Fibromyalgia And Stretching

• About
• Latest Posts

Adam Foster

Director at The Fibro Guy

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.

Latest posts by Adam Foster (see all)

• Walking with fibromyalgia: how much, and why it costs what it costs - 2 November 2026
• Water exercise and hydrotherapy for fibromyalgia - 2 November 2026
• Hypermobile hip exercises we use, and why clamshells aren’t one of them - 17 October 2026

Stretching helps fibromyalgia, a bit. Pain, physical function, quality of life and the fibromyalgia impact score, all tend to move in the right direction, the effect is modest though, and the certainty sitting behind it is low rather than fully settled ^[1]. It also doesn’t beat ordinary aerobic exercise when the two are put side by side ^[2]. So stretching is worth doing, but it was never going to be the whole answer on its own.

You most likely stretch because everything feels tight, and sitting underneath, is an old model of a muscle gone short and needing pulling back out to length. The tightness is real. The shortness is where the whole idea comes apart though, so that’s where this article starts.

Why everything feels tight in fibromyalgia when nothing is short

Shoulders up near your ears by eleven in the morning. Calves that feel like they’ve been set in resin overnight. A back braced like a fist while you’re lying flat doing nothing at all. Then somebody measures your range of motion and tells you it’s fine.

Both of those things can be true at the same time, and they’re both true because tightness is a sensation and length is a measurement. Different quantities. No obligation to agree.

The spasm story, and what the needles found

For a long time the explanation on offer was spasm. Knotted muscle, locked down, firing away constantly and generating its own pain. It’s a satisfying story, because it matches what the muscle feels like from the inside, and because it points at something simple to do about it (people love an easy fix).

So, people went looking for it with electrodes. Electromyography reads the electrical chatter a muscle gives off when it contracts, and quantitative EMG found only minor nonspecific changes, and no electrically detectable activity in painful muscles during examination ^[3]. Needle EMG, where the electrode goes into the muscle itself and which is about as direct as this gets, argues against frank spontaneous spasm or denervation like activity, the pattern you’d see if the nerve supply to the muscle had failed ^[4]. Whatever a painful trapezius is doing in fibromyalgia, it isn’t sitting there crackling away with continuous electrical fire.

What the muscle is actually doing at rest

Put people in a laboratory and run them through a relaxation and stress protocol, and those with fibromyalgia show higher mean normalised EMG and about half as much EMG rest time as controls, which fits reduced entry into true rest ^[5]. Rest time is exactly what it sounds like, the share of the recording where the muscle is genuinely quiet and doing nothing, and older work on repeated contractions reported the same shape of things, an inability to relax between contractions and higher unnecessary postural tension ^[6].

So it isn’t more contraction. It’s less complete release. The muscle switches dials up, which is its job, and then it doesn’t fully dial down again, and it spends far less of the day idling than it ought to. If you’ve ever noticed you can’t find the off switch for your shoulders no matter how hard you concentrate, that’s the measurement of the thing you’re noticing.

Why the stiffness studies and the electrical ones disagree

Measure the muscle mechanically, rather than electrically, and more turns up. Myotonometry, which taps the muscle with a small probe and reads how it springs back, found increased tone and stiffness in upper trapezius, in a forearm muscle called extensor carpi radialis brevis (absolute belter of a band name) and in medial gastrocnemius (the big calf muscle) with no difference in elasticity ^[7]. Pressure measured inside the trapezius came out roughly three times higher than in controls with other rheumatic conditions in one large study ^[8], and a later one found muscle pressure strongly correlated with pain scores ^[9]. Those are specific muscles in specific studies rather than a whole body verdict though, and the wider elastography literature, which estimates stiffness using ultrasound, is openly conflicting in both its results and its methods ^[10].

Context does a great deal of the work here also, which is most of why this field looks like it argues with itself so much. A naturalistic study of the trapezius found activity similar to controls in a quiet, low stress evening setting, and higher activity during imposed stress and during instructed rest ^[11]. Sitting at home on a quiet evening, being told to relax while wired up in a laboratory, waiting for a task to begin, and holding a light load for a long stretch are physiologically different states, so opposite findings can all be valid inside their own protocol ^[11]. Being told to relax and actually being relaxed are not the same event, and your muscles can tell them apart even when the paperwork can’t.

