Did you know that the majority of people who have had a limb amputated still report feeling some sensation in the removed limb, such as itching or tingling? As many as 80% of amputees experience a type of this phantom limb pain. This can manifest as almost any sort of pain, such as stabbing, throbbing, or burning. Pain can last anywhere from minutes to hours to days, with some amputees in constant pain for decades.
While no one is quite sure what causes phantom limb pain, many experts suspect damaged nerves or scar tissue. Some also blame the mixed signals sent to the brain when an entire limb suddenly stops sending information. When the brain stops receiving input from a limb, it emits the most basic message it can to convey that something’s wrong: pain.
Because no one is certain of the cause of phantom limb pain, no single treatment has been proven to work without fail.
Medications and noninvasive therapies are often a doctor’s first suggestion. Oral drugs, like antidepressants, anticonvulsants, or narcotics, are sometimes effective. Injected pain medications or steroids have also shown some success. Noninvasive techniques like acupuncture or transcutaneous electrical nerve stimulation (TENS) can be helpful, too.
Spinal cord stimulation, during which the doctor inserts small electrodes into the spinal column, might also reduce pain. An electrical current is transmitted through the electrodes, hopefully blocking pain signals. Similar to spinal cord stimulation, deep brain stimulation employs electrical currents to block pain signals, but the currents are instead delivered directly into the patient’s brain. If all else fails, surgery might be suggested to remove scar tissue or damaged nerves. However, this risks worsening the pain if the surgery is unsuccessful or other complications arise.
Other therapies used for phantom limbpain are meant to trick the brain into thinking that the amputated limb still exists.
For example, if a patient only has 1 remaining leg, a mirror box is used to make it appear that the missing leg is still there. Patients perform symmetrical exercises with the remaining limb while imagining that the phantom limb is performing the exercises simultaneously.
Recently, virtual reality (VR) programs have taken the place of traditional mirror therapy. Patients wear VR goggles while performing tasks with their remaining limb, but the goggles show the same tasks being performed by the missing limb instead. Alternatively, a patient can perform tasks in front of a screen equipped with motion tracking equipment and the screen shows the tasks being performed by the phantom limb.
These methods have had mixed results. Some patients report no difference in their phantom limb pain at all. Additionally, these therapies are useless for patients who have lost both arms or both legs, because there’s nothing for the mirrors to reflect or for the VR programs to mimic.
A new treatment for phantom limb pain takes this idea to new heights, while also providing a novel option for double amputee patients.
Max Ortiz-Catalan, a researcher at Chalmers University of Technology, recently carried out a case study with a patient who suffered from constant phantom limb pain for 48 years. The patient, who lost his arm below the elbow after a traumatic accident, had attempted drug therapy, acupuncture, traditional mirror therapy, and even hypnosis, but his pain remained. Researchers attempted a new treatment method with the patient that was detailed in a recent article in Frontiers in Neuroscience.
For the study, electrodes were attached to the patient’s arm stump. The patient was instructed to attempt 8 different movements with his phantom arm and hand, such as opening and closing his hand or flexing his wrist. These attempted movements “trained” the researchers’ computer program to translate myoelectric muscle signals in the stump and allowed the patient to control a superimposed arm on a screen. The superimposed arm responded in real time, fooling the brain into thinking it was controlling a real arm.
Not only does this method allow a patient to visualize the amputated limb, as in existing mirror and VR therapy, but it also engages the areas of the brain that control the limb’s movement. This, suggests Max Ortiz-Catalan, is the reason that this method is more effective at treating phantom limb pain. Even when the superimposed arm wasn’t visible, such as while playing a racing video game, the patient was able to achieve the same control over the arm and experienced the same benefits. Additionally, this therapy method’s function is based on muscle signals in the stump, rather than the reflection of a remaining limb, so it will work just as well for double amputees.
After 48 years of continuous phantom limb pain, the patient in Ortiz-Catalan’s case study reported being pain-free for 15-60 minutes after each therapy session. He experienced lessened pain at home between therapy sessions, and eventually reported experiencing periods of time at home with no pain at all for the 1st time since losing his arm. He also no longer experiences such severe pain at night that he’s woken up by it. When asked about the perceived position of his missing hand, the patient stated that it was relaxed and semi-open, as opposed to the strongly clenched fist he’s experienced until now.
This therapy is similar in function to myoelectric prosthetics. Indeed, a myoelectric prosthetic utilizes electrodes on a patient’s skin to control movement of the prosthetic arm, just as electrodes allow patients control of the superimposed arm in Ortiz-Catalan’s study. While data is somewhat unclear, there is some suggestion that use of a myoelectric prosthesis could relieve phantom limb pain to some degree. However, these sorts of prosthetics are not very common. A great deal of training is involved, both for the doctor and for the patient. Also, a myoelectric prosthesis is extremely expensive, with prices ranging up to $100,000.
Ortiz-Catalan’s therapy method could provide a much more accessible, cost-effective means of treating phantom limb pain, especially if patients are able to carry out this therapy at home. An at-home system has already been developed and is awaiting approval. The patient in the case study is using it regularly.
Neuralgia is sharp, and often severe, pain that runs along the path of a nerve. The basic cause of neuralgia pain is damage or irritation of a nerve. This damage or irritation can be caused by several different conditions, from disease to trauma.
To understand the cause of neuralgia, it’s first necessary to understand how nerves work.
The nervous system is responsible for carrying information back and forth from the brain to the rest of the body. Nerves are the long bundles of fibers that connect sensitive nerve endings to the rest of the nervous system.
Nerves are protected by a layer of protein and fatty substances called the myelin sheath. If the myelin, or the nerve that’s insulated by it, is damaged, the impulses sent along the nerve can be slowed or interrupted. This can lead to problems like neuralgia or neuropathy.
Both neuralgia and neuropathy are nerve-related and caused by damage to the nerves. However, by breaking down the origins of each word, it’s possible to see how the two conditions are different. Neuro- (or neura-) means nerve. –algia means pain, while –pathy means disease. Therefore, while neuropathy can be accompanied by pain, it’s also characterized by tingling, numbness, weakness, or other symptoms. Neuralgia, however, refers only to nerve pain.
Neuralgia pain is usually a side effect or symptom of something else.
According to the Better Health Channel:
“Generally, neuralgia isn’t an illness in its own right, but a symptom of injury or a particular disorder. In many cases, the cause of the pain is not known. Older people are most susceptible, but people of any age can be affected.”
Sometimes simple old age can be blamed for neuralgia. Other times, a disease might cause damage to the nerves, as in diabetes or multiple sclerosis. Infections like HIV, Lyme disease, or syphilis can also sometimes cause nerve damage. Even a bacterial infection, such as an abscessed tooth, can irritate nearby nerves and cause neuralgia. Pressure on a nerve might cause neuralgia pain, too; bone, tissue, or tumors that press on a nerve can cause painful irritation.
Unfortunately, some medications—including the medications used to treat cancerous tumors—might also lead to neuralgia. Sometimes even trauma, whether from an injury or from a surgical procedure, can cause neuralgia pain. Essentially, anything that can damage the myelin sheath can potentially cause neuralgia.
The different types of neuralgia are generally characterized by the cause or the location of the pain.
For example, the two most common types of neuralgia are post herpetic neuralgia and trigeminal neuralgia. Post herpetic neuralgia is characterized by its cause. It is the result of nerve damage from the herpes zoster virus, commonly called shingles.
Trigeminal neuralgia is diagnosed according to which nerve is affected and where the pain is felt. In this type of neuralgia, the trigeminal nerve is damaged or has painful pressure exerted on it. Trigeminal neuralgia pain affects the face. In addition to pain, there might also be such intense hypersensitivity that even brushing the teeth or feeling a breeze on the cheek can cause severe pain. The pain may begin in just one area or on one side of the face, but it can spread as the condition worsens.
Another type of nerve pain is glossopharyngeal neuralgia, which is somewhat uncommon. This occurs when the glossopharyngeal nerve is irritated or damaged, which produces pain in the neck and throat. Sometimes the pain can also extend to the tongue, back of the throat, tonsils, or ears.
Occipital neuralgia occurs when the occipital nerves, or the nerves that run from the top of the spinal cord up to the scalp, are injured or inflamed. This often causes pain that starts at the back of the head and radiates forward, but it can also cause pain on one or both sides of the head or behind the eye. Sensitivity to light or a tender scalp may also occur. This condition can sometimes go undiagnosed because its symptoms are easy to mistake for headaches or migraines.
There is a host of conditions that can cause or be accompanied by neuralgia pain.
Multiple sclerosis is well-known as a nerve-related disease, and it can indeed cause neuralgia pain. In fact, nerve pain is one of the best-known symptoms of multiple sclerosis. However, it’s not the only disease that can cause neuralgia pain.
Other conditions that might be accompanied by neuralgia include:
People with neuralgia pain have a lot of treatment options.
Each individual’s treatment for neuralgia pain might be different, depending on what caused the pain. For example, since the high blood sugar levels associated with diabetes are responsible for damaging nerves, someone with diabetes-related neuralgia pain might benefit from stricter control of diet (and possibly diabetes medications) to keep blood sugar levels at heathier levels. Treating the underlying condition causing the neuralgia is often a good way to treat the pain.
If treating the condition doesn’t relieve neuralgia pain—or if the cause of the pain can’t be identified—there are many other non-surgical treatment options. In some cases, over-the-counter pain medications may be sufficient. Heat therapy, massage, or rest might also do the trick. If not, a physician might be able to prescribe stronger medications, such as antidepressants, antiseizure drugs, or narcotics. Skin patches or creams that contain pain-relieving medications might also help. Physical therapy can sometimes be indicated, as well.
If the pain still persists, the physician may suggest injections of pain medications, such as an occipital nerve block injection for occipital neuralgia. He or she might also suggest radiofrequency ablation, which is focused heat that damages a painful nerve in order to cut off pain signals before they’re sent to the brain.
If non-surgical methods have failed to alleviate neuralgia pain, there are surgical ways that can treat it. The most common surgical procedures to correct neuralgia attempt to relieve the pressure on a painful nerve, perhaps by moving the blood vessel that’s pressing on the nerve. Other surgical procedures have a similar goal as radiofrequency ablation: the interruption of the nerve to stop pain signal transmission.
