Training Clients with Fibromyalgia by Louise Worboys
Fibromyalgia means that clients have non-specific pain in many areas of their body. This pain is muscular as opposed to skeletal, and there is no clinical way to diagnose it.
Most commonly it is diagnosed by ‘tender spots’; reporting pain in eleven out of eighteen spots.
The condition itself is associated with other issues like headaches, fatigue, bladder issues, digestion issues such as IBS, poor sleep, stiffness, anemia arthritis, low mood and depression. These all create challenges for us training clients with fibromyalgia as even most medical practitioners don’t understand it. As it stands there is no ‘cure’, but it seems that with the right measures in place we can support the millions of people who are suffering and help them to feel a little bit better.
Training Considerations: Closed Chain Exercises
These clients are likely frustrated because they feel like their body is failing on them. They become so much less confident in their ability to do simple daily tasks, and so getting them to move and feel safe is massively important.
Think about the use of closed chain exercises rather than open ones to help them feel secure. Use the things that people struggle with on a daily basis as a start point for your programming too.
Never underestimate how much value you can provide by making it easier for someone to get out of bed in the morning or clean their bathroom! Work with them on finding ways to integrate the types of movement they struggle with into your programming. It’s really important that you celebrate these types of things with your clients, and keep a note of them, you may need to use them to provide positive reinforcement/encouragement down the line.
Start With Short Sessions
When you plan sessions, start with short ones as these clients will probably tire pretty rapidly, so short session length is important, as is asking them when they feel the best. Some people have worse pain in the morning and once they have medicated and got going they feel a little better but others its the complete opposite, so design their session times around their input.
In terms of intensity, again you may have to tweak this on a session by session basis, I’ve seen clients rate the exact same exercise a 4 RPE one week and an 8 RPE the next, so make sure you take that into account and are flexible with reps and sets schemes. Don’t aim to get too high with the RPE, aim to keep it between 5-7, certainly to start with. If symptoms improve you can test out higher RPE’s.
Recovery from sessions is going to be pretty tough for these clients if you push too hard. They are already in pain and adding to that is less than ideal for their perception of the benefits of exercise. Recommend swimming or walking or gentle stretching to get them used to moving more. If they can find someone to do it with they are more likely to stick at it. Social support can be critical.
Use External Cues
Generally speaking, there are feedback/positional issues with sufferers, meaning that they struggle more with internal types of cues. Being able to cue externally, using external objects such as boxes, bands, benches, and sometimes just guiding them into place can be more effective.
Work With Their Medical Team
Chances are they will have been referred for physio, and providing a support network of people who have their best interests at heart will be useful for them as well as you. The physio can help and support you by advising on things to avoid.
Bear in mind it’s hard for people suffering this condition to make the first step to getting into exercise.
Many of them will come to see you because exercise has been recommended to them, not because they want to so they may need a slow start, and they may need to be given information and some time to go away and think (trans-theoretical model of change – pre-contemplation stage).
Once they start training their motivation may dip or they may cancel last minute because of a symptom flare-up. Being a supportive coach will help them be more honest and open with you about what’s going on and will hopefully help you break through some of the barriers and allow them to be honest with you.
References and Where to Learn More:
Precision Nutrition put together a pretty comprehensive overview for clients suffering Fibromyalgia, that can be found here.
The NHS has some good information about how Fibromyalgia can be treated and what things to be aware of here.
This is a charity dedicated to supporting Fibromyalgia sufferers and they also have some good resources here.
Dressendorfer, R. VanderKooi, S. 2016: Fibromyalgia and Exercise. Available from: https://www.ebscohost.com/assets-sample-content/Fibromyalgia_and_Exercise_-_CR.pdf
Gowans, S, deHueck, A. Voss, S. 2001. Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia. Available from: http://onlinelibrary.wiley.com/doi/10.1002/1529-0131(200112)45:6%3C519::AID-ART377%3E3.0.CO;2-3/full
Our hypermobility part 1&2 webinar are great resources on fibromyalgia and can be found here by scrolling to special populations and then looking for hypermobility part 1&2. Not a member yet? You can get access to all our resources on our 2 week free trial.