Fibromyalgia

Overview

Fibromyalgia is a long-term condition characterised by pain felt across many areas of the body, together with deep tiredness, unrefreshing sleep and often problems with memory and concentration (sometimes called "fibro fog"). The pain is real and can be severe, but tests such as blood work, X-rays and MRI are typically normal, because fibromyalgia is not a disease of damaged joints or muscles. Instead, the nervous system has become more sensitive, so that signals which would not normally hurt are experienced as pain.

It affects women more often than men and most commonly begins between the ages of 25 and 55, though it can start at any age. Symptoms tend to fluctuate — better weeks and worse weeks — and often flare with stress, poor sleep, illness, weather changes or doing too much on a good day.

We want to be honest about what we can and cannot do. Fibromyalgia cannot be cured, and no single treatment makes it go away. What good evidence does support is a combination of education, graded exercise, pacing, sleep habits and psychological support. Our role is to help with the physical side of that plan, working alongside your GP, who may discuss medication and other support with you. Many people with fibromyalgia find that, with the right approach, they can do more of what matters to them with fewer and shorter flares.

Causes and risk factors

• The exact cause is not fully understood; it involves changes in how the brain and spinal cord process pain
• A family history of fibromyalgia or other chronic pain conditions
• Physical or emotional trauma, major illness or a period of severe stress before onset
• Long-standing poor sleep
• Other conditions such as irritable bowel syndrome, migraine, rheumatoid arthritis or lupus
• Being female and aged 25–55
• Low physical activity, which can lower the body's tolerance to movement over time

How we may be able to help

Your first visit is an unhurried assessment. We listen to your history, map where and when the pain is worst, check your joints, muscles and movement, and screen for other causes of widespread pain that need medical attention. If you have not yet had a diagnosis or a recent medical review, we can arrange an online private GP consultation.

Physiotherapy for fibromyalgia looks different from physiotherapy for an injury. The core is graded, low-impact exercise — walking, cycling, pool-based exercise, gentle strengthening and stretching — started at a level that does not trigger a flare and increased very slowly. Research consistently shows that regular exercise is one of the most effective ways to reduce fibromyalgia pain and fatigue over time, but only if it is paced correctly, and this is where guidance matters. We also teach pacing: spreading activity evenly across the week rather than overdoing it on good days and crashing afterwards.

Gentle manual therapy, mobilisation and soft-tissue techniques may help some people feel looser and more comfortable in the short term, which can make exercise easier. Our chiropractor can assess for stiff spinal segments contributing to local pain. Dry needling may be considered for specific tight muscle areas in the limbs, though we use it cautiously because some people with fibromyalgia find it too stimulating. A 3D posture scan can highlight muscle imbalances or postures that add strain. UK guidance does not support electrotherapy such as TENS, interferential or ultrasound for fibromyalgia, so we do not rely on these; the emphasis stays on movement, pacing and support.

What you can do at home

• Move a little every day — even a 10-minute walk — rather than resting completely on bad days and overdoing it on good ones
• Keep a consistent sleep routine: same bedtime, no screens for an hour before, a cool dark room
• Pace your activities: break tasks into chunks with planned rests before you feel exhausted
• Try warm baths, gentle stretching or relaxation breathing during flares
• Keep a simple diary of sleep, activity and pain to spot your personal triggers
• Stay connected — support groups and talking therapies have good evidence for fibromyalgia