Unfortunately, some people are unable to find relief from neuralgia pain despite attempting all available treatments. However, most neuralgia pain is relatively minor and responds well to treatment.
Imagine waking up with intense, burning pain for no reason, or undergoing surgery only to find that the accompanying pain increases and spreads until it forces the use of a wheelchair. Worse still, imagine spending months—or even years—going to physicians who are unable to diagnose the condition. This is the grim reality for people with complex regional pain syndrome.
Once called reflex sympathetic dystrophy (RDS), complex regional pain syndrome (CRPS) is characterized by pain. According to the National Institute of Neurological Disorders and Stroke, “CRPS represents an abnormal response that magnifies the effects of the injury.” In other words, a small injury becomes a big pain.
The pain associated with this syndrome may be constant and severe. It may begin in one small, localized area, such as a finger, and spread to include a much larger area, such as the entire arm. It may also spread to the opposite extremity. Painfully-increased sensitivity, called allodynia, may also occur, so that even a light touch on the affected area can cause severe pain.
Difficulty with muscle movement and decreased ability to move the affected body part
Abnormal movement or fixed abnormal position of the affected body part
All of these symptoms are confined to the affected area of the body, so one leg might be swollen, blotchy, extremely painful, and difficult to move, while the opposite leg is completely fine. Sometimes, though, symptoms can spread, so both of an individual’s legs might be affected.
Cases of complex regional pain syndrome are divided into two types, although some sources list a third type, as well. Type one (CRPS I) is characterized by severe, burning pain at the injury site, accompanied by muscle spasms, joint stiffness, and rapid hair and nail growth. Type two (CRPS II) is more intense pain, accompanied by swelling, slowed hair growth, unhealthy nail growth, and atrophied muscles. When differentiated, type three (CRPS III) is accompanied by unyielding, wider-spread pain, irreversible skin and bone changes, and severely limited mobility.
Some people develop complex regional pain syndrome at random, with no identifiable triggers. These people may simply wake up one day in agonizing, unrelenting pain. However, many people afflicted with complex regional pain syndrome develop it after an injury or surgery. Even something as simple as a soft tissue injury, like a cut or bruise, can trigger complex regional pain syndrome.
In the case of photographer, blogger, and author Micaela Bensko, her complex regional pain syndrome developed as a result of a concussion and damage to her cervical spine after a tailgate hit her on the head.
As stated in her blog:
“Along with the mechanical injuries to my spine, after about a year symptoms began to develop that leaned toward a Motor Neuron Disease such as ALS or MS but with unrelenting pain unlike anything I had ever experienced in my life. After extensive neurological testing, and a multitude of doctors, I was diagnosed with Complex Regional Pain Syndrome in my spine after one of my procedures.”
As pointed out here, the diagnosis of complex regional pain syndrome can be difficult. The symptoms can vary from person to person. There is often no clear-cut cause. In some cases, the condition can improve without treatment, which might end all attempts at diagnosis until the symptoms flare up again and make it necessary to start the diagnostic process all over.
Additionally, there is no single test to confirm complex regional pain syndrome. A diagnosis relies on observation of symptoms and the combined results of several different diagnostic tests to rule out other conditions.
The researchers from the University of Liverpool’s Institute of Translational Medicine, alongside researchers from the University of Pecs in Hungary, carried out a study on the autoantibodies in people with complex regional pain syndrome. Autoantibodies are naturally-produced but harmful antibodies that attack and damage bodily tissue. Usually, the body self-regulates autoantibodies, but sometimes—particularly in autoimmune disorders—the body fails to do this, allowing autoantibodies to multiply.
In this study, researchers took autoantibody serum from healthy people and from people with complex regional pain syndrome. The serums were injected into mice. Mice injected with serum from people with complex regional pain syndrome began to show symptoms of the syndrome. As stated on the University of Liverpool’s website:
“Although it had previously been thought, that the cause of CRPS is exclusively an abnormal brain activity after injury, more recent results, including from the Liverpool group have pointed to an immune dysfunction.”
If the cause of complex regional pain syndrome can be pinned down by more studies like this one, there may someday be a cure for it.
For now, although there is no cure, there are several treatments that show promise at treating the symptoms of complex regional pain syndrome.
Traditional treatments for complex regional pain syndrome symptoms include rehabilitation therapy, neural stimulation, or medication. Some alternative treatments, such as biofeedback, acupuncture, or chiropractic care, have also had some success.
One newer treatment for complex regional pain syndrome symptoms is the use of hyperbaric oxygen (HBO) therapy. This involves the afflicted individual spending time in a pressurized, high-oxygen hyperbaric chamber. One study found that after regular HBO treatments, pain and swelling from complex regional pain syndrome were reduced, while the range of motion was increased.
Another potential treatment for complex regional pain syndrome symptoms is the anesthetic drug ketamine. A study in Australia found that 76% of patients experienced full, although temporary, relief from pain after receiving regular infusions of ketamine. Eventually, this treatment was brought to the United States, where it has shown real success.
A previous study at the University of Liverpool examined the effectiveness of intravenous immunoglobulin (IVIG). Patients in this study showed an average drop in pain of 1.55 on an 11-point pain scale. While this study wasn’t as thorough or as promising as others, it was noted that IVIG is significantly more cost-effective than some treatments, such as ketamine therapy.
In Italy, researchers recently found that a bisphosphonate called neridronate can have very profound effects on type one complex regional pain syndrome symptoms. Bisphosphonates are typically used to treat bone-related conditions like osteoporosis. However, this study found that regular applications of the bisphosphonate neridronate caused significant reduction of pain and hypersensitivity when given intravenously.
At Chronicillness.co Site of United States, the pain specialists understand that there are multiple avenues in which to treat chronic pain. Alternative therapies like support groups can be combined with clinical therapies like injections, minimally invasive procedures, medications, and other treatments to best benefit the chronic pain patient.
For anyone dealing with chronic pain, sometimes it may seem like you are the only one out there who is going through a difficult time. But this is not true. Support groups and group therapy are great tools for helping patients cope with their everyday pain and the overwhelming emotions that sometimes come along with it.
Belonging to a support group is beneficial because when a patient realizes another person has similar experiences, this helps the patient understand that they are not alone in struggling with their pain. A support group is able to help identify and deal with changes that happen when living with chronic pain. With the encouragement and support of a support group, members are better able to understand the fears, barriers, and difficulties of living with chronic pain. Support groups also allow patients with negative issues to change to positive ones such as pain management and finding hope and a purpose to live.
Many times a cure for chronic pain may not be realistic. In this case, the focus of a support group may become managing chronic pain, and all the steps involved in doing this, including the treatment plan discussed with a pain management specialist.
For those interested in starting a support group, the first step is finding the website relating to your specific pain condition and researching to see if there is a support group in your area. If there is not, local advertising can attract attention to a new group. There may be other chronic pain sufferers in the area willing to pitch in and help bring people together.
Group therapy is another good idea that helps patients get in contact with other people dealing with chronic pain. Supportive psychotherapy is the most powerful and therapeutic aspect of this activity. Patients have time to share their experiences with one another and talk about the effects of chronic pain on their work lives, relationships, hobbies, and their day-to-day activities. Patients can also share positive coping skills they have used or learned. Skills taught during the classes may include focused breathing, muscle relaxation, and guided imagery. These can all help patients decrease anxiety and pain levels. Another helpful activity is problem-solving with other patients on ways to decrease pain and cope with the consequences of chronic pain.
Every once in a while we get a client that comes through the door with both Fibromyalgia and sciatica. Unfortunately, for many people with Fibromyalgia, most new symptoms get put down to simply yet another Fibro symptom. However, if you do have Sciatica, then you will likely already know, that sciatica pain feels very different to normal everyday Fibromyalgia pain.
So, with that being said, I am going to say the same thing to you at home reading this, as we do to our clients in the studio: Do not put symptoms down to Fibromyalgia.
Sciatica is the loose term for one type of lumbar radiculopathy, essentially meaning pain and other symptoms, caused by irritation of a lumbar nerve root or at least a part of it. It’s also good to keep in mind that sciatica is a symptom, rather than a specific diagnosis, and not a particularly specific one either. The term sciatica can be rather confusing, with many medical professionals using it to describe radiculopathy involving the lower extremities and relating to herniated disks. And many patients refer to sciatica as any pain that shoots down the legs.
Now, for anyone with Fibromyalgia, adding sciatica into the mix can make an already painful day, into a seemingly impossible task! However, the good news though, is that most cases of sciatica will resolve on their own within 6 weeks, without the need for any special intervention or treatment.
Most people will never have this problem again, and the rest perhaps a few more times in their lives.
There are myriads of ways for the lumbar roots and sciatic nerve to get irritated, including, but not limited to: a nerve pinch, disk herniations, and genetic abnormalities. However, what’s important to remember, is that generally, nerve impingement doesn’t cause pain, inflammation does. In fact, the majority of the time, Sciatica is referred pain from the lower back and doesn’t even result from nerve-root compression. How one person reacts to load, movement, or even stretch, can be very different across the spectrum of people, and it’s likely that some people have nerve roots that are just a little quicker to react. Those with Fibromyalgia suffer from abnormalities in the way that the brain deals with pain. Supraspinal processes have a top-down enhancing effect on nociceptive processing in the brain and spinal cord. Studies have begun to suggest that such influences occur in conditions such as fibromyalgia. This means that those who do have Fibromyalgia and sciatica, they may be far more sensitive to noxious stimuli compared to the general population. Factoring in changes in tissues, stress, load, and movement, and those with Fibromyalgia may be more prone to reacting to these changes byways of producing pain.
Very rarely is sciatica mechanical in nature. Even issues like nerve impingement are fairly difficult to occur, due to the abundance of room at the nerve root. There are also many cases of actual impingement, where the individual doesn’t even have any pain.
Whilst you very well could have Sciatica, there are a few other things that can often mimic sciatica, things such as;
Piriformis syndrome
Genic abnormalities, wherein the sciatic nerve actually runs through the piriformis muscle, instead of under it.
And less likely, things like cluneal nerve entrapment.
I’m not writing to scare you, as the wide majority of cases of sciatica are completely harmless. However, it is important for you to understand that self-diagnosing sciatica is not a good idea. If it is troublesome, comes with a wide range of completely new symptoms, or you are worried, consult your doctor and get checked out.
