Fibromyalgia and Exercise

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Adam Foster is the founder of The Fibro Guy and one of the leading voices in hypermobility, EDS, and chronic pain rehabilitation. A former Reconnaissance Soldier, he developed chronic pain after an IED blast in Afghanistan and built his approach from the ground up when the medical system had no answers. Since 2009 he has worked with thousands of people across eight countries, drawing on pain neuroscience, motor learning, and sensorimotor rehabilitation. He co-authored "No Pain, No Pain" with trauma psychologist Dr Mairi Harper, directed the documentary "Invisible Monster," and has been featured in Forbes, BBC Radio 4, ITV News, LiveScience, and The Telegraph.

Does exercise help 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.

But, why is this?

Fibromyalgia Flare ups

When people with Fibromyalgia try to exercise, they can often get pushed into the Fibro Flare box, which we sometimes affectionally call here at The Fibro Guy “the Sh*t Box”.

Think of it like this. 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.

Let’s have an example of how the Sh*t box works;

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 Sh*t 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 Sh*t 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. This is especially relevant for those who also have Fibromyalgia & MCAS, where the body’s histamine response can add fuel to the fire. 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 Sh*t box.

The Sh*t 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. Click here to listen to it.

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.

Why is exercising with Fibromyalgia so hard

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, which likely explains the high prevalence of back pain in the Fibro community. 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.

The Best Exercises for Fibromyalgia

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.

Here are some of the most common:

Cardiovascular (Walking, cycling, running, and swimming)
Strength Training (Weights, circuits)
Low impact (swimming, pilates, Yoga, Thai Chi)

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 Fibro Guy, 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. The video below is a great example of this. 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.