Throwing up every day just isn’t my idea of fun. Don’t forget that smiley face, so no one knows anything.
3. If you do decide to announce early, be prepared for those that are worried about jinxing a healthy pregnancy. (FYI miscarriages are common. I was willing to discuss the news if it came.)
4. Because pregnancy symptoms are so variable, there really is not an explanation for most of them except, “well, you’re pregnant”.
5. If you want to be fit and throw up every day, good luck. Working out became a fond, distant memory. Don’t worry, working out returned, but just not at the same level.
6. Your breasts are no longer breasts. They’re jugs now and may be featured on a National Geographic.
7. Your body is working overtime, meaning more heat production. Sweating profusely while indoors is awesome!

With that being said, pregnancy opened my eyes to a whole new world, good and bad. Now that I’m beyond the first trimester, I get to feel a kicks and bumps of new life. It’s a constant reminder of the future. Some people say that being pregnant is the best thing in the world and could not have felt better.

The perk is I get to work with experts in pelvic floor and pregnancy. I get to walk in to work, ask bizarre questions, and advocate with my physician to get Physical Therapy when I have the first symptom. For all of you struggling pregnant ladies, having someone to help me along in the process has been a huge asset.

For all the pregnant women in general, kudos to you. Your body is doing an amazing thing that not everyone gets to experience. Remember that on your bad days.

Tuesday, October 21, 2014

Chronic Pelvic Pain

Chronic Pelvic Pain
 By Jill Menefee, PT

Chronic pelvic pain is defined in a variety of ways. A useful clinical definition of chronic pelvic pain is noncyclic pain that lasts six months or more; is localized to the pelvis, the anterior abdominal wall at or below the umbilicus, or the buttocks; and is of sufficient severity to cause functional disability or require medical care. As a Women’s Health physical therapist I have quite a bit of exposure to the diagnosis of chronic pelvic pain but I was quite shocked at the numbers associated with this condition upon reading an article recently while preparing for an in-service. Two to 10% of all gynecologic office consultations are for chronic pelvic pain. Twenty percent of all laparoscopies are performed for chronic pelvic pain. It is estimated that 10 million women suffer from this condition and that 7 million do not seek help. Up to 61% of patients are found to have no explanation for their pain. The economic impact of this condition is astonishing. The annual medical cost for diagnosis and treatment of chronic pelvic pain is estimated to be about $1.2 billion annually. The cost of lost productivity in these patients is estimated to be $15 billion annually. The most commonly made diagnosis in chronic pelvic pain is endometriosis (31%). The majority are undiagnosed or improperly diagnosed. (Ref. 1)

Initially the pelvic pain perception had been based on the theory that the level of pain should be proportional to the degree of tissue damage. So if your doctor could not see or palpate any masses or abnormal tissue-then you shouldn’t be feeling any pain.  That notion in the medical community is changing. Studies show that at best only 60-70% of women undergoing laparoscopic surgery for endometriosis experience pain relief, showing that there is more to the story. (Ref. 2) More information is now showing the presence of one or more other chronic pain disorders such as interstitial cystitis, irritable bowel syndrome, TMJ disorder, migraines, pelvic congestion syndrome, ovarian remnant, vulvodynia, or fibromyalgia suggesting that pelvic pain should be treated as a disease rather than just as pathological changes.

Musculoskeletal dysfunction can be a driver for pelvic pain, either as the primary problem or a secondary reaction to pelvic pain. Issues such as overactive pelvic floor muscles or hip dysfunction can be contributors. According to a Clinical Expert Series article on chronic pelvic pain from the Journal of Obstetrics and Gynecology-  “The mainstay of treatment of muscular components of pelvic pain is physical therapy, most commonly performed by a therapist with specialized training in the treatment of female pelvic pain. This subspecialty of the field has grown enormously over the pat 15 years in obvious response to growing recognition of muscular elements to pelvic pain and in recognition that it works.” (Ref. 2)

Hopefully attitudes towards chronic pelvic pain will continue to change and the medical community will move even further away from the “I can’t see it so you shouldn’t feel it” notion. It seems that more credence is now being given to treating the whole body and giving consideration to many factors such as anatomical, musculoskeletal, bowel and bladder function, and psychological issues. The multi-disciplinarian approach appears the best way to give women the support they need in dealing with this often misunderstood condition.


