Mysterious Chronic Disease Fibromyalgia May be Treated by Yoga

April 12th, 2023. Daily Helmsman

You probably have woken up sore more than once from having spent the night studying, sitting in a chair, or after a sports session. You may even be woke up mentally exhausted. Now imagine that this is your day-to-day, suffering pain and sensitivity throughout the body simultaneously as extreme fatigue. Those are the symptoms of people who have fibromyalgia.

Fibromyalgia is a chronic disease whose origin is unknown, and there is no cure or specific treatment. "It takes an average of 5 to 6 years for diagnosis because there's currently no test that can say that the person has fibromyalgia," said Mildred Velez, founder of Fibromyalgia Care Society of America, who has suffered from fibro since 2007. It is a disease that affects each person differently. "We see people who are isolated at home and cannot get out of bed, and then we see other people who are able to manage it and live "normal lives," said Velez. She also explains that although it affects all genders, there are more diagnoses in women, and the age range varies.

An example is Isabella Marquez, a 20 years old music major sophomore studying at Belmont University in Nashville. "For me, it started with pain in my lower back when I was 13," said Marquez. Her parents took her to every kind of pediatric doctor because none of them could figure out what was wrong. An orthopedic doctor said she was fine and put her in physical therapy. However, the pain spread to her arms and legs, making it difficult to move around easily, and although she went to therapy every week, she did not improve. "After that, the next biggest thing was the chronic fatigue and the brain fog, my brain was just so cloudy all the time that I couldn't think straight, and I was already having symptoms of depression and anxiety," said Marquez. Then she started therapy to treat her anxiety, and after research she found that fibro was the only thing that fits all the symptoms. "At that point, I was 17 when I went to a rheumatologist, and he said, it's definitely fibro," Marquez said.

Since then, she has been learning to live with physical and mental pain. She says that being a college student is very challenging at times. "It's a very different experience because there's this balance of, I want to be a college student, and I want to have fun, but I also know that if I push it today, I'm going to be out of commission for my classes the next day," explained Marquez. She has used a cane since moving to Nashville because she found it easier to move around. At the beginning of the semester, she contacts her professors and gives them letters and doctor's notes, so they know that if she misses class, it is not because she wants to. She said most of the teachers have been wonderful, and they offer her zoom meetings to help her catch up. Although others have a much harder time figuring out how to handle a chronically ill student. "I love my major, but I had some professors who told me if I perform with my cane, people won't take me as seriously at auditions," said Marquez.

As I said before, there is no specific treatment, but Velez explains that there are three FDA-approved medications; pregabalin (Lyrica), an anti-epileptic drug, duloxetine (Cymbalta), an antidepressant, and milnacipran HCl (Savella), a serotonin and norepinephrine reuptake inhibitor. "Cymbalta was the first thing they put me on, and it helped me the most regarding the brain fog and the depression. I'm also on Lyrica, I still have a lot of pain, but when I don't take it, it gets much worse," said Marquez. Insomnia is another symptom she suffers from, so she takes melatonin and has to take the B12 supplement. In addition to medicines, there are other alternative treatments that many people with fibromyalgia try.

Karen Moss has been teaching and practicing yoga for 25 years and opened Better Bodies in 2004. She is an IAYT Certified Yoga Therapist and a Certified Yoga Alliance E-RYT® 500, YACEP® Yoga Instructor, who has treated dozens of people who claimed to have fibromyalgia. Moss explains that this treatment consists of "symptom management" and "improving patient quality of life" and that yoga typically does enhance the quality of life depending on consistency. "However, I recommend that individuals with moderate to severe fibro symptoms seek guidance because any form of exercise, including yoga, can make symptoms worse if done incorrectly or too much," said Moss, "yoga practice for this population should be completely individualized and monitored carefully."

She practices mostly Hatha, Ashtanga, Iyengar, and Therapeutic Yoga. She recommends practicing it twice weekly, although it will depend on how the individual responds, because "certain vigorous styles of yoga are likely counterproductive to balancing mind, body, and spirit." She explains that yoga is not a panacea, so each person must find the style and pace that best benefits them. Moss explains that meditation is a good combination, the practice of which has been increasing among people with fibromyalgia. "Through meditation, people can quiet their minds, reduce stress, and eliminate situations in their lives they have no control over," says Moss.

