Fibromyalgia Got You Feeling Unbalanced? Try These Exercises.

Pilates instructor Shona Curley specializes in working with individuals diagnosed with fibromyalgia, Lyme disease, and chronic fatigue. Here, she shares her tips - and video demonstrations - for improving body awareness and regaining balance control.

Individuals with fibromyalgia can experience difficulties with balance, ranging from minor to debilitating. In my Pilates practice in San Francisco, I often work with clients who share how balance interferes with their daily life – they talk about falls, heightened senses of insecurity, and how participation in exercise programs feels more challenging to them. As someone diagnosed with Lyme disease, and who regularly works with people living with pain and fatigue, I truly understand their fears.

 

Shona Curley demonstrates a balancing exercise. Balance loss and body/space disorientation are common experiences in those with fibromyalgia.

What the Research Shows

In an online survey of 2,596 people with self-reported fibromyalgia, 45% reported balance problems.1 In fact, they noted that balance was one of their chief concerns. A smaller study of 34 people with fibromyalgia and 32 matched controls found that those with fibromyalgia had more difficulty with balance and experienced more falls, as compared to people who did not have fibromyalgia.2 A third study on walking gait and balance compared 26 female patients with fibromyalgia with 16 pain-free women. Here, researchers found that both gait and balance were severely impaired in those with fibromyalgia.3

Andrew J. Holman, MD, a rheumatologist retired from his practice with Pacific Rheumatology Associatein Washington state, spent his career specializing in fibromyalgia and related conditions. He wrote that “patients with FM have poor position sense, ie, awareness of their postural alignment."4 This awareness is clinically termed proprioception, or the ability to accurately sense the body’s position in space

Why Does Fibromyalgia Affect Balance?

I asked Melissa Congdon, MD, a fibromyalgia specialist in the San Francisco Bay Area (who has been diagnosed with fibromyalgia herself), to help me understand balance issues in fibromyalgia. She told me that the medical community is still unclear as to exactly why fibromyalgia affects balance. Muscle tightness and stiffness may contribute by reducing range of motion. Neurological issues may also adversely affect balance by diminishing proprioception (the ability to correctly sense one’s body position in space). In addition, some individuals with fibromyalgia report dizziness as a symptom, which can impair balance.

According to Dr. Congdon, “Many fibromyalgia medications have dizziness – and sometimes loss of balance – as a common side effect. Some people do not experience any side effects, others do. That’s why it is important to talk to your doctor if you are experiencing dizziness or balance trouble to see if one of your medications could be contributing.”

Specifically, she mentioned pregabalin (eg, Lyrica), gabapentin (eg, Neurontin), and zolpidem (eg, Ambien), which helps with sleep and may cause next-day dizziness. If you are taking any of these medications and experiencing issues with balance, talk with your doctor about possible alternatives.

 

How Can Exercise Help?

Several “studies suggest muscle training through physical therapy or exercise can improve balance for people (with fibromyalgia), and that this improvement may lessen or disappear if the person stops their exercise program,” says Dr. Congdon.

And, according to the Mayo Clinic, committing to an exercise program has been repeatedly shown by research to decrease pain and improve quality of life over time in patients with fibromyalgia.5 They advise starting slow, choosing low impact exercise, and pacing yourself in order to avoid worsening pain symptoms.

In general, I have found the slow-and-steady approach to be good advice whether you’re exercising to improve balance or for general conditioning. Let your body be your guide and go as slow as necessary to maintain comfort. There is no reason to exacerbate pain – the more comfortable you are, the more likely you are to stick with your program and improve your balance over time.

Movements You Can Do at Home to Improve Balance 

No matter the root cause of your balance or proprioception issues, there are gentle exercises you can do to improve. Below are a few exercises and techniques I use in my Pilates practice, all of which can be done at home. You may be able to creatively modify the exercises to keep them pain-free – let your body tell you what it can tolerate. Below is a video that shows me going through the exercises, if you’d like to follow along. I do recommend checking with your primary doctor or pain provider before starting this regimen, or any new exercise plan.*

https://www.youtube.com/watch?v=t59Mn5YUve4&feature=youtu.be

 

To soften tight muscles

  • Deep breathing: It’s amazing what a few deep breaths can do for releasing muscle tension. Before you start any exercise program, try taking a few moments to breathe in and out deeply, asking your muscles to relax.
  • Gentle self-massage: If you notice that you are particularly tight or sore somewhere, try using gentle touch to release. Just lay your own hands over areas where you feel tension and continue with deep breathing. Imagine your muscles softening. You can select an image to picture if that works for you, such as your muscles turning to warm water, or soft butter.