1.      Scialli AR, Barbieri RL, Glasser MH, Olive DL, Winkel CA. Association of Professors of Gynecology and Obstetrics Educational Series on Women's Health Issues: chronic pelvic pain: an integrated approach. January 2000; 1–9

2.      Steege JF, Siedhoff MT. ACOG Clinical Expert Series, Chronic Pelvic Pain.         September 2014; 616-629.

Resources International Pelvic Pain Society

Tuesday, September 30, 2014

Fibromyalgia and Interstitial Cystitis: Healthy Updates and Resources,
Integrative Medicine, September 2014
Maureen Mason-Cover MS PT, WCS, Comprehensive Therpy Services
September is Interstitial Cystitis (IC) Awareness Month, this is Part Two in a profile on IC, Part One last week featured information on Fibromyalgia and IC
Part Two: IC
How can PT help IC? A PT must decipher your primary “driver” for your overactive bladder. Anything that increases pain input to the nervous system, especially at the level of the bladder, can lead an to incresed sense of pain, urgency, urinary retention, dysuria, and pelvic muscle spasm. A PT investigates your “soft tissues; all the layers of skin, connective tissue, muscles, and nervous system structures, as a detective looking for “triggers” that create a sense of discomfort in the area of the hips, pelvis, low back, and legs. A NIH study in 2009, throughout the US, demonstrated significant reduction in pelvic pain, or painful bladder syndrome (PBS) symptoms, from PT soft tissue work.
Surgeries can create scar tissue that can limit the mobility of the bladder, and visceral mobilization, the expert assessment and gliding tissues into restorative ranges of motion and function, can improve bladder function. PT’s working with pelvic problems use visceral and scar mobilization as part of the treatment. Tight Ceserean scars are often problematic. Men with hernia repairs, and also surgery for Low Back Pain, seem to have an increased predominance of IC.
Tailbone sprains, injuring the tip, or coccyx, and or larger bone, sacrum, can lead to pelvic pain, muscle spasm, and associated bladder symptoms. The pelvis is a ring, and
any malalignment in one area can transmit force and uneven muscle and fascial tension across ligaments, causing pelvic pain.Montlhy cycles, childbirth, and menopause can also contribute to Pelvic alignemnt problems, causing pain and spasm, and feeding into IC.
Hormone imbalances that disrupt the estrogenation of tissues can cause thinning of support tissue around the urethra, and the development of urethral pain, feeding into IC.
A PT may recognize muscle thinning and recommend you discuss hormone levels with your MD. Non-restorative sleep, and chronic stress, can both affect hormone levels so that metabolic growth and repair do not take place.
 The pelvic muscles, also called Kegels, or PC muscles, can develop tender points and trigger points that sustain a sense of bladder urgency and frequency, by continuously activating the nervous system at the bladder level. Home trigger point relase can involve the use of vaginal dilators, wands, or vibrators, selected for the need of each client for pain relief. (Specialty training is needed for most individuals to use safely and effectively, and it is releiving for most, but potentially aggravating for some people).Myofascial pain sites, such as the urethral sphincter,and obturator internus, can be palpated and identified as holding extra tension, leading to a diagnosis of overactive pelvic floor. Also the larger associated muscles such as the hamstrings, adductors, quadriceps, hip flexors, and abdominals can have tender and trigger points that contribute to pain syndromes.All these areas are accessable to conservative treatment with PT.
Vulvar pain may develop after a bladder infection, or associated with hormone changes or scarring as above. Multifacted treatment for female vulvar pain, or male pelvic-or prostate related pain, can involve PT. Vulvar or male pelvic pain can exacerbate bladder symptoms.
Postural problems, neck and back pain, and pelvic organ prolapse are some other conditions that can aggravate IC. I often have clients who sit slumped and compress their pelvic organs with prolonged or frequent bearing down-from straning with voiding, defecation, power lifting, occupational heavy lifting strains, and /or child care. The bladder can signal a false sense of fullness and urgency, when it is in a position of prolapse, as our brain poorly localizes senations from the pelvic area .Pelvic organ prolapse, when mild, can be helped by PT specialists.
Thoracic or Lumbar or spinal cord problems can mimic a painful bladder; Thoracic nerves 11 and 12 wrap around the front of the pelvis, and if irritated in the back, may cause pain in the front regions near the bladder. Also surface nerves to the skin can become entrapped or compresesed after trauma or surgery; the Iliohypogastric, genitofemoral, and ilioinguinal nerve can all cause aching near the bladder and genital area, leading to a false sense of urgency and frequency.