So, the tightness is real, it shows up on more than one instrument, and none of it is a length problem. Nothing in that chain gets fixed by making a muscle longer, because nothing in it says the muscle was short in the first place.

What we used to think stretching was, and what survived

Stretching didn’t arrive from one laboratory with one claim attached to it. Ballistic stretching was popular in the 1950s, static stretching dominated from the 1960s to the late 1990s, and dynamic stretching came back into fashion, once studies started reporting acute performance drops after pre-activity static stretching ^[12]. Ballistic is the bouncing kind, static is the hold still and wait kind, and dynamic is swinging a limb through its range while you warm up. What changed across that run wasn’t whether people stretched. It was what they said it did.

The claims that didn’t hold

Post-exercise stretching to clear soreness is the one that fell hardest. It doesn’t clearly improve strength recovery or delayed onset muscle soreness compared with simply resting, and the certainty on that is very low ^[13]. So the ten minutes on the mat after a session, the thing half of us were raised on, has very little underneath it.

Injury prevention is the claim repeated most often and measured least. A scoping review of stretching trials in healthy athletes found direct injury outcomes sparse across that corpus ^[14], which is a strange state of affairs for something prescribed so widely on injury grounds.

The warm-up story needed correcting in both directions. Prolonged static stretching before an event really can dent explosive performance, though the larger deficits were tied mainly to longer durations, stretching in isolation, and no follow-up dynamic activity ^[15]. The correction then got oversold in its turn, and plenty of people now avoid static stretching altogether on the strength of protocols nobody actually uses. All of that was measured on athletes and gym-goers about to work hard, which is a long way from a bad morning in your body, and it’s the reason so little of the standard advice transfers.

What stretching actually changes

What survived all that is range of motion, which stretching improves reliably, across techniques and across populations ^[16].

The interesting part is how. The best current synthesis of static stretching finds both chronic reductions in overall stiffness and chronic increases in maximum tolerable passive torque, while fascicle length often doesn’t change at ordinary doses ^[17]. Fascicles are the bundles of fibres a muscle is built from, so that last part means the muscle generally isn’t getting physically longer. Earlier reviews concluded that shorter programmes mostly reflected sensory adaptation with little structural change ^[18], and the structural changes that do appear seem to need higher volumes or higher intensities, and come out small and inconsistent even then ^[19].

Maximum tolerable passive torque is a mouthful, so here’s the plain version. A good chunk of what you gain from stretching is a change in how much pull your body is willing to accept before it objects. You haven’t lengthened much. You’ve renegotiated the alarm threshold.

What that means in practice is that the thing you’re training is tolerance rather than tissue, and expectations follow accordingly. One more thing worth knowing before you build your week around it: full range resistance training produces similar range of motion gains, and often greater strength gains with them ^[20]. Stretching was the traditional way into flexibility rather than the only one.

Does stretching help fibromyalgia

Modestly, yes, and it’s worth having.

Twelve weeks of muscle stretching, set against resistance training and against a control group in a three-arm trial, outperformed resistance training for physical functioning and bodily pain, while resistance training did better for depression ^[21]. Pool the reviews and stretching improves pain, fibromyalgia impact, physical function or quality of life often enough to count, on trials that are small, varied in protocol and low in certainty ^[1].

What it doesn’t do is win. Flexibility work shows little or no clinically important advantage over aerobic training ^[2], and combined programmes now rank above stretching alone in several syntheses, with aerobic plus strength plus stretching coming out strongest ^[22][23]. Where stretching looks best is as an addition rather than a replacement. Added to a moderate intensity aerobic programme in women with fibromyalgia, it improved sleep, pain and fibromyalgia impact beyond the aerobic work on its own ^[24].

So the shape of it is that stretching is a decent small lever in a condition with very few large ones, and the biggest mistake you can make with it is letting it be the whole plan.

So what do you actually stretch, and how

Most articles answer this with a list of poses invented on the spot. There’s a better place to start, which is the one programme that was actually run and measured.

