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,