Marquez started practicing yoga, which she believes is a good balance of moving and stretching the muscles but not overworking them. She started with vinyasa yoga on the recommendation of her doctor: "I try to do it 2 to 3 times a week, but I have to be careful when I work out because if I push it a little too much, then I'm not going to be able to do much for the rest of the week," said Marquez, "there is a very fragile balance that I am still trying to figure out." Velez said she has also done different types of yoga, which helped, but it wasn't the one thing that made her feel much better." Some people say, oh, if you did yoga, you would be better. And it doesn't work that way. It's not just yoga. It's not just meditation. In our fibro society, we see that yoga doesn't help some people, so we offer them something else," explains Velez.

Grace Vedala is a physical therapist and yoga teacher who focuses on combining yoga with myofascial release therapy. She treats her patients individually in an hour to an hour and a half session. "The other kinds of yoga have a specific way of practice. MFR yoga is something I have created as a therapist to merge physical therapy with yoga, rating clients who are having body issues," explained Vedala, "fibromyalgia is a mind-body thing; when a patient has a lot of pain, it affects their mindset too, and I help them with that too." Vedala thinks it is therapy for "everyone willing to do the work," although it involves a process. She first worked on physical therapy, among other things, to assess their range of motion flexibility. And meanwhile, she asks them questions about their daily life, such as what their job is like or if they sleep well. "Before a fibromyalgia patient come to this clinic, they have been to a lot of doctors, and they have a lot of trauma," explained Vedala. By trauma, she means physical trauma caused by micro injuries for repetitive movements or mental trauma for all the pain, anxiety, and fatigue.

"My goal as a physical therapist is improving mobility, ability to move from sit, and decrease their pain level so they can function better," said Vedala. Through myofascial, she releases areas that are "stuck" or tight. "Most fibromyalgia patients will have trigger points, areas in the body that hurt when you put pressure on them. I release those areas but want them to feel a good hurt, so your mind becomes open to treatment," said Vedala. "When you release the area where the nerves are stuck, they can function better, and people can see results in the first session day."

She doesn't claim to be an expert in the mental aspect. However, she says that to help fibromyalgia patients fully, you have to challenge the way they think and put them in a perspective wherein it is more positive because they come to a point where they always think of their pain. "I don't promise people results because each person is different, and I have no control over what they do when they leave the clinic, but I have seen people with fibro that are now able to manage the pain much better," said Vedala.

At the same time as these physiotherapy sessions, the patient practices yoga classes. "There are a lot of types of yoga, is not just about postures, so what I taught them on day one, may it be posture or may it be breathing or meditation," said Vedala. She explains that a person with fibromyalgia has a "straight jacket" that needs to be loosened. "Yoga stretches can cause more pain, so first, I try to release that straight jacket before going into the yoga postures."

Marquez has not tried myofascial release, but she went to a physical therapist before. They gave her a back brace, and she will do small movements and exercises to stretch out her muscles and core. It didn't do much for her. "Maybe because I was in high school in a stressful time, I didn't see many benefits," said Marquez, "but I definitely thought about trying it again now that I have been diagnosed with fibro because I have heard a lot of good things from a lot of people."

Another possible treatment completely different from yoga and physical therapy is Transcranial magnetic stimulation (TMS). It is a non-invasive treatment, using magnetic pulses to improve brain function in selected areas, feeling like a light tapping. "I would say TMS is probably best for more of the mood part of things," said Dr. Helen Ly, a board-certified neurologist at Integrative Health Associates. "If you have depression and anxiety as a big part of your fibromyalgia symptoms, it can help." She says the pain part is more difficult to manage but that everything influences each other. So, the idea is that if you can improve the mood, you may also improve the pain and fatigue.

Everyone agrees that nutrition can play an important role. "I cut out gluten when I came to college, which has been a big help. And I've tried to cut out many things known to be inflammatory," said Marquez. Although as Velez explains, it also depends on the person.

These are just some of the treatments a person with fibromyalgia can access. However, the results are not guaranteed. Many people take years or do not even know they have fibromyalgia and suffer for a long time. It is called the invisible disease for a reason. But step by step, and with a lot of support, a person with this chronic condition can have a full and happy life.