Fibromyalgia and Posture: Everything you need to know!

What is meant by Fibromyalgia

The etymological meaning of the word “fibromyalgia” derives from the Greek and literally means ” pain of the muscles and fibrous tissues “, which is precisely the type of symptomatology that characterizes this disabling disorder.
It is a rheumatic pathology that affects the musculoskeletal system with involvement also in the joints and that presents some characterizing signals:

  • widespread pain showing a tendency to become chronic;
  • considerable rigidity in movements;
  • chronic fatigue that tends to worsen over time;
  • circadian rhythm sleep / wakefulness disorders ;
  • swings’ mood ;
  • irritable bowel syndrome .

At the level of the psycho-emotional sphere, the patient can be affected by anxious-depressive manifestations and above all by disorders caused by stress , a condition that constantly accompanies the disease.
In fact, the subject is in a state of perennial hyperalgesia , apparently without obvious causes , which is able to seriously worsen his lifestyle, in particular by limiting his movements.
In fibromyalgia, all symptoms can be present simultaneously, but they can also occur individually, thus making the formulation of a diagnosis very complex .
From an epidemiological point of viewthe female population is more likely to develop symptoms , with a ratio of 9: 1
and, although the disease affects all ages, the most affected range is between 25 and 55 years .
It is a rather widespread pathology since over 2 million Italians every year complain of symptoms related to a diagnosis of this type, although in all probability their percentage is higher because in many cases it is not possible to identify with certainty the disease, defined with reason a multifactorial syndrome .

Ankle Sprain 1

Symptoms of fibromyalgia

In this condition, the muscles are in a state of constant tension which does not allow any physiological recovery and which consequently becomes responsible for chronic and widespread fatigue throughout the skeletal system .
The muscles are forced to work continuously and therefore are unable to rest to restore the necessary physiological state of functionality.
The mainly affected sites are located at the level of the spine , the shoulders , the arms , the wrists, the pelvis and thighs .
Continuous muscle tension triggers an inevitablejoint stiffness as the joints constitute the critical points of the entire skeletal system; consequently the movements are very limited also due to tendon involvement.
The tendons become painful at the insertion point between bone and muscle tissue, contributing to the genesis of the ” tender points “, which represent the areas of the muscle where the algic stimulus is located.
These points play an extremely important role for diagnostic purposes.
A peculiar feature of the disease is that the parameters relating to inflammation are normal and there are no muscle and not even tendon changes.
Although it is a joint syndrome,it is not possible to identify typical symptoms of arthritis or even degenerative disorders such as polymyositis, lupus erythematosus or rheumatoid arthritis.
Furthermore, fibromyalgia does not respond to traditional therapeutic treatments with NSAID anti-inflammatories, while it is cured with some results by taking drugs for the central nervous system, thus confirming its neurological component.
The complexity of the symptomatic picture constitutes the main difficulty in classifying the disease, which was initially considered to be a simple fibrositis, or an inflammatory form of the muscles.
After the hypothesis of inflammatory involvement has been ruled out (given that the anatomical structures involved do not show alterations of this kind), a psychological nature of the disease is assumed .
Since 1976, when the official denomination of fibromyalgia was coined, the neurobiological component of the morbid picture has been identified with certainty , identified as a disease of the musculoskeletal system and connective tissue, belonging to the class of somatic and functional syndromes.
Since the subjective component of pain perception plays a role of considerable importance, psychological involvement has not been completely eliminated; therefore fibromyalgia is usually associated withdisturbances in the processing of suffering , which in turn are responsible for some neurobiological anomalies.
Indeed, it has been proven that neuronal transmission of pain is involved in the disease, which therefore can also be associated with communication problems of nerve impulses between cells.


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Causes of fibromyalgia

Not yet defined with absolute certainty, the etiological factors of fibromyalgia are numerous and for this reason the disease is defined as multifactorial genesis .
There is clearly a triggering event that relates to the onset of the morbid state, which can be physical, mental, trauma, viral disease or even an allergic form.
According to the most recent guidelines, there are anomalies affecting neurotransmitters , which are the chemical mediators responsible for intercellular communication.
Even a hormonal hypothesis is taken into account since hormones are substances which, in turn, transmit biochemical messages between the various cellular compartments.
The causes of fibromyalgia can be grouped into various classes.