Bed rest has been a popular treatment for sciatica for the better part of the last few decades. In terms of published evidence, most meta-analyses and reviews show that there are no significant benefits to bed rest over staying active when it comes to sciatica pain (and vice versa). However, as mentioned in a review posted in Spine, there is no considerable difference between advice to stay active and advice for bed rest, and there are potentially harmful effects of prolonged bed rest, it is reasonable to advise people with acute low back pain and sciatica to stay active.
So, if you do have fibromyalgia and sciatica, you have been checked out and there are no red flags, keeping active can be very helpful. However, being active doesn’t mean you need to be doing crazy exercises, it just means getting up and moving around, as much as the pain will allow.
In terms of movements, gentle dynamic movement that helps to move a joint through its full range can be incredibly beneficial when it comes to sciatica, helping us to utilise our own internal pain killers. Likewise, stretching can be incredibly beneficial, helping to calm the nervous system down, reduce muscle tone and guarding, reduce pain, and to help create a sense of safety. This sense of safety is a particularly interesting topic, as fear will cause you to guard, making you stiffer and most likely in more pain.
Heat can also be used on the surrounding muscles to help them relax. Due to the thickness of the tissue in the buttocks, heat isn’t going to have much of a circulatory effect on the nerves or muscles that can irritate sciatica. However, it will provide enough input to help calm down the nervous system. A good heat pad or warm bath is sufficient.
Likewise, vibration can be used for sciatica with a fairly good outcome. Vibration therapy may help to reduce muscle soreness and interleukin-6, helping to stimulate lymphocyte and neutrophil responses, a useful modality in treating muscle inflammation. Which if we learned anything today, is most likely more important than impingement.
It is not uncommon to see those with hypermobility and EDS covered in an abundance of brightly coloured KT tape. Kinesio tape comes highly recommended for those with hypermobility, however, just like most modalities, there are those that find it helpful and those who do not. There is an abundance of claims when it comes to using KT tape, ranging from injury prevention to increased circulation. However, what does the research say about taping joints with KT tape when you are hypermobile?
This is the topic for today and boy is it a doozy!
Kinesio taping was first brought about by chiropractor Kenzo Kase, back in the mid-1970’s, when he developed the original Kinesio Tape, which he called Kinesio Tex Classic. The term “Kinesio” is a shorthand for the word kinesiology, meaning “the study of movement”.
However, it’s important to note that this is not kinesiology, but rather good marketing. It could have easily been called a number of other things: Injury tape, Rehab tape, or Chiropractic tape. But that just doesn’t have the same ring to it, does it?
In 1980 Kenzo Kase established the “Kase Chiropractic Institute” in Kojimachi, Tokyo, and officially founded The Kinesio Taping Method.
By 1985 a dedicated taping instructor programme had been developed, and by 1989 the national Japanese volleyball team were using Kinesio Taping. Fast forward to 1997 and 7 of the major league baseball teams in America were using it.
At the 2012 Olympics, KT tape exploded! Many professional athletes were spotted on camera with colourful and elaborate designs, with even more elaborate reasons as to why they were wearing them.
At the Olympics there was a huge explosion in competition, with many new brands appearing also using the word ‘Kinesio’ in in the branding. Obviously, there are a few examples of cease and desist letters being sent in this time period, as Kase protected his trademark.
There are numerous claims when it comes to taping joints for those with hypermobility, and the list will probably surprise you;
Lifts the skin, decompressing the layers of fascia, allowing for greater movement of lymphatic fluid which transports white blood cells throughout the body and removes waste products, cellular debris, and bacteria.
However, bold claims require extraordinary evidence. Once you cut through all of the marketing and fancy claims, there are only really three points that may have any substance to them: pain relief, injury prevention, and increased performance.
These extreme claims have resulted in class action lawsuits and caused companies who market Kinesiology Tape to have to remarket and change their claims, as well as pay out considerable sums of money.
Under the terms of the KT Tape settlement, KT Health Holdings Inc paid $1.75 million to resolve the deceptive marketing allegations. In addition to creating the settlement fund to reimburse customers, KT also agreed to change the way that tape is advertised, removing the label claims: “it will keep you pain-free,” “prevents injury” and “provides 24-hour pain relief per application.”
The kinesiology tape packaging also changed to include a large bold disclaimer, to inform consumers that the athletic tape is “not clinically proven for all injuries.”
Likewise, RockTape faced similar class action allegations that its tape doesn’t provide the advertised pain relief. Unfortunately, sports medicine is far from evidence-based, with inventions such as theracanes and scraping tools having a tiny amount of research. However, taping has over 2000! So research isn’t exactly lacking in this area. But what does it say?
With so many claims out there for tape, it can be hard to separate fact from fiction, and placebo from actual mechanisms. As I mentioned before, once we take away the bogus claims, it leaves us with only three main points that may have any truth to them. If you are Hypermobile or have EDS, then I am going to assume that it’s more of the potential benefits to pain that you are most interested in.
The main issue with the current evidence on tape and hypermobility is that many of the research studies conducted conclude that KT tape may be effective, however, the quality of evidence (also known as grade) is insanely low. One example of this is a study in 2013 that concludes KT tape “may be effective in reducing pain during stair climbing activities”. However, the median effect of 0.5 on a pain scale from 0 – 10, was lower than the threshold of clinical importance. Meaning, that the quality of evidence for this study was rated “very low quality” as it was a single trial with a very high risk of bias. Some authors even concluded that Kinesio Taping was effective when their data did not identify significant benefits!
There is an abundance of people with hypermobility that rely on KT tape every day, yet in the same breath, there are people that it simply does nothing for. Likewise, if you take a closer look, there are also people who get negative effects from using tape, usually in the form of blisters, sensitivity, or burning, from the adhesive commonly used in Kinesiology Tape.
Whilst there is an abundance of research into KT tape, the research conducted around taping hypermobile individuals, who are arguably the population that needs it the most, is rather disappointing. Whilst some studies do show that KT tape may have some benefits when it comes to pain and hypermobility, most of the studies are fairly poor, lacking in control groups, consisting of very small sample sizes, and with no to very little follow-up.
A study conducted in 2021, showed that Kinesiology taping may be effective for reducing shoulder pain and improving function in patients with EDS up to 48 hours post application. But, again, this was a sample size of eight females, no control group, and a possible time effect. Hopefully, as research grows, a larger study will be conducted with a control group, more participants, and over a larger time period.
Likewise, a far superior study conducted recently in 2021, showed that 10 sessions of shoulder rehab, over a 6-week time frame, found no difference when KT tape was used. Both groups improved over time, in symptoms, range of motion, and functionality of the shoulder.
An interesting study showed that KT tape, when combined with foot strengthening exercises, compared to just strength exercises, was more effective at increasing navicular height: creating more of an arch. It was a decent sample size and could have been better controlled, but the main issue I have with this study is that it seems a little biased, directly quoting Kenzo Kase’s tape claims. However, it does give us a little food for thought. One of the exclusion criteria for this study though was no neuromuscular disorders, or more pertinent to hypermobility, no lower limb injuries.
The likelihood of someone using KTtape if they are hypermobile is because of recurring injuries and dislocations. So, how does this study compare to those who are injured and prone to dislocations? There is also the issue that one modality coupled with another, is pretty much always more effective than using a single modality alone, like results shown in this Masters thesis using KT tape and Orthotics.
An interesting study performed on recreational dancers found that Kinesio taping was fairly effective in eliminating sacroiliac joint pain, occurring in 13-25% of patients in the dance population. It’s a good idea to keep in mind, that people generally gravitate to activities at which they are naturally good at. This is one of the reasons why we find a higher prevalence of hypermobility amongst dancers, compared to say Rugby or other contact sports.
With research severely lacking in KT tape and hypermobility, I looked more towards the studies that would naturally include those with hypermobility, which is why these studies into dancers give us a little more insight into KT tape and hypermobility. Having analysed numerous publications on the effectiveness of Kinesio taping amongst dancers and athletes, you could conclude that KT tapes proves to be ineffective when it comes to increasing muscle strength or improving proprioception of the joints. However, only if it is used by healthy individuals using moderate physical activity.
Studies of Kinesio taping under strenuous physical exercises, for healthy individuals, have demonstrated numerous positive effects of taping, such as improvement of articular proprioception and postural stability (both static and dynamic), relieving of muscle fatigue and enhancing their recovery, as well as a reduction in the severity of delayed-onset muscle soreness. Kinesio taping turned out to be exceptionally effective for patients with different acute and chronic injuries of the musculoskeletal system. It helped to restore impaired proprioception, stabilise joints, ease pain symptoms, and improve muscle strength. However, there still is one giant issue when it comes to tape and hypermobility; what is the actual mechanism that yields these results? It is incredibly hard to dive deep into this topic with so little specific research into hypermobility and tape.
Not only is this a hard topic to research, but when we factor in the poor quality evidence of the studies and potential bias, it’s easy to get a headache.
Research comes with many levels of evidence, and unfortunately, most of these studies aren’t great. However, I did find a study that sits firmly at the top of the hierarchy when it comes to evidence. In this beautifully done research, it concluded that KT tape, when used for a range of musculoskeletal conditions, has no benefit over sham taping/placebo and active comparison therapies. In essence, the benefit was too small to be clinically worthwhile, or the trials were of very low quality.
Regardless of the comparison used or the outcomes investigated, most research typically showed no significant difference in outcomes between groups, or a trivial effect in favour of Kinesio Taping (ie, small enough to not be considered clinically worthwhile). It seems that the growing use of Kinesio Taping is due to massive marketing campaigns (such as the ones used during the London 2012 Olympic Games) rather than high-quality, scientific evidence with clinically relevant outcomes.
Therefore, current evidence does not support the use of Kinesio Taping for musculoskeletal conditions.
It is also possible that performance could potentially be increased, say through a combination of minor benefits. Alone they are hard to identify, but collectively they may be relevant. So there you have it, the evidence for using KT tape is not very good!
The evidence shows us that KT Tape likey doesn’t do what it says it does, and any effects are likely a placebo or brought about by any number of biological, psychological, or social variables. But, some people with hypermobility like taping. It makes them feel better, experience less pain, and it makes them feel like their joints are more stable. If there was ever a reason to use tape, it’s not because of the crazy marketing, but of how it makes you feel.
