H.O.P.E. | Movement

Movement is essential to all of us because it allows the blood to move freely. In most individuals, movement is pleasurable; stretching feels wonderful and moderate exercise makes us feel stronger and free of pain. The person with fibromyalgia feels little of this.

Everyone encourages them to stretch, from the doctors to the physical therapists and chiropractors. Few tell them how tricky it can be to find the right stretching program because it is not their area of expertise. So they send them to a gym where someone puts a pair of weights in their hands and says "Your muscles are weak. You will feel better if you lift weights and you will get stronger over time." This works in theory only and is the worst thing you could do.

When the skin under the skin (fascia) is too tight and full of knots, it can't strengthen. It will just rip more, and hurt more. I always use the analogy of the clothes line. If your clothesline of muscles is ripped, old and shrunk, it may be able to handle a blouse, but it can't sustain the weight of a winter coat. Trainers who ask you to do this and don't provide you with an alternative have little experience with individuals with chronic pain.

STRETCHING:

Whatever you call it, stretching produces better, and more consistent results. Stretching once in a blue moon will not help, and overstretching is just as dangerous. Stretching is the key before, during, and after whether you strength train or attempt to do a program which incorporates endurance training. Most flexibility programs are designed specifically to work in a sport such as golf or basketball; or a discipline such as yoga or tai chi.

General stretching programs won't suit your needs. Instead, pick an instructor or personal trainer with experience in dealing with individuals who have chronic pain.

Athletic Stretches: While some of the stretches involved in a sport might feel good at first, they are geared to increase the range of motion of the player. Often, that exceeds a regular individual's flexibility. Steer clear from any program which is done quickly or with bouncing.

Aerobic Stretching

Aerobic classes have stretches included in them and may be included in your routine as long as they are not bounced, or beyond your current range of motion. Never push on a joint such as the knee.

Specific Guidelines for You to Stretch

1. Find a safe, clean environment that is as quiet as you need. A warm place is nice, but too hot is not good.

2. If there is incense pouring from the classroom, run away. All my fibro clients have issues with strong scents such as incense or heavy perfume.

3. Too much light or too little light will cause you problems. Natural light is best, if available. In Michigan, I always loved using my living room which faced the woods. I had lots of natural light through the window, but I could adjust it by using Roman shades to make it warmer in the winter or cooler in the summer.

4. A thick padded mat with postural alignment lines on it work well to sit on. A good source for them is from a company called: Hugger-mugger.

DIFFERENT TYPES OF STRETCHING PROGRAMS:

Yoga

Yoga is divided into many different disciplines. The key for the fibromyalgia student is to find the right instructor. Evaluate their class by watching several before signing up for any series of classes or membership at a facility. Being able to recognize Sanskirt clues should not be part of a course.

Just because the program director at a facility defines the class as a beginning yoga class means nothing. Many of my clients have attended classes that have been very difficult and too intense for them despite the fact that they were labeled "Introduction to Yoga."

Power Yoga

Power yoga doesn't belong in the world of yoga. Classes labeled power yoga are totally unsuited for the fibromyalgia community and are often too exhausting for regular individuals, let alone those with balance problems, lack of strength, and endurance issues. Personally, I think power yoga should be renamed low-impact, high intensity aerobics or yoga for instructors and advanced students.

Bikram yoga classes are done in a very, very warm room. This type of class has always appealed to most of my students because they are always cold. Yet, the duration of these classes is usually 90 minutes. Most of my students have to ability to do a 30 minute class, not 90.

Many of my clients have other health issues, such as high blood pressure, so exercising in a super warm room for 90 minutes with other sweating bodies has never appealed to me, especially when I would be hitting that frigid Michigan air. Two of my clients have taken the Bikram yoga classes, on and off for years and loved them. They don't have fibro. So you make up your own mind.

Yoga Classes That Stress Alignment

A great part of yoga is about balance, physical, mental, and spiritual. Yoga classes that stress posture and the precise execution of a certain pose, or asana, are wonderful in theory. These are great courses, but are tough and not for beginners. There is also the tendency to place a hand on the student to correct the form. Avoid instructors who place their hands on your body without your permission.

We all learn differently, so I talk people through a pose, I let them see me go through it so they get a visual cue, and I let them feel it as they do it (kinesthetically). Many of my students have self esteem issues, or have been abused. After we have built up trust, I ask them if it is ok for me to help them into a pose, if they want. Choice is always theirs. Having an instructor crank or torque on my back never made me do it better, just made me stand in a different part of the room so they would leave me alone.