1. Neurotransmitter modifications
Some brain neurotransmitters, such as dopamine , serotonin , norepinephrine and gamma-amino butyric acid (GABA) are synthesized in significant quantities in response to strong endogenous or exogenous stress.
Their high concentration can contribute to the onset of the typical symptomatology , which in fact occurs simultaneously with perceptual changes at the level of the psycho-emotional sphere.
These nerve substances also control the endocrine and immune systems, helping to intensify neural stimulations on the musculoskeletal system.
On the other hand, the hyperactivity of theautonomic (orthosympathetic) nervous system responsible for the increased production of serotonin and norepinephrine, causes a decrease in muscle blood supply, which results in painful manifestations.

2. Stress
Stress is considered one of the most important predisposing factors for the onset of the pathology since the correlation between traumatic events and onset of symptoms has been confirmed.
Fibromyalgia is in fact often associated with post-traumatic disorder , chronic fatigue syndrome or even irritable colon , as many diseases resulting from stressful episodes.
Not only psychic but also organic traumas are called into question to explain the genesis of the disorder, which therefore can be linked to physical or emotional stress.

3. Hormones
The hormonal component is closely involved in the onset of fibromyalgia, with particular reference to the hypothalamic-pituitary-adrenal axis .
The development of the pathology seems in fact to be connected to a lower response of the adrenal to stimulation by the adrenocorticotropic hormone (ACTH) , with a concomitant decrease in the quantitative values ​​of cortisol .
Some recent neuroendocrine studies have focused on the relationship between the ACTH man and the onset of painful symptoms, especially at the tendon level, which is a constant etiological factor for fibromyalgia.

4. Genetic component
There is a family predisposition for this pathology, which probably derives from a polygenic transmission .
Although we cannot speak of a proper genetic transmission, numerous clinical researches have highlighted how genetic mutations can sensitize individuals to develop the disease, which is associated with genetic polymorphisms related to the neurotransmission system (dopaminergic, serotonergic and catecholaminergic).
These alterations, although not specific to fibromyalgia, are however related to functional modifications of the muscular and tendon system and confirm the connection betweenpsychic sphere and morbid framework already widely analyzed.
We can therefore speak of a genetic predisposition for people who, being more vulnerable to psychological stress and the perception of pain, are also more easily subject to the onset of fibromyalgia.

5. Infections
Some viral pathologies seem to be responsible for the appearance or aggravation of this morbid picture, in particular fibromyalgia arises following infectious mononucleosis Lyme disease , or bacterial contamination syndrome localized at the level of the small intestine.



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Fibromyalgia features

Although it is a disease associated with rheumatic conditions, such as rheumatic polymyalgia or rheumatoid arthritis , fibromyalgia does not manifest a degeneration or a compromise of the internal organs.
In many cases, however, the disease becomes chronic, making healing infrequent.
Rheumatic fibromyalgia consists of a particular type of disease, often associated with Raynaud’s syndrome , which involves excessive vasospasm induced by stimulation of the orthosympathetic nervous system.
This relationship would confirm the neuronal involvement of chronic fibromyalgia.
Related to an inflammation of the muscles that starts from the neck to spread through the shoulders and chest to the rest of the body, rheumatic polymyalgia shows a rather constant symptomatic picture related to progressive muscle rigidity.
Every time we talk about myalgia we mean a painful state of the muscle fibers which, in most cases, is also connected to disorders of the neurotransmission of stimulations at the level of motor plates .
It does not produce other secondary diseases , but the triggered pain can significantly affect the quality of life, also in relation to the fact that the state of chronic fatigue and sleep disturbances are responsible for a progressive deterioration of daily and professional activities, a global framework that is called ” fibro-fog “, which means fibromyalgia deterioration .