So for the people who do seem to get pain relief from taping, why is this?
Well, for those with Hypermobility, and especially those that sublux/dislocate, nociceptive pain can play a large part in their life, and this is where it gets interesting.
Nociception is where high threshold nerves that detect potentially dangerous stimuli, such as extremes in temperature, pressure, chemicals and stretch, inform your brain that something may be wrong. However, keep in mind that this is not a pain signal, because they do not exist. Let’s leave pain receptors in 1664 where they belong. However, for those with hypermobility and EDS, recurrent subluxations/dislocations, are going to cause a lot of nociception. In fact, this may even lead to nociplastic pain, wherein your nervous system changes how nociception works, making it more sensitive to keep you safe.
Let’s say you sublux your hypermobile ankle. Extreme stretching of the ligaments and tendons is likely to cause a nociceptive response. Your brain decided that because of the context of the situation and about 50 million other variables, producing pain to stop you from bearing weight on your ankle and damaging it further, is a very good call.
Your joint isn’t dislocated, however, it did go out and then straight back in…this is known as a subluxation (you probably already knew that if you’re hypermobile). Depending on the degree of subluxation/dislocation that occurs, nerves and blood vessels may be damaged, muscles and ligaments may tear or twinge, the joint may swell, compression of nerves may cause tingling, and inflammatory responses can be activated. Say hello to nociception!
Due to the subluxation, you have a local inflammatory response. Your nervous system is on high alert and it’s sending far more information to your brain than it normally does when it comes to your ankle. Your brain receives around 11 million bits of sensory information every second, so what is a little more if it keeps you safe.
Tape very likely acts as a competing input for those with hypermobility, helping to drown out nociception to some small degree. If you stub your toe on a coffee table, you’re likely going to produce nociceptive pain. The first thing you are going to do is to rub your toes sending competing information to your brain to drown it out. This is why the pain changes from that sudden, acute, and sharp pain, to a more manageable low-level throbbing pain. So, it’s not a far stretch to assume that it is likely the same mechanisms at work.
Likewise, we are human and as such we are incredibly tactile. We love to touch. In fact, it’s one of the very first things we learn as babies, as our mothers cuddle us and provide love. It’s also one of the very first associations we make as small children. We fall over, we scrape our knees, and mum makes it better with a kiss and cuddle. As humans, we often learn that when it comes to pain, sensory information helps. If you don’t believe me, then the next time you stub your toe, just don’t rub it and see how long you can stand. Touch and sensory information for humans is innate.
In the weird world of pain, there are many things that mediate and contribute to why someone experiences it. Likewise, there is also an abundance of factors that help to reduce it, and touch and sensory information is one of those things. Taping a joint does seem to give people have more ownership over it, becoming acutely more aware of joint positioning (well kind of), as well as being more conscious when it comes to moving the joint. After all, it is a lot harder to sublux a joint, if you are paying attention to it. Which coincidentally, is the main mechanism most hypermobility rehab, pilates, and yoga programmes use. The only issue here is that you can be absolutely fine whilst doing the exercise (because you are aware), however, once you finish and go about your day, pop, there goes your joint.
We have said it a million times here at The Chronicillness.co, the way that other professionals go about hypermobility rehab is not right at the moment. Consciously being aware of your joints does not stabilise them outside of sessions, only slightly inside of sessions. If you take a look a some of our clients, you will see that in a very short time frame their joints become stable outside of sessions not just inside, and this is largely because we work neurologically, and don’t stress conscious awareness.
Probably one of the better reasons to choose KT tape if you are hypermobile or have Ehlers Danlos syndrome, over say a rock-hard support splint, is the effect that immobilising can have.
Immobilisation can lead to hypoxic and inflammatory conditions in the joint capsule, which can easily become an initiating factor for issues such as joint contractures, as well as sending constant nociceptive signals.
With a joint that is repeatedly dislocating, there is a fair chance that the person suffering is likely going to avoid using the joint, choosing to immobilise it. This, however, can lead to a vicious cycle of disuse and lack of nourishment to the joint. In immobilisation studies conducted over 32 weeks by binding the hind legs of rats:
Immobilised cartilage had increased collagen content (scar tissue)
The severity of osteoarthritis increased as measured by Mankin scores
The trabecular bone plate area (the spongy bone at the end of long bones, like the thigh and shin bones) at the front and back of the shin showed bone loss, but not in the middle.
Chondral vascular ingrowth was seen in the subchondral bone. This means that blood supply was increased to the bone as the cartilage and outer bone was dying.
The centre of the knee joint was being fortified, as we see in the fact that bone loss was not seen in the centre of the top of the tibia bone.
Replacement of cartilage by bone may have been mediated by chondral vascularisation, suggesting irreversible changes. These findings stress the importance of weight-bearing and joint motion to maintain cartilage structure.
Not surprisingly, it has been shown that the more a specific joint is exercised, the stronger the bone-ligament and bone-tendon complexes become. Exercise specifically helps strengthen the fibro-osseous junction, which is where the ligament/tendon and bone attach to each other, and which, incidentally, is the area where Prolotherapy (often recommended and praised by the hypermobile population) treatments are administered.
With KT tape providing some sensory tickling, as well as helping to support the joint, but not completely immobilise it, it does have the potential to be a lot healthier, given the above.
So, a big reason why a lot of those with hypermobility and EDS use Kinesio taping, is because they feel that it adds to proprioception. Now I will preface this next section by saying here at The Fibro Guy, we do use tape occasionally, however, only ever in session, and we never make KT tape out to be more than it is. Tape can be helpful for some of our clients with issues like Thoracic Outlet Syndrome, to help cue them into positions where they aren’t causing compression. With that being said, it’s only ever added for a tiny boost to positioning and awareness. To be honest, it’s more like an addition to awareness, than actually increasing proprioception.
Research around proprioception and the use of KT tape in the hypermobile population, is again, unsurprisingly sparse!
An interesting study performed on those with hemiplegia due to stroke, found a difference in values before and after the tape was applied in the case of left and right deviation whilst walking. Not a fantastic study, due to a lack of controls, too small of sample size, and the fact that physiological and psychological factors were not considered relating to the subjects.
Many ankle studies show KT tape has no real significance when it comes to proprioception. Likewise, studies around the lower back and proprioception, yield the same results. One study looking at the effects of Kinesio taping of the knee on proprioception, balance, and functional performance in patients with anterior cruciate ligament rupture (ACLr) found some interesting results, in that KT may have beneficial effects on proprioception, balance, and functional performance in people with ACLr, but it cannot completely compensate for the loss of proprioception. The application of KT during rehabilitation may be a good therapeutic option either before ACL reconstruction surgery or as a conservative treatment for ACLr. However, it’s not a great study when it comes to tape, for many of the reasons I’ve already stated in the above paragraphs.
Then we have another study by a team of Italian researchers found that Kinesio Tape may help improve ankle stability for athletes with chronic ankle instability.
So, looking at the research, it looks like sometimes it may help slightly, other times it makes no difference at all, and there are 100,000 other variables that are likely involved, but unaccounted for.
Research always has limitations, and a large one is that a lot of these studies were performed with vision removed from the experiments. Vision is an important part of moving, as it works in conjunction with our cortical maps, to help us over through space and time. People, especially those with hypermobility and EDS, don’t walk through life with their eyes shut using just proprioception, they include visual data. Likewise, small sample sizes, some bias, and a whole host of other things, we end up with more questions than we first started with.
By looking at the research, we can see that something happens when we use KT tape. I mean it’s probably not the KT tape that’s responsible, but a whole host of other factors. But, the fact remains, that KT tape may make people more aware of their joints, but more importantly, it might help contribute to less pain, and that’s what it’s about isn’t it.
Tape isn’t particularly invasive, it’s not damaging (well sometimes, and I will get to that), and it makes some people feel better. Given all of that, if taping does help you, then you don’t really have anything to lose; just don’t go expecting miracles. I think that the use of tape in this context is fine. It’s a little like stretching, a lot of the reasons people do it got debunked years ago. But, if it feels good and it helps, go for it.
So, you have taken a look at the evidence, and you realise that there isn’t anything specifically magical about the tape. However, you do fancy a little bit more awareness of your joints and a little bit of sensory tickling. Well, then, that’s a pretty good reason to use tape. Let’s take a look in the next few sections on how to tape. But first, let’s start with some KT tape tips, that are going to save you a lot of headaches.
For those with EDS and velvet skin, and indeed even those without, perhaps those with mast cell issues, the tape can be an irritant, and in some instances cause blisters and soreness. For KT tape to stick to your skin, it is covered with adhesive. When you apply KT tape, you are recommended to rub the tape to help activate the adhesive. Now, if you do have skin that is irritable (and to be honest, I recommended this for everyone), do a little patch test first. Cut a small square of tape off and apply it to an area for 48hrs, then see how you react. Likewise a really handy tip if you are super irritable to tape, is to use barrier film spray, the same spray used for stoma bags.
It’s all well and good having your tape on, but there will come a time that you need to remove it. Even the smallest of hairs are going to hurt when the tape comes off. So, make sure that you shave the area if it is dense with hair, and you can save yourself some trouble in the future.
Often people end up cutting off more tape than they actually need. Remember, that tape stretches, which means that once you apply some tension to it, it will reach further. This is a handy little tip, especially considering how expensive some tapes can be!
KT tape has a tendency for the ends to curl up, getting caught on clothing. So, if you are going to tape, round off the corners of your tape and it will last far longer.
Trying to pull the backing tape off KT can be frustrating. Instead, if you tear the tape with your hands, you will tear the backing paper, making it easy to remove, whilst leaving the tape unaffected.
By looking at the research, we can see that something happens when we use KT tape. I mean, it’s most likely not the KT tape that’s responsible, but a whole host of other factors. But, the fact remains, that KT tape may give people more awareness of their joints, but more importantly, it might help contribute to less pain, and that’s what it’s about really isn’t it.
So, for those of you who are wanting to tape hypermobile joints, we have compiled a few videos of how to tape some of the most problematic hypermobile joints.
We hope you enjoyed reading, and more importantly, feel more informed about KT tape and hypermobility.
