Yoga Heals: Fibromyalgia

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Fibromyalgia is characterized by widespread, chronic pain, often localized in tender spots or common trigger points. The pain appears to be located in the fibrous connective tissue which surrounds muscles and joints, and as pain symptoms persist and grow stronger, sleep and memory function are disturbed, as well as mood and energy levels.

Although there is some thought that genetic markers may increase risk of fibromyalgia, the disorder has no known trigger or specific predisposing condition. It is most useful to consider fibromyalgia a set of symptoms that include chronic muscle pain and spasm, fatigue, poor sleep and the resulting mental "fog." These symptoms are common indicators of general imbalance in the body, and often are brought on by trauma, whether physical, as in an accident or illness, or psychological, as in depression or PTSD. Bringing the body into balance often requires lifestyle changes such as getting adequate nutrition and rest and reducing stress.

Originally thought to be a disorder in the muscle tissues themselves, research now supports the theory that fibromyalgia is a disorder of the central nervous system. Fibromyalgia is in fact referred to as a "centralized pain state," in which the nerves of the brain and spinal cord appear to hyper-sensitive to benign stimuli. In periods of stress, depression or illness, this sensitivity grows more pronounced.

 Common tender points for those with fibromyalgia.

Common tender points for those with fibromyalgia.

Tender points are commonly found on the neck, back, chest, elbows, hips, buttocks, and knees. The points themselves are relatively small (about the size of a penny), but even slight pressure in those areas can elicit a great deal of pain for those with fibromyalgia. It is important to note that there is no actual tissue damage present in these locations, as in other inflammatory conditions such as osteo- or rheumatoid arthritis. The tissue itself is healthy, but the nervous system amplifies pain or misinterprets stimuli to be pain.

One of the key components to relieving chronic pain is in fact retraining the nervous system. Studies show that those with chronic pain have reduced kinesthetic awareness--for instance, they are unable to describe the location of pain in great detail. It is thought that exercise and physical therapy have been successful means of treatment for chronic pain partially because they improve kinesthetic awareness and function of afferent motor neurons.

Yoga is uniquely suited to reducing the symptoms of fibromyalgia. Although there are a few pharmaceutical options which are FDA-approved for treatment of fibromyalgia, current evidence points to the greater efficacy of other lifestyle factors like exercise, cognitive-behavioral therapy (a form of psychotherapy based on altering negative thoughts and behaviors), and patient education on self-care techniques to reduce stress, improve sleep, and managing response to pain. Yoga, with its emphasis on total well-being, provides tools for healing the body and mind.

The physical practice of yoga (asana) alone can go a long way toward relieving the sensitivity of tender spots, increasing strength and stamina, and improving comfort. A complete yoga practice fosters awareness of actions (their motivation and results), the body, and the quality of energy and thought processes. Working with all of these elements in a patient and compassionate way improves our habits of thought and action, and will in turn help us not only to manage pain, but also to make choices which will lessen pain. 

Five Techniques for Fibromyalgia

Students with fibromyalgia should be encouraged to practice gently, to enter postures slowly enough that the body can relax throughout the practice. The following yoga postures are general movements which are especially helpful for relieving tension in the neck, upper back and shoulders. A qualified yoga teacher can help students develop a home practice in a private session or modify a group class based on specific needs.

Asana

Cat/Cow

On hands and knees, using a blanket under the knees for cushion as needed. Focus is on gentle, coordinated motion with the breath, not as much on degree of flexion and extension in the spine. For students who are uncomfortable placing weight on the hands, flexion breath can also be done seated or standing with elbows at a ninety degree angle.

Adhomukhasvanasana (variation)

For students with a fair degree of flexion in hips and shoulders, full downward facing dog pose may be an option. Otherwise, puppy pose, or downward facing dog with hands on a wall or the back of a chair may be a more suitable posture. Dolphin pose, which brings forearms to the floor, might be a preferred variation for those with tightness or tender spots in the neck and shoulders.

Bhujangasana

Cobra Pose is a gentle backward bending pose which can relieve tension in the upper back and neck, an area commonly sensitive for many with fibromyalgia. To practice, lie down on your belly with hands to the sides of your chest. Inhale while drawing shoulders together and down the back to expand the chest and lift the upper body away from the floor. Lower as you exhale. Repeat several times.

Gomukhasana

Cow Face pose is an excellent posture for reducing tightness in shoulders, neck and upper back, as well as hips and lower back. Please use a strap with the hands as needed, and sit on a folded blanket or block as needed. For students with tighter hips or hamstrings, sitting in a chair or in a cross-legged position might be more suitable.

Pranayama

Breath Awareness: Diaphragmatic Breathing

Rather than a particular pranayama technique, a student with fibromyalgia may be best served by simply practicing awareness of the breath and its movement (or lack of movement) throughout the body. Students should observe which spaces in the body seem to allow the breath to move freely and which seem to restrict its motion due to tension or poor tone. For example, do the chest and upper back expand and contract with each breath in and out? Do the ribs? Does the belly? In a complete breath, the diaphragm is free to expand and move downward as the lungs fill, and to draw in and move toward the ribcage as they empty.

Although it is easiest to concentrate on this flow of breath in a reclined position, a student for whom lying on the back is painful might prefer child's pose or a seated position.

Tips, Contraindications and Considerations

As with any form of exercise, yoga techniques should be done mindfully, in a spirit of soothing or quieting the body, especially if the student is already experiencing pain. Fibromyalgia symptoms differ from person to person, and even from day to day. For some students, yin yoga (a type of yoga which emphasizes mostly seated or reclined deep stretches held for long periods of time) might be very nourishing, but others may prefer restorative yoga, a style which is fully supportive and emphasizes total relaxation rather than stretching. In general, most students with fibromyalgia will benefit from a gentler, more mindful experience. Remember that the goal of practice is to promote balance, not place further stress on the body.

Keep in mind that common tender spots on the back and hips may make seated or reclined positions uncomfortable for students. Some students may have tender spots in the knees which will make kneeling positions uncomfortable as well. Postures should be adapted to meet the needs of the student, either with the use of props to provide cushion, or by turning the pose at another angle to avoid placing pressure on tender areas.

There are no known contraindications for practicing yoga with fibromyalgia. Many students find that practice during a flare-up increases pain. Especially for beginning students, caution should be taken with more vigorous forms of yoga (such as vinyasa, ashtanga, power, etc) or yoga done in a highly heated room, as the stress on the body could result in sympathetic arousal and increased pain and fatigue.

Research

Early research indicates that regular gentle yoga practice significantly relieves common symptoms such as pain and fatigue, improves mood, and supports pain catastrophizing, acceptance, and other coping strategies.

A review of the efficacy and safety of various meditative movement practices (Qi Gong, Tai Chi and Yoga) in managing the symptoms of fibromyalgia. Over the course of 3-6 months, all three practices reduced sleep disturbances, fatigue and depression and improved quality of life. However, the group which practiced yoga was the only group which experienced a significant reduction of pain that was maintained through the end of the study.

Various smaller studies have revealed yoga and mindfulness to be useful tools in reducing pain, stiffness, anxiety and depression, and improving overall well-being for those who have fibromyalgia. Notably, research supports that the more yoga is practiced, the more benefit the student receives.

Additional Resources

The Art of Surrender: Yoga & Fibromyalgia - Yoga International

Inspiring story about a woman's experience with fibromyalgia and the power of yoga in her healing process.

Yoga Eases Fibromyalgia Pain - WebMD

Standing Yoga Poses for Fibromyalgia - Fibromyalgia Hope

Fibromyalgia: Maligned, Misunderstood and (Finally) Treatable - Scientific American