Balance & Fibromyalgia
Fibromyalgia is a painful muscle and fascia disorder that was largely ignored until the beginning of the 1990s. Fibromyalgia has many overlaps with other disorders and because of that it is often misdiagnosed or ignored.
A Little More on Fibromyalgia.
Fibromyalgia syndrome (FMS) is recognized by the World Health Organization (WHO) as a chronic condition characterized by widespread pain.
Accompanying symptoms include fatigue, sleep disturbances, and cognitive disorders.
FMS is associated with various other syndromes: irritable bowel syndrome, dry mouth, dry eyes, orthostatic intolerance, temporomandibular joint dysfunction, among others.
Different rheumatological societies have proposed various definitions and diagnostic criteria for FMS over the years.
The 2016 diagnostic criteria for FMS focus on:
Multi-site pain in 6/9 body areas, lasting at least 3 months.
Sleep problems OR fatigue, assessed as moderate to severe by a healthcare professional.
FMS has a global prevalence of 2–4%.
The condition is more common in females, with a female to male ratio of 3–9:1
In the 1990s the diagnosis for fibromyalgia mainly relied on the positive findings of widespread pain and pain upon touch in 11 or more of 18 areas. These areas included:
Occiput: Bilateral, at the suboccipital muscle insertions.
Low Cervical: Bilateral, at the anterior aspects of the intertransverse spaces at C5-C7.
Trapezius: Bilateral, at the midpoint of the upper border.
Supraspinatus: Bilateral, at origins, above the scapula spine near the medial border.
Second Rib: Bilateral, just lateral to the second costochondral junctions.
Lateral Epicondyle: Bilateral, 2 cm distal to the epicondyles.
Gluteal: Bilateral, in upper outer quadrants of buttocks in anterior fold of muscle.
Greater Trochanter: Bilateral, posterior to the trochanteric prominence.
Knee: Bililateral, at the medial fat pad proximal to the joint line.
While the diagnostic criteria for fibromyalgia has changed one thing that we have learned over the past few decades is the relationship between fibromyalgia and balance.
Fibromyalgia & Balance
Many patients with fibromyalgia have balance issues. Whether its balance while standing still, balance while walking and turning, or balance while standing up or reaching for an object, individuals with fibromyalgia have worse balance control.
As we’ve mentioned in previous blogs balance is controlled and maintained by three systems: our eyes, our inner ears, and our musculoskeletal system. These three systems give input into our brainstem to let brain know where we are at as we navigate the world.
However, in individuals with fibromyalgia it has been found that many of them have altered inner ear and visual function and that they are dependent on their muscular system as the primary input for maintaining balance. Since the musculoskeletal system is doing more work in these individuals due to the lack of normal function of the visual and vestibular systems the musculoskeletal system becomes fatigued and a muscle that is constantly fatigued and doesn’t have enough time to recover will eventually become painful.
When we look at the 9 tender areas that used to be the diagnostic criteria, included below, 8 of them are directly involved in maintaining our balance and keeping us upright. Essentially these areas that are major contributors to keeping us balanced eventually fatigue and become painful, the body also is utilizing more energy and effort to keep itself upright which most likely explains the cause of the moderate to severe sleep problems and fatigue found in these individuals.
Occiput (suboccipital muscles): These muscles play a role in head and neck movement. Proper alignment of the head and neck is crucial for maintaining overall balance and posture.
Low Cervical (intertransverse spaces at C5-C7): The cervical region of the spine is essential for neck movement and stability. The neck provides significant sensory information for postural control.
Trapezius: This large muscle extends down the back of the neck and upper spine. It's vital for moving and stabilizing the shoulder blades and supporting the arms, all of which are important for balance, especially during arm movements.
Supraspinatus: Located on the upper part of the scapula, it's one of the rotator cuff muscles and helps with arm movement. While not a primary postural muscle, it aids in arm stability, which can influence balance during arm movements.