When it comes to the topic of Fibromyalgia and exercise, there is an abundance of research showing exercise to be extremely beneficial when it comes to managing pain. However, for many with Fibromyalgia, exercise may seem completely counterproductive. After all, you really don’t need to look very far to find people who have tried to exercise but have then experienced one of the biggest pain flare-ups of their life, as a direct result of exercising.
So, why is exercise held in such high esteem, especially when there are so many people who seem to have such negative reactions to it?
Why can some people with Fibromyalgia seem to get away with exercising, yet others end up in bed for a week with a fibromyalgia flare-up?
If you are one of the many sufferers of Fibromyalgia from around the world, you’ve probably asked yourself the question “should I exercise when I have Fibromyalgia?” The available research and guidelines do say yes to this question, but is it really that simple?
In this article, let’s dive into the top of exercising with Fibromyalgia, and take a look at how people often get it wrong, and what you need to actually be focusing on when exercising with Fibromyalgia.
There is no doubt that you will have been told by friends and family that exercising can help with your Fibromyalgia. Whilst most of the time this is meant as an honest way of trying to help, nonetheless, it can often be very unsolicited advice that leaves you feeling down, as you have likely already tried exercise, all to no avail. There are reasons why people with fibromyalgia struggle with exercise, this is despite it being one of the most effective treatments for chronic pain.
But first, before we look at why people struggle with exercise, what does the research actually say about exercising with Fibromyalgia?
Research does support the idea that aerobic and strength training helps not only improve physical fitness and function, but also reduces the symptoms of fibromyalgia, whilst also improving quality of life. There are also numerous other reasons to exercise when you have fibromyalgia, such as the fact that it has largely beneficial effects on symptoms of depression, which if you are in constant pain, you will very likely have. Another study found that for those with Fibromyalgia who did take part in exercise, it significantly improved pain catastrophizing, sleep, and even anxiety.
However, not all exercise is created equal. The studies above were performed using low to moderate intensity. But, it’s important to remember, that exercise is a human construct. It’s unlikely our ancestors put aside an hour a day to exercise when their entire lives were focused on hunting and movement. Simply reframing exercise as movement, can completely change the narrative around fibromyalgia and exercise, and in some instances, actually make it enjoyable. Exercising doesn’t mean you have to go to the gym and hit the treadmill, it simply means moving.
Many people with Fibromyalgia have found this to be true when engaging in movements such as Tai Chi, a low-intensity form of self-defence. In fact, one study found that yang-style Tai Chi was one of the most effective forms of exercise when it came to Fibromyalgia, producing results fairly quickly, with very limited pushback or side effects.
Whist all of these things sound and look great on paper, it still doesn’t change the fact that there are millions of people with fibromyalgia, who end up with a flare-up from trying these exercises.
Think of it like this. We called it fibro “box”. Everyone on the planet, Fibro or not, has an exposure limit for stress. This is where the brain and body essentially put you into protection mode to keep you safe from actual or perceived, danger or damage. With Fibromyalgia, we became more sensitised to stressors: physical stressors like exercise or lack of good quality sleep, psychological stressors such as dealing with a death in the family, or social stressors such as a 40-hour work week or a global pandemic!
For those with Fibromyalgia, our exposure limit to these stressors is greatly reduced, which means that it does not take a high degree of these stressors to put us into a flare up. The important thing to keep in mind here is that when the brain senses danger, it has a brilliant little protection method to ensure that you immediately start limiting that stressor: we call this pain.
June has Fibromyalgia and currently works 39 hours per week. June starts to struggle with the work week, and often finds by the time Thursday rolls around, she is in so much pain that she is literally limping into the next work week. June has tried for 6 months now to just push through and keep working, however, one day, by the time Thursday comes, she has a huge flare-up of pain and has to call in sick on Friday. This is June going over her exposure to stress limit.
After a week, June’s pain is back down to her normal baseline and she goes back to work, unfortunately, she gets hit with another huge flare–up. June recovers and has a back-to-work meeting with her boss, where it is agreed that she can drop her hours down to 20hrs per week.
June goes back to work at reduced hours and everything is much better. After 2 weeks, June is really starting to enjoy work as it’s not so physically and mentally demanding anymore. However, as brains often do, June’s exposure limit drop and one day June goes into work and is hit with another huge pain flare-up. June rests for a week and then goes back to work, but 20hrs per week feels just like 39.
After another back-to-work meeting with her boss, June agrees to only do 10hrs per week and off she goes back to work, all whilst staying under her exposure limit.
For a little, while everything seems fine, that is until she has another huge pain flare-up. Over time as the exposure line drops more and more, June can deal with less and less stress, until eventually, she goes into the Flare-up Box.
In the box, yes she is in pain and she is still tired, but as long as she doesn’t try to push herself out of it, she will avoid any major flare-ups. This is where most people with Fibromyalgia eventually end up, conditioned and forced into the box.
Now, keep in mind, that this is not just exclusive to work, it also applies to exercise and just general mobility. Pain is a conditioning tool that absolutely works, and your brain wants nothing more than for you to be safe. So, if you’re doing exercise that your brain deems as dangerous or you are pushing past your exposure line, then you are going to slam down into that box.
The Box is a concept we came up with when we noticed a repeated cycle in many of our Fibro clients. We actually recorded a Podcast episode going into this concept in a little more depth.
The takeaway here, for those trying to exercise who have Fibromyalgia, is that exercise is a physical stressor. The amount of stress that you as an individual are able to handle at the moment, is unique to you, driven by an incredible amount of variables. Variables we will discuss in this article.
There are two reasons why exercising with fibromyalgia is so hard and difficult: Sensitisation and exposure limits. However, before we get into that, we need to look at what Fibromyalgia pain actually is. There are three main recognized definitions of pain:
Neuropathic pain: This is where there is damage to the actual nervous system. Some examples of this are nerve damage after surgery, viral infections, cancer, vascular malformations, alcoholism, neurological conditions such as multiple sclerosis and metabolic conditions such as diabetes.
Nociceptive pain: This is pain that arises as a direct result of nociception. Within your body, there are no such things as pain receptors. In fact, this outdated idea was first coined back in 1664, and keep in mind, that we were still burning people at the stake back then because we thought they were witches. Luckily, science has progressed a lot since then. We now know that what we once thought were pain receptors, are actually nociceptors.
A nociceptor is a special kind of nerve that detects anything that may be potentially dangerous, So, extremes really, of temperature, chemicals, stretch, pressure, and vibration. The job of nociceptive nerves is to report to the brain about potential danger. That’s it, they don’t tell your brain that you are in pain, they just tell your brain that something may be wrong. Once your brain has this information, it’s up to your brain to decide if producing pain is warranted or not.
Nociception and pain are two completely separate entities and they are not mutually exclusive. You can have nociception and pain, you can have nociception and no pain, and you can have pain without nociception. But when pain is created as a result of nociception, we call this nociceptive pain. An example of nociceptive pain would be stubbing your toe on a coffee table, or any injury really.
Nociplastic pain: The pain that those with Fibromyalgia experience, in general, and not just from exercises, is what we call “Nociplastic pain“. This is where there is a change in how nociception works. When pain is created, despite no clear evidence of actual or threatened tissue damage causing the activation of nociceptors or evidence for any disease, we call this nociplastic pain. Think of it as a faulty check engine light on your car, that keeps going off even though your engine is fine. This nociplastic pain is when your alarm system for danger and threat keeps going off when it shouldn’t.
So, we mentioned earlier that a reduced stressor exposure limit, is going to cause problems with how people exercise when they have fibromyalgia. But, there is also another issue that can arise to cause even more problems: sensitisation.
As we mentioned above, those with Fibromyalgia suffer from abnormalities in the way that the brain deals with pain. Supraspinal processes have a top-down enhancing effect on nociceptive processing in the brain and spinal cord. This effectively means that those with fibromyalgia may be far more sensitive to noxious stimuli compared to the general population. Brains are predictive at the end of the day, and research shows us that when a brain is unsure of the exact movement that causes pain, it will just guess. Meaning that movements that should not be inherently painful can soon become that way. Combine that with a nervous system that reports danger or a threat to tissues, when there isn’t any, and a drop in tolerance to stress, and exercising with Fibromyalgia can seem an almost impossible task.
To answer this question, we need to really understand its intent. Because as it stands, an exercise that one person can do with fibromyalgia, is often an exercise that another cant tolerate. If you are looking for a quick fix exercise to dramatically bring down your pain or push you into a full recovery/remission, then I’m sorry to say, that is not how it works. Whilst there may indeed be some form of exercise that most people with Fibromyalgia can tolerate, there are going to be people who feel worse for it.
There are many suggested forms of exercise for Fibro, which all have their own individual benefits.
As we mentioned before though, not everyone is going to have success with these forms of exercise. But, they do seem to be the most tolerated forms of exercise for those with Fibromyalgia.
Here at The Chronicillness.co, we don’t even approach the topic of exercise, until we have a good understanding of what issues our clients are facing. And when you work like this, it makes things so much easier. After all, would you rather exercise when your danger alarm system is heightened or turned down: it’s always going to be latter. We initially saw Kit online. She was practically immobile when we first met her. The slightest use of her body swung her into a flare-up for days. But, focusing on the underlying issues as to why she had Nociplastic pain in the first place, it allowed us to calm those nerves down and increase her stressor exposure limit enough to be able to start exercising and reaping the benefits. These days you can catch her at her Zumba class and hiking the hillside.
But, you’re not here to listen to us talk about our clients, you are here to learn about fibromyalgia and exercise. So let’s take a closer look at these most tolerated exercises.
We mentioned earlier that Tai Chi was one of the most effective and safest forms of exercise for Fibromyalgia. So, let’s take a closer look at why this potentially is.
Remember when we mentioned earlier that we don’t even start thinking about exercise before we find out the reasons why someone has Nociplastic pain. Well, Tai Chi is a great form of exercise because it allows people to jump straight in, without worrying all too much about the reasons why they are in pain, but still reap benefits from exercise. There have been some brilliant studies done on Tai Chi as an exercise for fibromyalgia and the benefits may surprise you.
Tai Chi is a very graceful form of exercise, it’s slow, elegant, and as far as your brain is concerned it’s a pretty low stressor. This is great for anyone with Fibromyalgia who wants to exercise, as it allows them to take part in exercise without pushing above their stressor exposure limit and causing a huge flare up. The current body of evidence shows Tai Chi to help with increased well-being and improved sleep. Something to also note is that there were no studies that found tai chi worsened a condition.