Specific to deep in the pelvis, pudendal nerve symptoms may need exploration and treatment for a comprehensive approach. IC may be associated with a compression of the pudendal nerve. This nerve wraps between 2 ligaments in the buttocks and if compressed, can cause urethral and other discomfort. The pudendal nerve has branches to the anus, vaginal or scrotal area, urethra, and clitorus and / or penile shaft. Aching, pressure, sharp fleeting pains, senses of itching or cramping in these areas can all come from pudendal compression. Soft tissue mobilization, posture, and exercises may help reduce pudendal copression.
Bladder histories are essentail to understanding urinary patterns. Children that are humiliated in front of an elementary school class for wetting their pants, or adults that experience medium to large leaks, may lead to a fear/anxiety reaction with bladder filling. A partially full bladder may eventually trigger a sense of anxiety and panic to avoid a leak, leading to an  increased frequency of progressively smaller voids.
Inflammation, and a tendency to a greator sensitivity to PH of foods, environmental allergens, and emotional triggers of stress reactions are also items that can increase IC symptoms. This requires investiogation of food/beverage triggers, environmental allergens, and emotional stressors. Any factor that increases a sense of fear, anxiety, or worry can increase the “dangometer” processing in the brain and allow nerve flow to areas so that pain signals are magnified. Stress can increase pain. Any factor that causes peace and contentment, or relaxation and comfortable body sensations, can dial down the “dangometer” to the brain, and reduce pain signal perception. Therefore it is critical with IC that individuals perform self care with nutrition, healthy homes and work sites, and stress management.
Soaps, detergents, and tight clothing can irritate genital tissues. Hypoallergenic soaps,
And loose fitting clothing is imperitive in reducing skin inflammation and irritation.
Vaginal douches can disrupt the PH of the genital area, and are to be avoided.
Finally, breathing exercises can be accessable and developed to a skill level to calm and restore nervous system balance and health. As hormone imbalances can be an underlying component of FMS, and IC, living in a high stress “fight or flight” state can involve hormone imbalances and increased muscel tension and pain. Cortisol is released in response to stress, and it alters hormone levels and nervous system actitivity such that increased pain may be perceived The pelvic muscels should relax when we inhale, and this is opposite to how most have been trained to “take a breath”. We erroneously puff out our upper chest and tense the pelvic muscels, which may increase baldder urgency . We can develop the ability to recruit upper, mid, or lower rib cage motions, as well as to allow the diaphragm to desend fully with inhalation. We can learn to relax, and sense the pelvic muscles.This use of brathing exercises to relax the pelvic muscles can take PT training, as well as spine, rib, and visceral mobilization. Breathing exercises, combined with stress management, prayer, or meditation, can promote health and wellness, and for IC sufferers, lead to a path of improved function in life.
In summary, PT specialty tratment can help IC and may involve soft tissue, visceral, postural, body mechanics, modalities, and stress management training, in conjunction with fluid and fiber and medication management with a medical team.
1. care/clinical-guidelines.cfm?sub=ic-bps
2.Interstital Cystitis, Diagnosis and Treatment, An Overview, Jane M Meijlink, International Painful bladder foundation,
4.http://www,pubmed/Rev Urol. 2004; 6(Suppl 5): S2–S10. Female Pelvic Floor Anatomy
Manual Therapy
1.Barral, Jean Pierre, Visceral Manipulation, Eastwood press, Seattle, 1988
2. Travel, Janet, Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 2, The Pelvic Floor, Williams and Wilkins
3. National Institute of Diabetes and Digestive and Kidney Diseases, 2010
Urological Pelvic Pain Collaborative Research Network
Interstitial Cystitis Collaborative Research Network, Clinical notes with Rhonda Katarinos, PT
            “A Single-Blinded Randomized Multi-Center Trial to Evaluate the Efficacy and Durability of   Myofascial Tissue Manipulation in Women with Interstitial Cystitis/Painful Bladder Syndrome”
( Maureen Mason-Cover MS PT and Cindy Furey PT were research therapists with UCSD on the San Diego arm of this study).
Relaxation, Mind Body Therapies
1.Kraftsow, Gary, Yoga for Transformation, Penguin Compass, 2002
2. Franklin, Eric, Pelvic Power, Mind/body exercises for strength, flexibility, posture and balance, Elysian 2003

