Angele Skinner, BMR-PT Physiotherapist

H.S.C. Outpatient Physiotherapy

Department

Fibromyalgia Education and Treatment Program

H.S.C. outpatient physio department

Number of fibromyalgia referrals received

2012: 87

2013: 91

Group Program and /or Individual Program

Group Program Offered 3-4 times per year

Groups of 10-14 people

4 week program, twice weekly sessions

All sessions include a 60 minute education component and 30 minute exercise component

4 of the sessions, the exercise component is in the pool

Individual Program For those patients unable to attend the group sessions

Patients are assessed and provided education and individualized exercise prescription

The Program is based on the following Principles:

• The 2012 Canadian Guidelines for the Management of Fibromyalgia states that regular physical activity should form the cornerstone of treatment.

Fibromyalgia treatment should include principles of self management, healthy lifestyle habits and coping skills.

• Self management strategies fostering a strong internal locus of control are imperative

Exercise • High level evidence supports exercise in the

management of fibromyalgia

• Focus on endurance or conditioning type of exercise

• Recommended amount of exercise for adults according to the Canadian physical activity guidelines is 150 min/week of moderate to vigorous exercise

• Most of our patients are unable to initiate a program at this level

• Start with as little as 2-3 minutes of low intensity exercise

• Low impact Exercises:

• Walking

• Cycling

• Aquatic Exercises

• Change the patient’s perception of what is expected of them with exercise.

• Start low and go slow!

• Anything is better than nothing to start

• Educate regarding appropriate response to exercise

• Progress will be slow

Other Types of Exercise

Generalized Stretching and Range of Motion Exercises are also prescribed.

Strengthening exercises are usually prescribed individually once basic exercise program of conditioning and stretching established

Education Posture Education and Core stabilization exercise

Lifestyle Changes

o pacing and priorizing activities

o balancing rest and activity

o listen to body

o avoiding flare ups and aggravating factors

o energy conservation techniques

Education Sleep Hygiene

Stress Management and Relaxation Techniques

Alternative Therapies

Pain Management Focus on tools that can be used as part of active self

management strategies

Heat and Ice

T.E.N.S. – trial of a unit will be done to assess benefit of purchasing a home unit

Massage - Patients can be instructed in self massage techniques to help relieve pain in localized areas. (Myofascial trigger points)

Summary • Physiotherapy does not exclusively treat the pain of

fibromyalgia.

• Our role is to encourage the use of active self management strategies to promote a strong internal locus of control.

• Goals of treatment are focused on improving generalized well-being and function rather than specifically focused on symptom reduction.

References Fitzcharles, M et al, Canadian Pain Society and Canadian

Rheumatology Association Recommendations for Rational Care of Persons with Fibromyalgia. A Summary Report.

The Journal of Rheumatology, 2013; 40:8

Fitzcharles, M et al, 2012 Canadian Guidelines for the diagnosis and management of fibromyalgia syndrome: Executive Summary, Pain Research and Management, 2013; 18(3):119-126