So, Tai Chi as an exercise for Fibromyalgia looks like a good way to start increasing your stressor tolerance level. If it can help to increase your well-being and improve your sleep, your pain levels will come down, which means your tolerance level to stress will go up.
One of the main forms of exercise most guidelines advocate is strength training and with very good reason. Strength training has unrivalled benefits for both chronic pain and the general population. Strength training is not just about working out your tissue, it’s also about working your nervous system. Whilst you may not see muscle growth initially, this is because neural adaptation is taking place, wherein your brain is getting better at recruiting muscle fibres.it already has. Making you feel stronger, which honestly, is a huge benefit in itself.
When you feel stronger, you hold yourself differently, you interact with people differently, and you gain a new sense of ownership over your body. When it comes to fibromyalgia, this is important, as it can often feel like you don’t own it. We get better at the things we do, and the better you get at producing feel-good chemicals from exercise, the easier it is to produce them in general.
As a general rule, we use the following when introducing strength training to a Fibro client:
Do they understand it?
Do they enjoy it?
Is it not overly complicated?
Is it needed?
Is the client’s nervous system able to deal with the stress?
If the answer is yes, strength training is in. Bear in mind that it is important to lay the groundwork in the form of education and changing the narrative around pain before jumping in at the deep end and picking up a weight.
When we begin a strength training journey there are some common themes which always occur.
Number one is the person gets a sense of achievement. Having not done much for a long time, the sense of pleasure from completing a new movement task can be like a drug. With very good reason, the brain is like a pharmacy and in its cabinet are some of the most potent drugs known to man. The use of movement, strength training or otherwise, helps this mushy pharmacist release those “feel good” chemicals (namely Dopamine and Endorphins) These chemicals give us the feeling of having achieved something and craving it again.
This is why it is so important to address any factors pertinent to YOUR pain before beginning as this process can be just as easily a negative one.
Number 2 is the person will start to notice changes in their body. Weight loss, changing shape, muscles popping up and even muscle soreness will all occur pretty early into the process. Muscle soreness is a weird one. It can be scary to think the pain is being made worse by exercise, but on the other hand, it is an excellent way to prove that although the soreness comes, it goes just as quick. And this can be where the magic truly happens. When you have tangible, physical proof that the body can repair and recover, the associated sensitivity from chronic pain starts to dial down over time and you become much more resilient. Both physically and mentally. After all, a good way to show your brain that your body isn’t damaged is to show it what it can do. Remember earlier when we said that if a brain doesn’t know what movement causes pain, it will just guess? Well actually moving is a good way to for your brain to figure this out.
Number 3 is catching momentum. Once you have experienced a change in your symptoms for the better, the nervous system craves movement. You’ll be itching to move more and actually look forward to exercising. At this stage, the movement has become a tonic and is much more energy-producing than fear-inducing or painful. Again, it all comes down to the narrative and having someone guide you through the process to help address the underlying issue as to why you have Nociplastic pain in the first place.
A Spanish study, of 33 women with fibromyalgia, demonstrated that: “a warm water pool-based exercise program for 12 weeks (2 times/week) led to a positive immediate decrease in the level of pain in female patients with fibromyalgia.” The women involved in the study also reported feeling less depressed and more sociable, as a side benefit of their swimming programme.
Swimming gives someone with Fibromyalgia a chance to exercise without having too much load on their tissues, meaning the alarm system is going to be a lot more forgiving than it normally would be. However, there is one issue with swimming as an exercise for fibro: It’s just not transferable to everyday life. Once you are out of the pool and subject to the same load and gravity that is normally enacted upon you, are you going to be able to deal with that stressor? Unfortunately, there isn’t any research on this so it stays as food for thought.
The name Osteoarthritis is somewhat of a misnomer, as “Osteo” means bone,”‘Arth” means joint, and “Itis” means inflammation. And when we realise that Osteoarthritis is a degenerative condition, not an inflammatory one, we can start to see why there is likely so much misinformation around fibromyalgia and osteoarthritis, especially considering it’s not even named correctly!
There is a lot of misinformation around Osteoarthritis, even more around Fibromyalgia, and an absolute abundance around exercise. So, let’s take a look at some studies and start to break down those damaging narratives that you have likely been told or have read.
One study focusing on professional football players found that 92% of football players had at least 1 spinal degenerative condition, but in some cases, more than 6 were found. The interesting thing was that none of them reported any pain. This is a nice study that helps us look at the complexities of pain, as when it comes to chronic pain it isn’t always about the tissue.
There is a ridiculous amount of evidence that shows us that pain is not tightly linked to tissue damage. And when it comes to Osteoarthritis, there should also be evidence of people with severe degeneration shown on a scan, but who feel fine, and vice versa. This study of 113 people found exactly that, a huge disconnect between degeneration and pain. In which they found that the people with less degeneration had more pain, and those with more degeneration had less pain!
As we mentioned earlier, those with Fibromyalgia suffer from abnormalities in the way that the brain deals with pain. Supraspinal processes have a top-down enhancing effect on nociceptive processing in the brain and spinal cord. Studies have begun to suggest that such influences occur in conditions such as fibromyalgia. This means that those who do have Fibromyalgia may be far more sensitive to noxious stimuli compared to the general population. Factoring in changes at the joint, those with Fibromyalgia may be more prone to reacting to these changes byways of producing pain.
There have been a few studies that have looked into how Fibromyalgia may affect Osteoarthritis. One such study published in the European Journal of Neuroscience, measured brainwaves in response to short painful laser pulses on the skin of patients suffering from osteoarthritic and fibromyalgia pain, as well as test subjects who had no underlying pain. Scientists discovered that the insula cortex part of the brain increased its activity when expecting a painful pulse, as it predicts the extent and intensity of the patients’ own chronic pain.
It is important to keep in mind, that increased activity in this brain area has been linked to a number of phenomena, including body perception and emotional processing, which might explain the greater pain perception in some patients.
In essence, there are a lot of factors that come with fibromyalgia that can make osteoarthritis worse, when compared to individuals without it. One such factor is sleep disturbances. It is well documented that with sleep disturbances and lack of sleep, comes an increase in pain. For those with Fibromyalgia, getting a good, restful night’s sleep can be somewhat of a challenge due to pain. Meaning that it has the potential to create a breeding ground for worsening the symptoms of not just fibromyalgia pain, but also the pain of Osteoarthritis.
The take away though, is that changes and sensitisations seem to be the pain driving forces of osteoarthritis. While you may worry that exercising with osteoarthritis (OA) could harm your joints and cause more pain, research shows that people can and should exercise when they have osteoarthritis. In fact, exercise is considered the most effective, non-drug treatment for reducing pain and improving movement in patients with osteoarthritis.
Conclusion
We have looked at some of the many issues that present when it comes to Fibromyalgia and exercise, and we have looked at the research on the different forms of exercise. As it stands with everything we have discussed, most likely the safest and most beneficial form of exercise for those with Fibromyalgia is Tai Chi.
Tai Chi looks to give individuals a form of exercise that can be built upon, without adding too much stress to an already stressed system. As we mentioned earlier, the true key is to find the reasons why you have nociplastic pain in the first place. As it is far easier to exercise with reduced pain levels and higher tolerance.
We hope you enjoyed reading this and we especially hope we managed to answer some of your burning questions.
At the end of the day, pain is multifactorial and comes down to hundreds of interplaying factors.
Here at The Chronicilness.co of the United States, we know that living with chronic pain can be stressful. But one of the best ways patients can help reduce the stress in their lives is by learning how to relax through breathing exercises.
Deep breathing helps lower stress in the body because breathing deeply sends a message to the brain to calm down and relax. The brain then sends this message to the body. Deep breathing also causes certain things that happen when stress occurs, such as increased heart rate, fast breathing, and high blood pressure, to decrease.
Another good thing about breathing exercises is that they are easy to learn. Patients can do them whenever they want, and they don’t need any special tools or equipment. Patients can also try out different exercises to see which works best.
The following methods focus only on breathing exercises, but there are other ways, such as combining breathing with things like yoga, imagery, and meditation.
The first exercise presented is called belly breathing and is simple to learn and easy to do. It’s best to start there, especially for patients who have never done breathing exercises before. The other exercises are more advanced, but all of these exercises can help patients relax and relieve stress.
Belly breathing is easy to do and very relaxing. Patients can try this basic exercise anytime they need to relax or relieve stress.
Sit in a comfortable position.
Put one hand on your belly just below your ribs and the other hand on your chest.
Take a deep breath in through your nose, and let your belly push your hand out. Your chest should not move.
Breathe out through pursed lips as if you were whistling. Feel the hand on your belly go in, and use it to push all the air out.
Do this breathing 3 to 10 times. Take your time with each breath.
After mastering belly breathing, patients may want to try one of the following more advanced breathing exercises.
4-7-8 breathing This exercise also uses belly breathing and can be done either sitting or lying down.
To start, put one hand on your belly and the other on your chest as in the belly breathing exercise.
Take a deep, slow breath from your belly, and silently count to 4 as you breathe in.
Breathe out completely as you silently count from 1 to 8. Try to get all the air out of your lungs by the time you count to 8.
Repeat 3 to 7 times or until you feel calm.
Roll breathing The object of roll breathing is to develop full use of the lungs and to focus on the rhythm of breathing. It can be done in any position, but while learning, it is best to lie on the back with knees bent.
Put your left hand on your belly and your right hand on your chest. Notice how your hands move as you breathe in and out.
Practice filling your lower lungs by breathing so that your “belly” (left) hand goes up when you inhale and your “chest” (right) hand remains still. Always breathe in through your nose and breathe out through your mouth. Do this 8 to 10 times.
When you have filled and emptied your lower lungs 8 to 10 times, add the second step to your breathing: Inhale first into your lower lungs as before, and then continue inhaling into your upper chest. As you do so, your right hand will rise and your left hand will fall a little as your belly falls.
As you exhale slowly through your mouth, make a quiet, whooshing sound as first your left hand and then your right-hand fall. As you exhale, feel the tension leaving your body as you become more and more relaxed.