Thursday, September 18, 2014

Fibromyalgia and Interstitial Cystitis: Healthy Updates and Resources,
Integrative Medicine Sept 2014
Maureen Mason-Cover MS PT ,WCS, Comprehensive Therapy Services

September is Interstitial Cystitis Awareness Month!
If you have a diagnosis of IC, you may also have associated symptoms in other areas,
and you may have a diagnosis of Fibrymyalgia Syndrome, FMS. Conditions that aggravate your IC would potentially aggravate other symptoms that you have as well, symptoms that are part of your FMS. This is because the entire immune system, nervous system, muscular system, and metabolism are interconnected. In Part I, I will explain FMS in more detail, and then in Part II next week, how Interstitial Cystitis, IC, and it’s profile of problems, can be treated with physical therapy (PT).
Part One: FMS
FMS is a chronic pain disorder, with multiple areas of dysfunction throughout the body. Typical problems include symptoms such as sleep disturbances, widespread pain, fatigue, and possible associated headaches, digestion problems such as ulcers and irritable bowel disease (IBS), bowel and bladder disorders, numbness and tingling in arms and legs, and other ailments. The key musculoskeletal signs are the presence of pain and tender points in 11 of 18 regions throughout the body. (Reference 1). The American College of Rheumatology established the “tender/painful point” criteria for diagnosing FMS in 1990. Recently researchers have identified vascular and sensory changes in the hands of patients with FMS, and you can view the links at the end of this article for more information. If you have FMS, you may have felt overwhelmed at the diagnosis, and felt your future was bleak. Read on!
Medically, health practitioners have to investigate the causes of symptoms, and a combination of physical trauma (strains, sprains, falls, car accidents), hormone imbalances (hypothyroidism, endometriosis), stress, and nutritional deficiencies can all contribute to FMS. Emotional trauma can trigger FMS, as well as infections such as Mononucleosis, and Lyme disease. Cases I have seen have had an onset after military deployment, a car accident, pelvic surgery for endometriosis, and thyroid cancer treatment. Most cases have a few triggers from the preceding list, so that the illness can seem to come up with no real cause for the individual suffering with symptoms.The bodies systems for recharge and energy production can dwindle, with a decline in work performance and mood. Ultimately, an individual with FMS may end up feeling weak, not sleeping, and losing function for basic activities of daily living (ADL’s) such as stair climbing, lifting groceries, and general fitness decline. Due to the myriad of causes for FMS, a multifaceted treatment approach can help reduce pain and increase function and quality of life. Whereas individuals with FMS have been “written off” as simply “depressed” in the past, now there are clinics and programs that offer resources and solutions for healing.
Your MD can screen hormones and blood values, and nutritional deficiencies such as anemia, low vitamin D, and thyroid imbalances can be addressed. SLEEP DISORDERS must be addressed, and a program for “restorative sleep” created, so that an individual with FMS “charges their battery” during sleep. You cannot work, and work out with fitness, if your own personal energy level is like a battery without a charge.Medications, stress and relationship management with counseling, and changing nighttime routines (reduce TV, warm bath, earlier bed time, block light at night) can all help improve restorative sleep.
Conservative treatment of bowel, bladder, and musculoskeletal pain problems is offered by Physical Therapists for FMS. Elimination of dietary irritants, healthy food choices with nutritional class support, and honoring posture and optimal body mechanics can reduce symptoms. Manual therapy, massage, and visceral (organ, fascial and muscular) treatments can help you to rebalance and lighten your physical pain. Hypnosis, counseling, acupuncture and massage therapy are often helpful as well, and can be part of your FMS therapeutic tools. A local military MD tells her patients they have to “have fun” regularly, so play time with art class or similar relaxing adventures can create good moods and alter your outlook and enjoyment of life.
Medical studies have been performed with analysis of the benefits of strength exercise and aerobic exercise for FMS, and it is a fact that these treatments can help reduce pain and improve function. The key is to gradually increase health exercise performance and to stay with it so it becomes a part of your healthy lifestyle.
What is the best type of aerobic exercise? That which you perform consistently that suits your lifestyle, such as bicycling, treadmill or outdoor walking or running, elliptical trainer, or hiking. Pool fitness, including aerobic activities, is also recommended. Ottawa panel guidelines (reference 2) identified positive benefits of aerobic exercise programs from two times up to three times a week, from 20 to 60 minutes, for 8 weeks, up to 24 weeks. Participant benefits ranged from pain relief, improved psychological well-being, reduced depression and anxiety, improved quality of life and sense of self-efficacy, improved sleep, muscle strength, cardio respiratory fitness, balance, coordination, and mobility.
What about strength exercises? Can individuals with FMS lift weights and reduce, rather than aggravate, their FMS symptoms? The Ottawa Panel of researchers performed a comprehensive analysis of the studies on strength training with FMS, and they universally recommended weight lifting for helping FMS patients (reference 3).
The exercise ideally should be individually tailored to each person, be provided near the persons home, and include feedback and social encouragement. Intensity can be moderate to strong resistance without aggravation of the FMS, depending on the individual. Expected improvements from strength training can be found in an improved quality of life, decreased sense of depression and of course increased strength. A PT or restorative-fitness professional can train you in progressive fitness as part of functional training, so you can walk, climb, lift, push and pull with more power. The BenchFit strength training DVD and Book (Mason Home Fitness) are 20 minute workkouts and contain progressive fitness protocols that can be performed at home, and are joint and spine-safety oriented as designed by this author for healthy fitness for beginning to intermediate level exercises (Reference 4). Key ingredients for a fitness recipe for you include assessment of interests, measurements of starting aerobic and strength levels, goal setting, and creating an action plan with weekly and monthly adjustments.

