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Developing a Home Program for Your Fibromyalgia
Mark Pellegrino, MD posted:
We've discussed physical medicine treatments and mental strategies; what about developing a successful home program? By this I mean the physical things we can do to better manage our fibro and try to keep it at a stable baseline. This isn't easy, but we know that nothing comes easy with our fibro. Our home program is our responsibility and we want to be organized and consistent with it.

Basic goals for a home program include:
* It is practical. Buying a 15-piece indoor gym set and building an additional room for it is NOT practical!

* It should improve/maintain fitness/endurance/physical activity. One of my favorite sayings is: "It's better to have fit and painful muscles than unfit and painful muscles."

* It can be easily modified. If we have a flare-up, we should still be able to do the program, just less of it, or work on other parts of the body not flared up..if you can find any!

* It helps maintain a stable baseline.

Everyone is unique so your program will be just for you. I think there are 5 things to include in your home program, and you shape it just right for your unique needs.

1. Fibronomics. These are the building blocks of a home program. Follow the 4 rules (see previous discussions) and they will become automatic after a while.

2. Modalities. I like moist heat. It's the easiest home modality to apply and can recur doing the day: hot morning shower, microwave heat pack during day, heat-producing creams/patches, hot soaks at night. Use heat before you exercise to "loosen" up the muscles. Others love their cold treatment ((shiver)) and others do well with their electric-stim (TENS) unit.

3. Stretching. This is a vital part because our muscles are so stiff and tight. We can stretch any time and all the time if necessary. For one who has been sedentary for a long time, I advise on slowly and gradually stretching for at least a month before adding any type of conditioning esercises. I'm a big fan of icing after stretching, muscle creams and, if dotor-advised, over-the-counter anti-inflammatory medicines to help smooth over the transition period. Ideally one works with a physical therapist or fitness instructor to learn how to stretch and develop your own stretching program.

Many do well with exercise using elastic bands which allow dynamic, resisted stretching to increase range of motion, and improve the strength and flexibility of our muscles.

4. Massage. Oh what a wonderful way to decrease pain, relax muscles, improve circuation, passively stretch muscles, and overall..feel good! Massotherapy could be done daily if one had access to this treatment. Many of my patients try for twice a month. Significant others can be trained to perform your therapeutic massages.

Self-massage is a fairly simple procedure that can be learned and performed effectively. It's best done in the shower where the hand can glide easily by using soap. Stretching is easily combined with self-massage. A massotherapist I know likes to instruct patients to give themselves a hug when taking a shower. This provides stretching, self-massage, and starts the day off with a hug!

5. Light conditioning. As a general rule, people with FM may not tolerate a lot of exercise, but a little bit of exercise is helpful. Set realistic goals for a body that is far removed from high school! Weight-lifting, walking, treadmill, exercise cycle, stair machine, arm pulley systems, aquatics, aerobics, dancing, (what works for you?), are different ways to perform light conditioning.

With a successful home program, I believe any flare-up is rarely due to the actual exercise program. Find your balance...but most importantly, try to find your home program that works for you.

The FMoral of this story: There's no place like home when you have FM!

Please share what works for you.

Dr. P
Lauralizzie01 responded:
Dr P! awesome post, this is something I'm tackling right now so Awesome timing!! I am currently doing Curves, and I like it for a lot of the reasons you've mentioned! It's flexible, the people are non judgmental and helpful. I usually go with my mom, and there are days I only use a few of the machines and mostly do the "movement boards" where you just move on a square board to keep your heart rate up. Then there are days where I do the whole circuit twice!! I also enjoy that I can skip machines if my chest is sore, or my arms, shoulders etc. and nobody blinks an eye which I love! Mostly I like that it gets me out and about and social. I also make sure I stretch religiously, used to be OOBER flexible, and I'm trying to get that back but we will see!!
I do wonder... how do you (everyone) know when to lay off? Lol that sounds idiotic, but I've always been taught and done it, just to push through, and you'll feel better in the end. Now I'm learning thats far from the truth. But I cant seem to find the line of "overdoing it!"
bcbailey1977 responded:
I know mine may be weird because I am in the early stages, so to speak. I have a Wii, with the fit board and the 1st edition and 2nd editions of a fitness game that lets you set your own pace. I mainly do pilates or stretching. My doctor wrote the prescription for it so I am hoping to write it off on my taxes.
annette030 responded:
As many folks have already heard, I am doing belly dancing, lol. The warm ups are like the range of motion exercises we did on patients in the hospitals where I worked, but set to music. The other movements are isolated to one area of the body, then another, and another, then trying more than one at a time. I am up to one and a half, to two hours a day, more exercise than I have ever done before. I have done this every single day for the last 5-6 months. It is FUN.

The only disagreement I have with what you have already written is the part about "arms stay home", not lifting your arms away from the body if possible. I may have misunderstood it many years ago when I first read your books. I followed this adage carefully for the last ten years or so. All I found was that I have decreased strength and a tight range of movement in my upper body that is not really good for me. A rheumy I saw recently disagreed with this also, and said to just go slowly and move everything to its full range of motion. He said the strength and flexibility would return.