Practice breathing in and out in this way for 3 to 5 minutes. Notice that the movement of your belly and chest rises and falls like the motion of rolling waves.
Practice roll breathing daily for several weeks until you can do it almost anywhere. You can use it as an instant relaxation tool anytime you need it.
Caution: Some people get dizzy the first few times they try roll breathing. If this happens, slow breathing down and get up slowly.
Fibromyalgia and Costochondritis are two conditions that often go hand in hand with each other. Over the years we have lost count of the number of clients who were plagued with the hallmark sharp stabbing pains, that often come with Costochondritis. Within this topic are many questions, most of which become a whole lot harder to answer when we factor In Fibromyalgia.
There are many people in the general population who have Costochondritis, it’s not just another issue that comes along with Fibromyalgia. However, as we will come to find when we take a look at some of the research, Costochondritis does seem to be far more prevalent in those with Fibromyalgia.
Costochondritis is the term given to inflammation of the cartilage that joins your ribs to your breastbone, also known as the costochondral joint. Inflammation is a natural response to illness or injury, it’s essentially the immune system’s response to help initiate the healing process, in other words, it is a defence mechanism that is vital to our survival.
Whilst Inflammation is one of the body’s greatest tools, it doesn’t feel all that great when it does happen. After all, the point of inflammation is healing, and this means that more blood is redirected to the area, tissues become more permeable to allow increased blood flow and nutrients to the areas, and the nerves in the surrounding areas become a whole lot more sensitive. If you have ever had a paper cut you will know exactly what I mean. For such a small cut, it sure does impact your day to day activities.
With Costochondritis, the costochondral cartilage, which connects your ribs to your breastbone, and surrounding tissue can become inflamed, making it tender and unpleasant when pressure is applied, and in most cases, simply from breathing or even moving.
The obvious leading symptom is chest pain, typically it is described as a sharp or stabbing pain, and sometimes it is described as more of a dull ache which often becomes worse when moving or exerting the chest muscles. This can also include breathing, which can cause an increase in pain with large breaths. Many people find that even the slightest touch or pressure around the sternum and ribs can fire off a pain response, as the nerve becomes more and more sensitive due to the inflammatory response.
The most commonly reported pain from Costochondritis can be found in the sternum, around the 4th-6th ribs. However, as the inflammation increases, it’s not uncommon for the pain to begin to spread.
Again, this question takes a little research and some critical thinking to answer. There are some good studies that show us that there is a pretty strong connection between fatigue and Rheumatic conditions in general. In one study of patients with different rheumatic conditions, there was found a 54% prevalence of fatigue for those with a single inflammatory rheumatic disease, such as rheumatoid arthritis, systemic lupus erythematosus, or ankylosing spondylitis. However, this prevalence shot up to 82% for those with Fibromyalgia. In essence, from this and multiple other studies, one out of every two patients with a rheumatic disease seems to be severely fatigued.
On one side of the coin, there are many folk in the general population who do have Costochondritis but report minimal fatigue. And on the other side of the coin, we have those with fibromyalgia and Costochondritis, who report major fatigue associated with it. It’s unlikely that costochondritis directly causes fatigue, as both those with fibromyalgia and without it would be affected. However, that does not mean that it does not indirectly cause fatigue.
If you ask anyone with chronic pain about sleep, they will tell you that it’s incredibly difficult to get a good nights sleep when you are in pain. And one of the hallmark symptoms of sleep disturbances and deprivations is fatigue. Therefore, it’s not such a huge leap to assume that someone with Costochondritis, or Fibromyalgia and Costochondritis, would experience fatigue as an indirect result of being unable to sleep properly due to being in pain.
Likewise, many people with Fibromyalgia, often learn and develop certain coping skills for sleeping when it comes to dealing with the pain of Fibromyalgia. It’s very likely that due to differences in the pain experience, Costochondritis may cause undue stress and anxiety which could disrupt sleep also. Pain from Costochondritis is very hallmarked, it’s sharp, disruptive, and can often make people wonder if there is something wrong with their heart. Therefore, many people with Fibromyalgia and Costochondritis may struggle to sleep due to the new pain that comes from Costochondritis.
When living with Fibromyalgia, it is often hard to distinguish what pain comes from which issue. Many people have gone to their doctors with legitimate concerns, only for those concerns to be passed off as just another Fibro symptom.
One example of this is from a consultation we had here at chronicillness.co, some years back. A young woman had been suffering from severe headaches and every time she went back to the doctors it was promptly put down as caused by Fibromyalgia. However, at her consultation with us, and after going through her history, it was blatant that this young woman had Ehlers-Danlos syndrome. What also stood out was that her headaches were immediately cut in severity when she lay down. Suspecting a Cerebrospinal fluid leak we quickly referred her to her local hospital. And low and behold, it was indeed a spinal fluid leak. After a blood patch, and bed rest to closely monitor for leak recurrence, she recovered after around 6 weeks and has never had another headache since.
We have many stories from over the years just like this one, but the point to take is that you should never put new symptoms down to Fibromyalgia.
While working with our clients in the studio, it’s really not uncommon for us to get the “Is my Costochondritis and Fibromyalgia related?” question. And this is a good question, anecdotally you probably know a whole host of individuals with Fibromyalgia and Costochondritis, but are they related.
When looking at the evidence on this topic, it becomes more clear that they are likely linked, as the prevalence of patients with Fibromyalgia who also have non-cardiac chest pain is far higher than in the general population. In a study conducted in 2016 that looked at symptoms of people with Fibromyalgia, across 4 groups it was found that on average, 29.1% of the 313 participants either currently or previously had Costochondritis. And when compared to the general population, it was found that chest pain in primary care it only accounted for 13%.
In an overview of symptoms of patients hospitalised in the US between 1999-2007, there were over 1.7 million people during this time with Fibromyalgia, of those patients, 10% presented with non-specific chest pain (around 170,000 people). While this is closer to the general population we have to remember that these were only the ones who felt the pain was bad enough to go to the hospital, and its worth remembering that when living with Fibromyalgia, it tends to take a much higher level of pain before seeking medical intervention due to living in pain being accepted as normal.
There may well be a few reasons why are more commonly found together:
Sleep If the last few decades of research into sleep and pain have taught us anything, it’s that with lack of sleep comes a prevalence for more pain. Sleep disruptions lead to hyperalgesia pain changes, which means that your brain becomes far more responsive to noxious stimuli, lowering the pain threshold, and even going as far as to impact our own bodies’ ability to realise pain-killing chemicals. For those with Fibromyalgia, sleep is most often a major issue. Therefore, an activity that would not normally be deemed as strenuous, may become strenuous for someone with Fibromyalgia, and could potential lead to the development of Costochondritis, due to inflammatory responses from strenuous activity or movement.
Guarding response For those in pain, it’s really not uncommon to find them adopting postures to make the pain more bearable. Whilst this may help in the short term, over time staying in any one position can become painful. In the instance of Costochondritis, it’s not a far reach to assume that putting prolonged strain on the costochondral joints and cartilage, could potentially cause an inflammatory response causing Costochondritis for those with Fibromyalgia.
Lack of activity The decrease in activity levels amongst those with Fibromyalgia, as well as being in pain, can lead to sensitisation which lowers tissue tolerance to stress before an inflammatory response is deemed necessary. For tissue to be healthy, we need to move, and for those with Fibromyalgia, this can often be an issue. This gives us another potential reason for a link between Fibromylagia and Costochondritis.
Hypermobility It has been shown in a number of studies that there is a link between hypermobility and Fibromyalgia. One study showed that 46.6% of the Fibromyalgia patients participating, scored at least 4 or more on the Beighton scoring system (A method used to determine hypermobility), compared to 28.8% of the control group. When we look deeper at the connection between Fibromyalgia and Hypermobility, the issues surrounding chest pain and Fibromyalgia can be further explained.The high prevalence of misdiagnosis in the hypermobile population, most likely contributes to the increase of those with Fibromyalgia experiencing inflammation of the chest. A common symptom surrounding hypermobility, is that of joint subluxation/dislocation, due to the genetic make-up of collagen. And a common issue associated with this is rib subluxation. We wrote an article around hypermobility rib subluxation earlier this year, which you can find here. Hypermobility may account for the prevalence of Costochondritis in the Fibromyalgia population, as slipping rib syndrome is pain from inflammation of the cartilage that.
Chest pain can be terrifying when it happens, it can even be severe enough to mimic the symptoms of a heart attack. I remember when I had my first experience of this, I actually thought I was dying and it wasn’t until I was in the hospital, that I found out that I was fine. But, none the less it was a pretty scary experience, as I couldn’t breathe properly because of the pain, and it felt like a tight band around my chest.
The good news though, is that Costochondritis is it is not cardiac related, so it isn’t related to the heart. When there is inflammation in the chest this often leads to shortness of breath, due to us trying to breathe in a more limited fashion to reduce the pressure on the chest. This change in our respiration will often lead to us not taking in as much oxygen as we normally would, and can leave us feeling like we can’t breathe and panicked. But, again, Costochondritis is it is not cardiac related.
Living with Fibromyalgia is bad enough, but when adding Costochondritis to the mix it can seem a whole lot worse. But can Fibromyalgia make Costochondritis worse?
Fibromyalgia often leads to central and peripheral sensitization where nerves are a lot more sensitive to noxious stimuli, so it will take less pressure on the chest before these nerves fire and alert the brain of a potentially dangerous stimulus. This would make it feel a lot more tender to the touch than it should normally be. Think of a turn dial that usually likes to sit at 1-3 unless something is wrong (like inflammation) and is then turned up when there is an issue. With Fibromyalgia though, the dial is already sitting at 7, so when a potential threat is noticed this can turn it up to 10. This can result in more painful sensations than are usually warranted. So, given what we know about the current pain mechanisms, having fibromyalgia is likely to make having Costochondritis worse than it would be for someone without fibro.
Your first port of call when it comes to Fibromyalgia and Costochondritis should be your doctor. Anti-inflammatories will help to deal with a lot of the pain from Costochondritis, but this isn’t a long term solution. As we previously mentioned, having a healthy and happy rib cage means that it needs to be able to move freely, so this should be your second port of call: focusing on relearning to move your ribs.
We would also suggest that you check to make sure that you are indeed not Hypermobile and that the pain doesn’t arise from a rib subluxation.