As you look for resources to help your FMS, please recognize that each person FMS is unique, and avoid anyone selling a “#1 cure” product, as success comes a multifaceted approach. One person’s FMS may have evolved from physical trauma and infections, another from genetics, digestive problems, and nutritional deficiencies, and your MD can help you decipher the causes of your condition. As you go through treatment, try to add one new healthy habit a week, rather than change your whole life suddenly. Consult the Web MD and National Fibromyalgia Association websites (references 1, 5). There are FMS support groups both locally and nationally, and  Janet Lawler, massage therapist, helps with a local chapter and can refer you to a local support group as needed (reference 6). You can keep a “healthy habits tracker” that you can pick use to log your progress. Keeping a written record, having specific goals, and medical and peer support are all ingredients for success.


2. Brosseau, Wells, Tugwell et al, Ottawa Panel
Evidence-Based Clinical Practice Guidelines for Aerobic Fitness Exercises in the Management of Fibromyalgia: Part 1, Physical therapy Journal, Volume 88, Number 7, 857-871, July 2008

3.Brosseau, Wells, Tugwell et al, Ottawa Panel
Evidence-Based Clinical Practice Guidelines for Strengthening Exercises in the Management of Fibromyalgia: Part2, Physical therapy Journal, Volume 88, Number 7, 873-885, July 2008

4. Mason-Cover, Maureen, BenchFit I 20 Exercises, Book and
DVD, Mason Home Fitness, 2004,