Ankle sprain 4

Fibromyalgia and Posture

According to some epidemiological research, a link has been shown between an alteration of postural control and the onset of fibromyalgia .
Being a disorder involving the functioning of the musculature, it is quite intuitive that the position of the body in space can be clearly affected.
Many fibromyalgia patients have impaired postural control , which worsens following alteration of sensory stimulation, but which is not related to contractile force.
A correlation between this pathology and a modified perception of vestibular inputs (responsible for postural balance) produced by neuronal degeneration of the brain stem is likely .
These sensory deficits on the one hand worsen postural control and on the other hand contribute to deteriorating the functionality of the muscular system facilitating the onset of fibromyalgia.
At the basis of this connection there are once again neuromediators , biological substances whose role is to supervise the functioning of the muscles (controlled in turn by the nervous system).
Almost 50% of patients with this disease have balance disorders , which are probably the most debilitating symptoms along with pain.
The pathology in question clearly involves the psycho-emotional sphere, a component also present in cases of compromised balance control.
Furthermore, there is a probable correlation between the lack of muscle strength typical of the fibromyalgia sufferer and the ability to maintain correct body posture .
According to these hypotheses, both the psychological component and the loss of strength are factors commonly present in people with fibromyalgia, thus confirming a link between the disease and the postural structure.
On the other hand an alteration of the posture , with the assumption of wrong positions of the body in space,inevitably causes an incorrect functionality of the muscles which, in an attempt to remedy postural problems, contract in an uncoordinated way .
Taking into account that one of the main symptoms of fibromyalgia consists precisely in muscle tension which is not able to alternate with any relaxation phase, the hypothesis that relates the pathology to postural problems may be plausible .
When the musculoskeletal system functions physiologically, its position in space remains correct both in terms of balance (controlled by the vestibular apparatus) and ambulation (controlled by brain areas).
At the basis of these postural mechanisms are neurotransmitters, substances also involved in the genesis of fibromyalgia (first class of the causes of pathology).
Whenever functional anomalies of neuromediators occur (especially norepinephrine), wide-ranging consequences occur , since these substances participate in practically all biological reactions of the organism.
Another confirmation of the connection between posture and fibromyalgia derives from the fact that in many cases patients derive considerable advantages from postural rehabilitation sessions , through which the muscles decrease their tension.
Gymnastics of this typeit is able to restore muscle balance , acting on the stiff and painful areas present in fibromyalgia patients.
Among the various benefits deriving from postural practices we note the acquisition of a better elasticity and tonicity of the muscle fibers, which are consequently less tense.
By promoting movement and stretching of painful muscles, functional tensions are eliminated, with improvement of posture and at the same time with easing of painful symptoms .
Optimizing the functioning of the muscle fibers also restores the alternation between contraction and relaxation, which is missing in patients with fibromyalgia.
Being able to take advantage of a physiological postural structure,the patient completely eliminates a component of the disease since the muscle-tendon tension deriving from incorrect body positions is lacking.
The increased functional capacity of the spine, and therefore of the musculature connected to it, guarantees the overcoming of an important contributing cause of this chronic disease.
Treatments of this kind can prove decisive in all those cases (and they are very numerous) in which drug therapies have no effective results.
Being anti-stress methods, postural treatments help to minimize some symptoms of fibromyalgia which has a strong psycho-emotional component and which often does not show any significant improvement.

Therapeutic approach of fibromyalgia

Fibromyalgia treatment must be personalized according to the needs of the individual patient.
Traditional medicine is based on the use of painkillers and psychotropic drugs.
From a psychic point of view , the most frequently prescribed medicines are tricyclic antidepressants (amitriptyline and trazodone), often associated with a benzodiazepine , as well as SSRIs (citalopram and fluoxetine), which by acting on the reuptake of serotonin modify its metabolism .
In many cases, such treatments are combined with muscle relaxants (cyclobenzaprine and tizanidine).
As for theanalgesics , although not specific for this disease, can alleviate painful symptoms.
Among these the most used are tramadol (opioid drug), acetaminophen , or traditional NSAIDs , such as sodium naproxen and ibuprofen. Cognitive-behavioral pathways associated with physical therapies such as TENS , iontophoresis or thermotherapy
are also suggested to support drug therapy .

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