A home based trial tested daily low intensity stretching for 6 minutes and found a clinically meaningful improvement in fibromyalgia impact against usual care, with 83% adherence and an 18.7% improvement in the stretching group ^[25]. Over 6 weeks that worked out at 9.7 points on the revised Fibromyalgia Impact Questionnaire ^[25]. Those are small numbers on paper, and they come off a protocol asking for 6 minutes a day, which is about as low as the bar goes for anything in this field ^[25]. The adherence figure is the one to notice, because a plan that gets done beats a better plan that doesn’t.

How hard, and how often

Low intensity, and pain free. Static, low-intensity, pain-free stretching is the most directly tested practical format in fibromyalgia ^[26]. Go to the first point of resistance, the place where you feel a pull rather than a protest, and stay there. If you’re gritting your teeth you’ve gone past the dose anybody tested.

Short, and daily. The version with the clearest support is brief and every day ^[25], which is the opposite of the weekly hour most of us picture when somebody says stretching. Six minutes survives a bad day. An hour doesn’t.

Don’t chase range. You’re training what your body will tolerate rather than the length of anything, so the win is the same stretch feeling like less of an event than it used to, not your fingertips getting nearer the floor.

Which muscles, and what to actually do

The head to head comparison in fibromyalgia set a whole body postural approach against ordinary segmental stretching of individual muscles, and both reduced pain, improved pain threshold, lowered fibromyalgia impact and improved postural control, with no significant difference between them ^[27]. The elaborate method and the boring one of stretching whichever bit feels tight came out level, so pick the muscles that are actually bothering you and stop looking for the correct sequence.

Which leaves what that looks like in a bedroom at seven in the morning, so here is how to put the usual suspects on a gentle stretch. None of them need the floor and none of them need you to be any good at this.

Upper trapezius, the muscle running from your neck out to the top of your shoulder, and the one most likely to be sitting up near your ear by lunchtime. Sit on one hand to anchor that shoulder down, then tip the opposite ear towards the opposite shoulder until you feel a pull down the side of your neck. If you need your other hand to drag your head further over, you’ve gone too far.

The front of the chest and shoulder. Stand at a doorway with your forearm flat against the frame and your elbow at about shoulder height, then turn your body slowly away from that arm until you feel it across the front of the chest. The temptation is to lean your weight into it, and leaning is how a pull becomes a protest.

Hip flexors, the muscles at the front of the hip that spend the day folded up if you sit or lie down a lot. Half kneel with the back knee on a cushion and the other foot in front, tuck your tailbone under so your lower back flattens a little, then shift your weight forward barely at all. That tiny shift is the entire movement, and if you can feel it down the front of the back hip you’ve done it correctly.

Hamstrings, the back of the thigh. Sit on the edge of a chair with one heel on the floor in front of you and that leg straight, then hinge forward from the hips keeping your back long rather than curling over your knee. You’ll get plenty well before you’re anywhere near your toes.

Calves. Hands on a wall, one leg back with the heel down and that knee straight, then bend the front knee until the back calf starts to complain mildly and no further. Bend the back knee slightly as well and the pull drops lower, towards the Achilles.

The side of the trunk. Sitting or standing, reach one arm overhead and lean away from it slowly, keeping both sitting bones down or both feet flat. It’s the easiest one to forget and it’s often the one that feels most overdue.

You don’t need all of them though. The ones you’ll actually do beat the ones you won’t, and if one of them hurts rather than pulls, that one is out for today.

What if stretching makes you flare

It might at first, and that’s a recognised thing rather than a sign you’ve broken something.

Sensitivity to starting exercise is well described in fibromyalgia, and symptoms worsening after starting is a known barrier to people sticking with it ^[28]. It’s the reason the recent syntheses keep landing on low intensity, gradual progression, supervision where you can get it, and tailoring to symptom tolerance rather than pushing dose or intensity ^[22].

There’s an ordinary physiological reason the gentle version is the sensible one. When something hurts for long enough, the system carrying the signal gets easier to set off. Nociceptors, the high threshold nerve endings that report potentially damaging pressure and stretch, start firing at lower provocation, the spinal cord passes more of what they send onwards, and the brain starts treating ordinary input as worth flagging. Sensitisation is the word for that, and it’s a real change in a real system rather than a figure of speech. A stretch taken to the edge is a large input into a system already primed to report. A stretch nowhere near the edge isn’t.