We often get asked about Fibromyalgia and Osteoarthritis from our clients, because more often than not, they have been told numerous scary stories by consultants. Likewise, many of the people we speak to have read many articles online, that are laden with misinformation. Osteoarthritis as a whole, gest a bit of a bad reputation, despite being completely normal and inevitable.
In fact, even the name Osteoarthritis is somewhat of a misnomer, as “Osteo” means bone,”‘Arth” means joint, and “Itis” means inflammation. And when we realise that Osteoarthritis is a degenerative condition, not an inflammatory one, we can start to see why there is likely so much misinformation around fibromyalgia and osteoarthritis, especially considering it’s not even named correctly!
For those of you reading, we can appreciate that having more labels attached to you can be a scary thing. A lot of the time people have only just gotten used to and accepted the Fibromyalgia label, before being hit with another in the form of osteoarthritis. Unfortunately, for most people, a quick google of Fibromyalgia and Osteoarthritis brings up many horror stories and a tonne of misinformation. This misinformation has the potential to not only make your pain worse, but ultimately make your world smaller and smaller as you inevitably try to protect yourself more and more over time.
So, in the following article let’s take a look at a few things that we should know about when it comes to Fibromyalgia and Osteoarthritis.
Osteoarthritis is defined as “Degeneration of the joint cartilage and underlying bones, usually accompanied by pain and stiffness, and most commonly found in the hips, knees and thumb joints.”
In a healthy joint, a coating of tough but smooth called cartilage covers and protects the surface of the bones, helping them to move freely against each other. However, when a joint develops osteoarthritis, part of the cartilage thins and the surface becomes rougher. This means the joint doesn’t move as smoothly as it should, causing the protective cartilage on the ends of your bones breaks down, potentially causing pain, swelling and problems moving the joint. When cartilage becomes worn or damaged, all the tissues within the joint become more active than normal, as the body tries to repair the damage. This can result in swelling and inflammation of the joint.
As we mentioned earlier, Osteoarthritis isn’t really properly named, because whilst there can be inflammation present, it’s the degeneration that defines it. After all. we already have a name for inflammatory arthritis which we call Rheumatoid arthritis.
There is a good chance you are reading this because you have Fibromyalgia and Osteoarthritis, and you want to know if they will affect one another. Well, having fibromyalgia does change a few things when it comes to osteoarthritis, but it’s mainly not anything to do with the actual tissues, and don’t worry, we will cover these other factors in this article. But, before we get into how Fibromyalgia may affect osteoarthritis, let’s start with a question that’s a little easier to answer for: why do we get Osteoarthritis in the first place?
As we age our bodies incur wear and tear from just being alive. Our hair grows thin and turns grey, our skin thins, and we developed wrinkles. It is essentially just part of the human condition, and just as we degenerate on the outside of our bodies, we also degenerate on the inside.
No, they don’t, well not physically anyway. Anti-wrinkle cream is a multi-million-pound industry, so it’s evident that wrinkles do cause some emotional distress for the majority of us!
So then, if degeneration on the outside of the body doesn’t cause us any pain, then why would degeneration on the inside cause it?
Keep in mind also, that we are way more sensitive to changes on the outside of the body than we are on the inside. There are a great many people right now, with very severe degeneration, who have absolutely no pain. Likewise, there are also people with very little osteoarthritis, who are in a great deal of pain. Before we get into the complexities that is Fibromyalgia and Osteoarthritis, it’s important to remember that this wear and tear is a normal part of ageing. In fact, in the next section, let’s take a look at a few studies that show us that normal wear and tear can actually be painless or not correlate to damage.
As we mentioned before, there is a lot of misinformation around Osteoarthritis, and probably even more around Fibromyalgia. So, let’s take a look at some studies and start to break down those damaging narratives that you have likely been told or have read.
One study focusing on professional football players found that 92% of football players had at least 1 spinal degenerative condition, but in some cases, more than 6 were found. The interesting thing was that none of them reported any pain. This is a nice study that helps us look at the complexities of pain, as when it comes to chronic pain it isn’t always about the tissue.
There is a ridiculous amount of evidence that shows us that pain is not tightly linked to tissue damage. And when it comes to Osteoarthritis, there should also be evidence of people with severe degeneration shown on a scan, but who feel fine, and vice versa. This study of 113 people found exactly that, a huge disconnect between degeneration and pain. In which they found that the people with less degeneration had more pain, and those with more degeneration had less pain!
It kind of changes your opinion on some of the stuff you have been told doesn’t it.
Another study looking at the general population, wherein the focus was on the difference between structural changes in the knees and symptoms, found that there isn’t a great connection between the severity of the condition and pain. However, they did find that the symptomatic group had a slower walking speed, longer stride and standing times and reduced strength. Which, when you think about it, makes complete sense. If you are in pain it’s unlikely that you’re going to be moving quickly, but rather taking your time in an effort to not increase pain levels.
That was the only real difference that this study found between those with Osteoarthritis who had pain and those with it who had no pain. Keep in mind also, that another study found that cartilage defects were found in around 11% of those under the age of 40 who had no pain. This percentage jumped to 43% for those over the age of 40, but still without pain. As you can start to see, that actual amount of degeneration doesn’t really correlate with the amount of pain you would expect someone to have.
In this study, it wasn’t just the cartilage they focused on, but also tissue. There were instances of meniscal tears in up to 19% of the study, bone marrow lesions and even bone spurs were present in 12-24%. I think a good place to end this section is to look at a study from 20 years ago, that will really challenge your beliefs about osteoarthritis and pain.
This study showed that people who received a fake arthroscopic knee surgery for Osteoarthritis had results just as good as people who received the real surgery. And in 2008, the New England Journal of Medicine added more experimental evidence to the pile, reporting that “surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.”
In the years to follow, there has been an exceptional level of evidence showing that arthroscopic debridement has no benefit, showing that it is no better than a placebo.
We have established that the amount of Osteoarthritis doesn’t really correlate with the amount of pain a person experiences. So what is going on then if it’s not about the actual degeneration? Well, this is where Fibromyalgia can start to make things a little bit more complicated.
When we look at the pain and symptom severity of Osteoarthritis, historically, cartilage damage was believed to be the hallmark of Osteoarthritis. However, since cartilage is an avascular, aneural tissue, the mechanisms of pain are likely to be way more complex than first thought, and most likely influenced by non-cartilaginous structures in the joint including the synovium. The current body of evidence points to pain sensitization, and molecular pathways, as the possible main driver of Osteoarthritis pain.
Like we said before, when it comes to chronic pain, it’s not always about the tissue. We know chronic pain changes the brain and nervous system, causing the brain to take note of inputs that it really shouldn’t be. Hence why so many with conditions like Fibromyalgia often developed other conditions such as allodynia.
The Simple answer is yes, it is more common than you think, in fact when you are going through all the tests to get your Fibromyalgia diagnosed, you’ll most likely be told about degeneration somewhere in the body.
Both diagnoses have overlapping symptoms such as pain, stiffness, and limited range of motion. It’s also not just Osteoarthritis and Fibromyalgia, but other rheumatic conditions. One study showed that between 20-30% of those diagnosed with Fibromyalgia, also had co-morbid rheumatic conditions. When we look at the data for just Osteoarthritis, we find that between 10% – 17% of those living with Fibromyalgia also have Osteoarthritis
As we mentioned earlier, Fibromyalgia does indeed have the potential to complicate Osteoarthritis.
Those with Fibromyalgia suffer from abnormalities in the way that the brain deals with pain. Supraspinal processes have a top-down enhancing effect on nociceptive processing in the brain and spinal cord. Studies have begun to suggest that such influences occur in conditions such as fibromyalgia. This means that those who do have Fibromyalgia may be far more sensitive to noxious stimuli compared to the general population. Factoring in changes at the joint, those with Fibromyalgia may be more prone to reacting to these changes byways of producing pain.
There have been a few studies that have looked into how Fibromyalgia may affect Osteoarthritis. One such study published in the European Journal of Neuroscience, measured brainwaves in response to short painful laser pulses on the skin of patients suffering from osteoarthritic and fibromyalgia pain, as well as test subjects who had no underlying pain. Scientists discovered that the insula cortex part of the brain increased its activity when expecting a painful pulse, as it predicts the extent and intensity of the patients’ own chronic pain.
It is important to keep in mind, that increased activity in this brain area has been linked to a number of phenomena, including body perception and emotional processing, which might explain the greater pain perception in some patients.
In essence, there are a lot of factors that come with fibromyalgia that can make osteoarthritis worse, when compared to individuals without it. One such factor is sleep disturbances. It is well documented that with sleep disturbances and lack of sleep, comes an increase in pain. For those with Fibromyalgia, getting a good, restful night’s sleep can be somewhat of a challenge due to pain. Meaning that it has the potential to create a breeding ground for worsening the symptoms of not just fibromyalgia pain, but also the pain of Osteoarthritis.
With chronic pain, also comes the prevalence of mental health issues, which can also make symptoms worse. It is well established that mental health issues can be a large driving force behind chronic pain. And for those with Fibromyalgia, they may be more prone to experiencing pain with Osteoarthritis, whereas those without fibromyalgia may likely not even notice these degenerative changes.
We have taken a look at what Osteoarthritis is, how it’s caused, and how Fibromyalgia may affect it. All that is left now is to look at some of the things that can help you when it comes to Fibromyalgia and Osteoarthritis.
Massage It has been shown that massage can be particularly effective at lowering pain in osteoarthritis and Fibromyalgia. An analysis of 9 studies found that massage helped to improve pain, anxiety, and depression associated with Fibromyalgia.
Stay hydrated It is estimated that around 70% of your cartilage is made up of water, and when we are dehydrated this is going to affect the joints, as the more lubricated a joint is, the less friction there will be. This is important when we remember the studies into those with Fibromyalgia being more sensitive to noxious stimuli. We want to reduce the amount of noxious stimulus coming into the nervous system.
Cold showers The benefits of cold showing with Fibromyalgia can be found in a comprehensive blog post we wrote, which you can find here. The benefits of cold showering with Osteoarthritis can help by reducing pain, decreasing swelling, and constricting blood vessels.
We hope the above has helped to answer the questions you have about Fibromyalgia and Osteoarthritis, and we wish you the best of luck on your journey.