To re-center your balance

These exercises can be destabilizing if you are not used to them. If your proprioception is severely impaired, start off by holding on to something such as the top of a chair or a railing, and progress to letting go as you can.

  • Standing with eyes closed: Stand, holding on to something if you need to. Once you have your balance, close your eyes and feel your body as you stand. Focus on feeling your balance and any slight movements your body makes in space. Progress to letting go as you can. (Let your body guide you as to how long you continue. If you feel discomfort, it’s time to move on. If you are enjoying the practice, stay with it as long as you like.)
  • Moving your arms in space, eyes closed: Stand, holding on to something with one hand if you need to, eyes closed. Practice variations on ballet’s port de bras (meaning movement of the arms). You can look up examples on YouTube, or watch this example that I like https://www.youtube.com/watch?v=dcjPEo_R3xg). You can also just invent arm movements that feel gentle and graceful to you.
  • Move your arms, or arm, slowly and gently, sensing your body as you move. Let your shoulders relax and imagine keeping your chin level – this will help prevent soreness in your neck and shoulders. Soften your knees. Let your torso twist a little as you are able, following the movements of your arms. Remember, you are looking to increase your awareness of your positioning in space, not to work out and make your muscles burn. Go easy, and rest if you feel tired or sore.

To improve sensation in the soles of the feet

Norman Doidge, MD, is the author of both The Brain’s Way of Healing and The Brain that Changes Itself – two of my favorite books on brain plasticity, that is, the brain’s ability to rewire itself to accommodate changing circumstance or challenge. Dr. Doidge writes that good balance is intimately linked to our ability to sense the bottoms of the feet.6,7 (See also, What is Brain Plasticity and How Can it Help My Pain?)

We tend to lose sensitivity to our feet over time through wearing shoes. When was the last time you walked barefoot in a forest? Think of how sensitive our ancient ancestors had to be to avoid cutting their feet on rough stones, or to balance on a fallen tree.

The good news is, you can build foot sensitivity with practice – because of your brain’s ability to adapt. Similar to the exercises above, hold on to something if you need to.

  • Raising and lowering heels, eyes closed: Stand on solid ground, ideally in bare feet. Hold on to something if you need to. Take some time to feel the soles of your feet. What is the texture of the floor you’re standing on? What is the temperature? Can you feel each toe individually? (Most people can’t do this at first, and I still have a hard time with my middle toe.) After some time, raise your heels slightly, very slowly, and then lower them back down. Try this 2 to10 times, as you can, pain-free. Do you notice tension in your feet? In the rest of your body? Can you relax, and still find your balance?
  • Standing on one foot, eyes closed: Again, stand on solid ground, barefoot if possible, eyes closed. Hold on to something if you need to. Try standing on only one foot. Can you feel the sole of your standing foot? Which side of your foot do you tend to lean toward? Can you relax as you balance? See if you can hold your balance for 10 to 30 seconds or so on each side.

Keep Moving!

I find that my clients get the best results if they practice balance exercises at least twice a week for 10 minutes. If you can do more, you will see better results! Ideally, practice 5 days a week, for about 10 minutes or so each time.

Exercise can help to improve awareness of your body in space and your balance, and once you make progress, you are likely to see an improvement in your quality of life as well. Go slow and find what works best for you. Invent your own exercises! As time goes on, you will be able to challenge yourself even more.

Editor's Note: Recent reserach has further shown that core stability-based physiotherapy, as well as acupuncture, can help to improve dynamic balance and postural control in women with fbromyalgia.8

*Disclaimer: The exercises described and demonstrated herein are not meant to provide clinical or medical advice. Each case is different. Always talk with your doctor before starting any exercise regimen.

Updated on: 05/18/20
Continue Reading:
Fibromyalgia: Why Do My Feet Hurt?
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