Second Rib (near the costochondral junctions): While the rib muscles (intercostals) primarily aid in breathing, the thoracic stability they provide indirectly supports postural control.
Lateral Epicondyle (forearm extensor muscles): These muscles extend the wrist and fingers. They're not primary postural muscles but play a role in tasks that require hand and arm stability.
Gluteal muscles: These are major muscles for postural control. They stabilize the pelvis and support movements of the hip and thigh, crucial for standing, walking, and any activity that requires lower body stability.
Greater Trochanter (hip muscles): The muscles around the hip, like the gluteus medius and minimus, are essential for pelvic stability and leg movement. They're directly involved in postural control, especially during walking or standing on one leg.
Knee (medial knee region): While the tender point is near the knee, the muscles around the knee joint, like the quadriceps and hamstrings, play a significant role in leg stability and movement, directly influencing postural control.
Currently, the typical treatment for fibromyalgia involves one or a combination of: pain relievers varying from your typical tylenol to a stronger muscle relaxer, anti-depressents, physical therapy, and counseling.
However, due to the fact that we know that balance is altered in many individuals with fibromyalgia not assessing or working to improve the function of the visual and vestibular system and overall balance is leading to many individuals with fibromyalgia from achieving the relief that is possible.
Where we come in.
At Optimize Chiropractic one of the key aspects of our exam process is the analysis of the three systems that maintain our balance. We do this by utilizing force plate technology which gives objective measures of the systems that maintain our balance. Combining this with measurements of how well the body moves in different planes of motion and which moments feel altered or painful allows us to create a specific plan to address the pain and balance issues that come with fibromyalgia. Due to our comprehensive approach we have seen great improvement in many individuals with fibromyalgia who previously felt like their improvement was at an end.
If you or someone you know suffer from fibromyalgia share this blog with them and let them know that we offer complimentary consultation to learn more about their condition and to find out if we can help. Click here to schedule your complimentary consultation.
References
Liptan, G. L. (2010). Fascia: A missing link in our understanding of the pathology of fibromyalgia. Journal of Bodywork and Movement Therapies, 14(1), 3-12. https://doi.org/10.1016/j.jbmt.2009.08.003
Núñez-Fuentes, D., Obrero-Gaitán, E., Zagalaz-Anula, N., Ibáñez-Vera, A. J., Achalandabaso-Ochoa, A., López-Ruiz, M. D. C., Rodríguez-Almagro, D., & Lomas-Vega, R. (2021). Alteration of postural balance in patients with fibromyalgia syndrome: A systematic review and meta-analysis. Diagnostics, 11(1), 127. https://doi.org/10.3390/diagnostics11010127
Peinado-Rubia, A. B., Osuna-Pérez, M. C., Cortés-Pérez, I., Rojas-Navarrete, A., Ibancos-Losada, M. D. R., & Lomas-Vega, R. (2023). Effectiveness of vestibular rehabilitation in improving health status and balance in patients with fibromyalgia syndrome: A single-blind randomized controlled trial. Biomedicines, 11(5), 1297. https://doi.org/10.3390/biomedicines11051297
Plaut, S. (2022). Scoping review and interpretation of myofascial pain/fibromyalgia syndrome: An attempt to assemble a medical puzzle. PLoS One, 17(2), e0263087. https://doi.org/10.1371/journal.pone.0263087
Reddy, R. S., Tedla, J. S., Dixit, S., Raizah, A., Al-Otaibi, M. L., Gular, K., Ahmad, I., & Sirajudeen, M. S. (2022). Cervical joint position sense and its correlations with postural stability in subjects with fibromyalgia syndrome. Life, 12(11), 1817. https://doi.org/10.3390/life12111817
Toprak Celenay, S., Mete, O., Coban, O., Oskay, D., & Erten, S. (2019). Trunk position sense, postural stability, and spine posture in fibromyalgia. Rheumatology International, 39(12), 2087-2094. https://doi.org/10.1007/s00296-019-04399-1