Leaving my arms closer to my body did limit my pain somewhat though. My current doctor said at my last visit that "No one should have to decrease activity to control pain." She adjusted my pain meds rather than have me decrease my activity levels down to an hour a day to control the pain.

The best thing about dancing is that I don't need any equipment, and I don't have to go anywhere to do it. I just follow along instructional DVDs.

Take care, Annette
MagPrincess replied to annette030's response:
Okay so

I take 15 minute walks two to three times a week. Its actually part of my work but i can vary the time and when i go. If i am really hurting prior i will use some arnica spray and stretch first.

At lunch time i typically lay on the hard floor and have three flat ice packs that i move around and use deep breathing for twenty minutes. I finish with a minute with one ice pack on my face. -this is the only time i use ice.

at night i take a hot epsom salt bath with lavender and arnica. i do forward bends in the bath tub and stretch the hamstrings.

Then in bed i do full body stretch and a progressive relaxation meditation and sometimes i follow it with a guided imagery.

on the weekends we try to get to at least one park to walk and visit with nature.
Erin Given the choice between the experience of pain and nothing, I would choose pain. William Faulkner
fibroinsd responded:
Annette...the Belly Dancing sounds great !!

I do have a Yoga DVD I do at times...but being consistent with it is a problem. I feel better after I use it...but convincing myself to do it , that is the problem...

I have just started lifting weights at a health club...Today will be my third day. I do think it helps...and I have to write down what I do...and for how long...I hope that will make me more accountable.

Let's put the fun back in dysfunctional !- Mary Englebright
lb707 replied to MagPrincess's response:
Well at the moment I am starting my day as usual....moist heating pad on lower back and one that wraps around the shoulders with apiece that goes up the neck and has a magnetic closing.

I walk two small dogs every day......time varies as I need serious surgery on one of my feet.

I have a Pilate's machine I use at least 3-5 times a week.

Last night while watching TV in the guestroom/exercise room I sat on my ball. I watched a whole NCIS while doing stretches. That was a new one I think I will do more often.

In our airstream(RV) I keep my bands to exercise in a small place.

I honestly feel of all the things I do these are the things that really keep me going. And when I can it is the epsom salts baths.

MaMaTwig responded:
Hi Dr. P,
Well I just started TAI-CHI about 3 weeks ago, I do that 2 days a week for an hour each session, My Teacher (sue) is awesome, she takes her time with me, and the relaxation I feel when I leaver t here is ASESOME. I feel so much better the res of the night, and I have more energy to burn.

I also try to walk 2 to 3 days a week also, I try to walk for 45 minutes to an hour, but If I can't walk that long I don't push it.

I am really trying to set a realistic goal and keep to it, I know I will keep doing the TAI-CHI, it is great, I love it.

Thanks for all of you input Dr. P..... :)
Caprice_WebMD_Staff responded:
Give yourself a hug, Dr. P! :-D Yet another post to add to my watchlist.
We must let go of the life we have planned, so as to accept the one that is waiting for us. ~Joseph Campbell
bellydancinmama replied to annette030's response:
Yay for bellydancing! I am so glad you are enjoying it! I think I traded posts with you a few months ago about bellydancing...I have just started dancing again this week after a hiatus of almost 16 months due to pregnancy and FM pain. I'm going slow but hope to be up to my old tricks eventually. What DVD's do you use? I've just started the tribal bellydance series from Gypsy Caravan.
annette030 replied to bellydancinmama's response:
Yes, we did "talk" before about belly dancing. I am in the place of trying different instructors out, I have one by Jenna, I like her warmups the best. I also have a beginning one by Sadie, much more athletic a workout. One by Autumn Ward, very artistic dancing, I like her short choreographies to practice to, and a couple of DVDs by Sarah Skinner for a nice change.

I recently ordered new ones from Sadie, Jenna, and Sarah Skinner.

I will look for the series you are using, but it is probably way ahead of where I am. I am just a beginner.

I just turned 60 last month, it is good to know I am still finding "new" things to do and try.

Please keep in touch.

Take care, Annette
annette030 replied to MagPrincess's response:
It sounds like you have a good start going.

The ice would kill me, I used to use it on my neck but it makes me hurt too much anymore. I use heat now.

Take care, Annette
annette030 replied to fibroinsd's response:
Hi, Cece

I always feel better and sleep better after sitting in my hot tub, but I used to try and skip it some nights. Not feeling well was enough for me to learn from, it just took awhile. Now, I sit in it every night before bed. I get all nice and relaxed and then go to bed.

Same with exercise, I do feel better, and getting started is sometimes hard, but once I get into it, I do fine, and feel better.

Writing down what you do is one way to stay accountable. There must be a way to do that, maybe with a group, that would keep me more accountable, lol.

Take care, Annette
Booch007 responded:
DR P.....where would we be without you. This is so great for all, not just the newbies but to have a general guide to get moving.

Get out and get up!!

Thanks you so much. I paste to a file, I kling to all your words..for the future, (when I don't have my memory!!!)
You are the best! Thanks, Nancy B
annette030 replied to bellydancinmama's response:
I checked out Gypsy Caravan on line and they are from right near me in Oregon. I will have to check out where they will be dancing and go see them. Thanks for the tip.

Take care, Annette

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