On actual harm, very little got collected. In the Cochrane review only one adverse effect was described among 132 flexibility participants, an Achilles tendinitis case of uncertain relation to stretching ^[2], and that near silence reflects sparse harms reporting rather than proof of zero risk ^[2]. Unalarming and unproven at the same time.

Practically, the move when a gentle stretch flares you is to make it shorter and softer rather than to stop altogether. Well short of the point of protest, and then the same again tomorrow. A flare after starting is information about where your tolerance currently sits, and tolerance is the thing the whole exercise is aimed at.

If you’re hypermobile as well

Fibromyalgia and symptomatic hypermobility turn up together often, and co-diagnosis of the two is common enough to be clinically important ^[29][30]. How often depends on where you look and what you measured with, and the reported overlap varies widely by setting and by diagnostic method, across clinic samples, case-control studies and specialist centres ^[31][32][33]. Anybody quoting you a single confident percentage has picked one of those settings and not mentioned which.

What changes when both are in play isn’t whether you should move or not: It’s what the stretching is pointed at.

The rehabilitation evidence in hypermobility consistently supports therapeutic exercise, especially motor control, proprioception and strengthening, and it doesn’t support indiscriminate end range stretching of already unstable joints ^[34]. Proprioception there means your sense of where your joints are without looking at them. Exercise tends to help when it’s individualised and built around strength, motor control, proprioception and joint stability ^[35], and the single most useful line in the primary care guidance is also the plainest one: stretch tight muscles, not lax joints ^[36].

That distinction is actually less difficult in practice than it sounds. A hypermobile shoulder that subluxes, meaning it slides part way out of the socket and back in again, isn’t a stiff shoulder, and nothing good comes from stretching it.

Take the rest of the advice for the overlap as precaution rather than a tested result, because indirect and precautionary is what it currently is ^[35][37]. The caution flagged for hypermobile bodies tends to be greater soreness or altered biomechanics rather than injury, with the response being to adjust the parameters ^[38]. So go gentler and go slower than the version above, and leave the end of the range alone.

The short version

Stretching helps fibromyalgia modestly. Pain, function and quality of life move, the trials are small, and the certainty is low ^[1].

It isn’t better than other exercise. Aerobic work matches it, and combined programmes beat it ^[2][22][23].

It works best as an add on. Stretching on top of aerobic exercise improved sleep, pain and fibromyalgia impact beyond aerobic alone ^[24].

The tested version is 6 minutes a day ^[25], and the smallness is the point, because a plan has to survive a bad week.

Low intensity, and pain free ^[26]. First pull rather than first protest, and no gritted teeth.

Usually you’re training tolerance, not length ^[17]. The target is the same stretch feeling like less of an event, not a new range of motion.

If you’re hypermobile too, stretch the tight muscle and leave the lax joint alone ^[36].

Your muscles aren’t short, so don’t spend your limited energy trying to lengthen them. Give the ones that genuinely feel tight 6 minutes a day ^[25], keep it gentle enough that you’d happily do it again tomorrow, and spend what’s left on the aerobic work and the strength work.

Adam

References

[1] Støve, M.P., Dissing, A.M.L., Thomsen, J.L., Magnusson, S.P. and Riis, A. (2024) ‘The effectiveness of stretching exercises in patients with fibromyalgia: A systematic review’, Clinical Rheumatology. https://doi.org/10.1007/s10067-024-07066-4

[2] Kim, S.Y., Busch, A.J., Overend, T.J., Schachter, C.L., van der Spuy, I., Boden, C. et al. (2019) ‘Flexibility exercise training for adults with fibromyalgia’, Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd013419

[3] Zidar, J., Bäckman, E., Bengtsson, A. and Henriksson, K.G. (1990) ‘Quantitative EMG and muscle tension in painful muscles in fibromyalgia’, Pain. https://doi.org/10.1016/0304-3959(90)91122-y