Article by Shane Armfield

What is Fibromyalgia?

Fibromyalgia is a disorder that causes widespread pain in the muscles of the body and fatigue. People with fibromyalgia have many “tender points” on the body and increased sensitivity to various things that are not ordinarily painful or unpleasant. They can also experience high levels of fatigue that are disproportionate to their activity levels and sleep.

What Causes Fibromyalgia?

Fibromyalgia is estimated to affect about 5% of the population and occurs in women much more than men. The problematic thing about fibromyalgia is that there is no known cause. It isn’t an inflammatory disease. It isn’t a degenerative disease and isn’t an auto-immune disease. This makes it difficult to diagnose and treat.

The onset of fibromyalgia has been linked to:

  • a traumatic event that caused a physical injury
  • stressful/ traumatic life event such as a car accident or bereavement
  • disease/ illness – sudden onset illness or chronic illness (i.e. IBS, lupus, rheumatoid arthritis)
  • sleep disturbance.

The symptoms of Fibromyalgia vary for each individual, but the most common symptoms are:

  • Widespread muscle pain, stiffness and tenderness in the muscles and joints (see picture above)
  • Fatigue – often disproportionate to the person’s level of activity or amount of sleep
  • Restless sleep or awakening after a long sleep and feeling tired for the rest of the day
  • Anxiety, depression, disturbances in bowel function
  • Poor memory or a feeling of brain “fogginess.”

What are the Symptoms of Fibromyalgia?

  • Pain, stiffness, tiredness and tenderness of the muscles, tendons, and joints.
  • Restless sleep, awakening feeling tired, chronic fatigue, anxiety, depression, and disturbances in bowel function.

These symptoms ‘feed’ off each other, as demonstrated in the following diagram:

How is Fibromyalgia Diagnosed?

The symptoms of fibromyalgia can be associated with many conditions or diseases, making it difficult to diagnose. Your doctor or rheumatologist usually makes the diagnosis after ruling out other diagnoses. As well as palpating several sensitive points around your body, your doctor may perform blood tests, scans and x-rays to rule out other causes of pain.

Conditions that can mimic fibromyalgia features include an underactive thyroid (hypothyroidism), vitamin D deficiency, rheumatoid arthritis, and even sleep apnoea.

Fibromyalgia Treatment

The management of fibromyalgia is complex but can be broken down into several parts. Treatment tries to help you slowly break the fibromyalgia cycle by addressing each of the points shown in the diagram above.

Understanding your pain and symptoms through education

  • Having a good understanding of your symptoms and how your life has been affected by fibromyalgia. Also, having a good assessment of your painful areas can help reduce anxiety or concerns about an injury.
  • Understanding the complex nature and cycles of pain can also help you address fibromyalgia’s impact on your life.
  • Physiotherapy can help with both these aspects of understanding Fibromyalgia.

Exercise in moderation

Exercise is an excellent way to help deal with stress and depression. Regular exercise also helps to improve eating and sleeping habits, which will lead to better general health, better mental health and less sleep deprivation.

  • activities such as hydrotherapy, tai chi, pilates, yoga, walking, swimming or cycling can benefit people with fibromyalgia
  • stretching and mobility exercises can help reduce pain and tightness
  • specific exercises to help build strength and endurance in the ‘posture’ muscles of the body and take the load off achy muscles


In some cases, your GP may prescribe medications such as an antidepressant to help normalise chemical imbalances and improve pain.

Relief of muscle and joint stiffness, tenderness and pain

  • Massage – can assist pain relief and help muscle relaxation
  • Acupuncture – can be helpful for the comfort of your pain
  • Joint mobilisation – can improve muscle tightness, tenderness and joint stiffness

Managing activity levels and fatigue

  • Fibromyalgia symptoms can fluctuate, meaning that you can have good and bad days. Sometimes overdoing it one day can lead to increased symptoms the next day, so being able to manage your effort is essential.
  • Pacing activities and doing activity/ fatigue diaries can help manage the fluctuations in activity and assist a person in achieving their goals.

Improve ability to cope with daily stress and depression

Daily stresses from work or home can increase your fibromyalgia symptoms. You and your physiotherapist can work with your GP to help you develop strategies to manage these stresses.

Referral to a psychologist can also help in developing strategies to cope with stressful situations.

Sleep health

Understanding sleep and its influence on health are vital in helping people who have Fibromyalgia. Poor sleep health can affect:

  • Mood – Sleep benefits our mood, memory and concentration
  • Brain function – Sleep helps to organise memories and improve concentration.
  • Emotion – Lack of sleep can make you irritable, affecting your emotions, social interaction, and decision making.
  • Immune system – Without adequate sleep, the immune system becomes weak, and the body becomes more vulnerable to infection and disease.
  • Nervous system – Sleep is a time of rest and repair to neurons. During Sleep, neurons rest, replenish and grow.
  • Hormones – substances produced to trigger or regulate particular body functions are timed to release during sleep or right before sleep.


Surgery is not used to treat fibromyalgia. However, if a doctor or specialist felt a problem needed surgery, which influenced your fibromyalgia, then surgery for that specific problem may be an option.

What Results Can You Expect?

Over time, with good advice and commitment to a patient-centred management programme, fibromyalgia symptoms can ease and reduce the levels of pain experienced.

Please seek the opinion of your physiotherapist or doctor for your specific needs.