Warm Water Exercise for Fibromyalgia & CFS/ME

Warm Water Exercise for Fibromyalgia & CFS/ME

Fibromyalgia (FM) and CFS/ME 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 FM & CFS/ME focuses on total body fitness, as well as stretching and strengthening specific areas of the body.


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 abduction) - in the deep water warm-up and varying the speed to create alternate periods of work and rest. FM & CFS/ME 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 non weight-bearing exercises help strengthen the body gently and safely:

• sit kicks


• heel lifts


• bent-knee twists


• quick scissors


• v-kicks


• 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 FM & CFS/ME patients report the most pain.

• Curl and stretch


• Hamstring stretch


• Cross-chest stretch


• Overhead tricepsStretching 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 FM & CFS/ME 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.

Several years ago, FM & CFS/ME 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.


Getting Started

Many places have scheduled classes for people with FM or CFS/ME, where you can learn from a qualified instructor.

• Check with your doctor before beginning aquatic therapy or any exercise program.


• Look for a qualified instructor or therapist.


• Start slowly, with short, low-intensity sessions and then work up gradually.


• Start with 2 sessions a week, several days apart, to see how your body responds to the exercise.


• Know your limitations and stay within them. Don't feel like you have to make it through an entire class.


• Don't try to push through the pain, as it will likely make you hurt much worse later on.


• Talk to your doctor about the timing of any pain killers you are on. If you take them before exercising, you may miss your body's cues that you're working too hard.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Sources:

* Lynda Huey, MS and Pattie O'Leary, PTA, Treating the Pain of Fibromyalgia in Water, CompletePT and Huey's Athletic Network, http://www.lahuey.com.

* Clinical and Experimental Rheumatology. 2007 Nov-Dec;25(6):823-30. All rights reserved. "Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia."

* Journal of Rehabilitation Medicine. 2008 Apr;40(4):248-52. All rights reserved. "Eight months of physical training in warm water improves physical and mental health in women with fibromyalgia: A randomized controlled trial."