Article: Treating Fibromyalgia in Water

Treating the Pain of
Fibromyalgia in Water
by Lynda Huey, MS and Pattie O'Leary, PTA

Fybromyalgia Water Therapy For more than two years, Diane Schneier and her mother Joyce have been doing aquatic therapy three times a week, trying to alleviate the pain of fibromyalgia syndrome. Fibromyalgia is not fatal, disfiguring or crippling, and it doesn't get progressively worse. But it is often frustrating, because a person's pain, symptoms and energy levels can change every day. For Diane and Joyce, aquatic therapy relieves their condition and improves fitness and well being.

"The pool is the only place I can work out that doesn't hurt me," says Diane, a film producer who often spends 16 hours a day on her feet. "When I can get two or three months in a row of steady therapy sessions, I start to feel strong and physically capable again."

Fibromyalgia, the pain of fibrous tissue and muscles, isn't considered a disease, but rather a combination of symptoms that range from mild to severe. Up until 1990, this syndrome wasn't diagnosed directly. Instead, doctors ruled out other disorders that produced similar symptoms -- arthritis, lupus, rheumatism, connective-tissue disorders, thyroid disease or neurologic disorders.

In 1990, however, the American College of Rheumatology stated that fibromyalgia could be diagnosed by a history of widespread pain that occurred for more than three months in combination with pain in 11 of 18 specific, bilateral points in muscle tissue. If tender spots appear in all four quadrants of the body, a patient is diagnosed with fibromyalgia.

General symptoms include burning or stabbing pain deep in the muscles, sensitive skin, tingling or numbness of the hands and feet, headaches, bloating, dizziness and blurred vision. Approximately 15 percent to 20 percent of patients treated by rheumatologists have fibromyalgia.

Fibromyalgia patients are notoriously deconditioned; they often can't walk, use a bicycle or go to the gym without incurring more pain. The water, however, helps improve fitness while simultaneously treating aches and pains. Water's buoyancy virtually eliminates painful tissues and joints and provides an ease of movement not possible on land.

Water also provides a three-dimensional resistance to movement so that muscles develop strength equally in all directions. The water applies hydrostatic pressure to bodies immersed in it, and that reduces swelling and discomfort.

The following water protocol for fibromyalgia focuses on total body fitness, as well as stretching and strengthening specific areas of the body. All of these exercises are explained in detail, with photos, in The Complete Waterpower Workout Book by Lynda Huey and Robert Forster, P.T. (Random House, 1993).

Deep Water Warmup Deep-water warm-up. By avoiding all impact, patients slowly perform general warm-up exercise with a sense of ease. Most patients have their heads above water, but people with severe neck pain do warm-ups submerged. This takes the weight of the head off the neck so they can exercise more comfortably. For safety, all patients are tethered to the side of the pool.

Deep-water interval training. An interval training session is created by combining the three skills -- deep water running, deep water walking and flies (hip and shoulder ab/adduction) -- in the deep water warm-up and varying the speed to create alternate periods of work and rest. Fibromyalgia patients should work at low to medium intensity levels to gain maximum aerobic benefits without crossing over into anaerobic work, which can cause undue fatigue. Pacing is important to help these patients make it through the entire session. Again, patients with neck pain are submerged.

Deep water-power exercises. The following nonweight-bearing exercises help strengthen the body gently and safely: sit kicks, heel lifts, bent-knee twists, quick scissors, v-kicks and deep back kicks.

Kick training. All of the following kicks target the muscles of the hips, thighs and buttocks: front and back flutter kick, bicycle kick, straight-leg deep kick and slap kick. Therefore, the lower extremities are reconditioned without any impact or undue fatigue. Patient's shoulders are protected by doing these exercises in a corner or on a step.

Stretching. The following stretches cover all the major muscle groups, but particular focus is on the shoulders and neck, where fibromyalgia patients report the most pain.

Curl and stretch
Hamstring stretch
Cross-chest stretch
Overhead triceps stretch
Biceps stretch
Clasp-hands-behind-back stretch
Wall pec stretch
Neck flexion
Neck rotation

Upper extremity exercises. This series of range-of-motion exercises helps shoulders and arms gain strength, flexibility and function. On days when the pain level in the neck, shoulders and arms is minimal, we may ask a patient to use webbed gloves to create more resistance, thereby gaining strength. On days when pain is great, we may ask them to slowly perform the following pain-relieving exercises:

Front/back pull
Dig deep
Up/down pull, front and back
Biceps/triceps curl

Swimming or assisted swimming. If a patient swims, she can use the stroke that causes the least pain and aggravation. For people with back or neck pain, we often add face masks, snorkels, flotation belts for the hips and cervical collars for the neck. Most patients, however, do either a combined stroke (breaststroke with flutter kick) or a modified backstroke. The backstroke modifications apply the least amount of pressure on the neck, upper back and shoulders.

Watsu. This relaxation technique yields the greatest pain relief for fibromyalgia patients. The therapist cradles the patient in her arms, then gently rotates her own body from side to side, which causes the patient's limbs to sway. During a 15- to 20- minute treatment, the therapist moves from one side of the other side. During this motion, the patient floats with eyes closed and ears in the water, creating sensory deprivation, which relaxes and breaks the pain cycle. Watsu also has a cumulative effect on well being. For instance, if patients are pain-free for an hour or so after the first session, they may not have pain for up to four hours the next time.

Waterpower Workout exercises. These low-impact jumping exercises are optional and used only on days when a patient has little pain and feels strong and energetic. Exercises such as lunges, crossovers, squat jumps, side straddles, leg swings, front kicks, back kicks and frog jumps give patients a sense of athleticism they don't normally possess.

Besides the Schneiers, who helped inspire us to develop fibromyalgia protocols, dozens of other patients with fibromyalgia and rheumatoid arthritis have benefited from this program. On rare occasions, the symptoms of a few people increased, which made us shorten the first session of all fibromyalgia patients until we saw their reactions. We didn't want to overwork them and cause a flare-up. Other than that, we have no generalized contraindications for treating fibromyalgia patients in the pool. We simply let the patient's pain guide the program. If a specific exercise hurts, we skip it that day.

Our success with these patients has inspired rheumatologists to send other fibromyalgia patients to us. Insurers, workers' comp and private, are reimbursing steadily for treatment as well.

Several years ago, Fibromyalgia patients had few options, but with aquatic therapy, they have a valid treatment plan that provides what they need: pain relief and a fitness routine that won't exacerbate their condition.

Lynda Huey, MS, who pioneered the use of aquatic therapy with Olympic and professional athletes, is co-author of The Complete Waterpower Workout Book (Random House, 1993) and Heal Your Hips (John Wiley & Sons, 1999). Since 1994, Pattie O'Leary has worked with Lynda Huey in Southern California and Florida. You may contact the authors at (310) 829-5622.