PAIN AND POSTURE

We could discuss that the air of the medical world today is filled with, among other things, dissension regarding the diagnosis of fibromyalgia (FMS). Does such a disease entity really exist? Are we seeing a physical problem complicated by depression, or simply the physical manifestations of depression? A significant portion of the medical community does not acknowledge FMS as a legitimate disease entity. So I thought this might be an appropriate moment to revisit this topic and to address some issues. 

The respected American College of Rheumatology has put forth criteria for the diagnosis, including the major criteria which must be present for the diagnosis to be confirmed: widespread pain, in all four quadrants of the body, lower and upper extremities. The pain must be of at least 3 months duration. Almost all FMS people have sleep disturbance characterized by alpha wave intrusion in delta sleep. Consequently, they awaken unrefreshed, stiff, and in pain. They usually complain of severe mid-day fatigue, often of headaches, jaw pain, gastrointestinal disturbance such as irritable bowel syndrome, cognitive dysfunction, etc. On physical examination, diagnosis is confirmed by finding 11 of 18 paired "tender points" at specific locations on the body. (See diagram). These people often feel depressed and frightened, not understanding their condition. Why should they be so sick? Is there something really serious going on? 

This is precisely where some of the most important problems and conflicts lie. There are no laboratory or blood tests to tell us "Yes, you have FMS" or "No, you don't have FMS" OK, so you're sick; your doc says you have FMS; you accept this and know there is no cure. You depend on supportive measures: massage, acupuncture, medications, both over the counter and prescription- and thus you are now a captive of the System. You are dependent on health care givers indefinitely. Have you been helped by this diagnosis? Does the knowledge lead to improvement in the quality of your life? Not at all. Conventional medical wisdom says you'll schlepp this baggage around for the rest of your life. 

But is that all necessarily true? What if FMS is a limited condition or not even a discrete entity in itself? What if the disabling signs and symptoms are controllable and alterable to the point at which life becomes livable again? We don't know what causes fibromyalgia (if we acknowledge that it does exist -and I happen to be one of the believers.), but frequently in our practice we note concurrence of FMS, myofascial pain syndromes and dysfunctional postural mechanics charcterized by anterior weight bearing, abdominal, and gluteal weakness and psoas major tightness. If this relationship is valid, then maybe we can do something positive and constructive about FMS. 

People with fibromyalgia have widespread, chronic pain involving the upper and lower back and often both upper and lower extremities. People with postural back pain exhibit a similar distribution. Both groups frequently suffer from headaches, stiff necks, temperomandibular joint dysfunction. Both suffer disturbed sleep and feel stiff upon awakening. Characteristic of psoas dysfunction/insufficiency is the development of myofascial pain syndromes with associated trigger points. Dysfunctional postural mechanics can predispose to the development of and/or perpetuation of the fibromyalgia syndrome. The modification or elimination of the perpetuating factors should facilitate improvement. To that end, the program at CR&SM is directed. At Catskill Rehabilitation & Sports Medicine postural re-education, neuromuscular retraining, trunk stabilization, strength and flexibility training, trigger point and tender spot injections and needling, acupuncture, guided imagery and relaxation techniques are used to give FMS patients what they need most: a modicum of control over their condition.

All of these treatment modalities are available at Catskill Rehabilitation & Sports Medicine.