Yoga is supposed to be your personal journey, not a competition. Fibromyalgia students want to get it right and they will work at it endlessly until they do. Most are type A personalities. They will work so hard at getting the pose and perfecting it, they miss out on the experience and fun of the moment.

An experienced yoga instructor may spot that, but only if they have worked with the fibromyalgia population a lot. If the instructor has no clue, they will just admire your determination and encourage you to hold the pose longer. The next morning you will be so sore that you will curse all exercise, not just yoga, which you thought was safe and pretty. You will get very depressed because of a simple yoga stretch that the pregnant woman next to you in class did effortlessly or that the 80 year old gentlemen in front of you zipped through with no difficulty but have you aching in spots you didn't know you had before.

Your mindset will confirm to you your hidden belief that any exercise will cause you major grief, so it is ok to go back to whatever destructive patterns you did before such as smoking, drinking or hiding inside because it was cold, dark and everything hurt.

Yoga with a good, intuitive instructor will help you work on breathing first. Then you can do a few modified poses, on the floor with back support and never holding it until you have enough muscle strength and endurance to support the stretch. I prefer to work one on one with all my fibro clients until they are familiar with what is good for them. If they attend a class later on, they know which poses will drive them over the edge. I give them a couple of options.

Back support is crucial in all new students since most don't have the abdominal muscles or other core muscles to help them sit for fifteen minutes, let alone ninety. I like to face students, so I can watch them breathe. They sit against a solid wall or sofa on a very thick yoga mats under them. This keeps them in alignment. Doing yoga without a thick mat is usually too hard for them, and I don't like students being just on the carpet breathing those fumes.

BREATHING: SOUNDS EASY; ISN'T

All my clients have had trouble with tension, stress and breathing. I have never had a problem with any of my deep-breathing techniques from tai chi until I moved to Florida. I moved permanently here during what is now known as the summer of the worse hurricane season ever. My stomach was in knots for six weeks. My diaphragm was way up in my ears. I have never felt as much tension and stress in my shoulders as I did then.

The first thing I did was turn off the cable channels which worried me endlessly about stuff I couldn't control and whose anchors were just looking for fillers since hurricanes always slow down and they had space to fill.

The second thing I did every morning was to practice my tai chi and my breathing exercises even though I knew I was doing them poorly.

Somewhere between Hurricane Francis and Hurricane Ivan, my shoulders went down; I started sleeping again, and my stomach relaxed. I started smiling and enjoying life even though the pundits were still endlessly yakking about doom and gloom.

Better breathing is something so essential and yet so misunderstood. Most people don't realize that they take shallow breaths. Overtime, that increases the stress and tension in one's muscles and makes simple chores horrendous.

In most stretch classes or yoga or even tai chi, the instructor will tell you to relax. You can't relax. Telling you to relax and just breathe makes you feel like a failure or cause you endless anxiety, like the weather channel counting the minutes till something bad happens again in Florida.

A more useful approach is to make the fibro student aware of how much stress and tension builds up pain in their muscles by not breathing. So I breathe with them. I usually suggest that they see a massage therapist who can release their diaphragm and then work with them to release it themselves.

I never expect them to relax. I tell them jokes. Talking is a good way to share. They talk about their pain, their frustration. They don't think it will ever end, no matter what they do. Allowing them to vent is important even if you have heard the tale a million times. Every one of my clients here has heard my Florida hurricane stories at least twice and now we just all laugh.

After you have found a great instructor who lets you observe and listens to you, ask them if it is ok to substitutive an easier stretch while other students are doing their poses. If the teacher has a problem with that request, pass on their class.

TAI CHI:

Tai chi is moving stretch done slowly, while breathing.

Advantages

1. It can be done in regular clothing, so you can stay warm. 2. Classes concentrate on balance, posture, and good body alignment. 3. It is done standing. 4. Tai Chi moves side to side to help with depth perception issues. 5. Classes release the body's natural pain killers or endorphins, so you feel great when you're done.

PHYSIOBALL CLASSES:

One on one classes done with a personal trainer are great. Large classes will be too intense, so pass on that.

PILATES:

Pilates has suffered from years of its instructors fighting among themselves as to what is the only correct style of Pilates or Pilates-like training is worthwhile. Such legal wrangling and snobbery has taken away from some great ideas put forth by Joseph Pilates to work with injured dancers and athletes. Some Pilates training might be helpful, but those instructors who say this is the only suitable form of training have either spent lots of money on the training and the equipment, so they are bias. Pilates has a very specific way of doing everything and thinking outside of the box is not encouraged. Choose wisely.

PERSONAL TRAINERS:

1. Find someone who is passionate about their work. 2. Pays attention to what you are doing and not watching TV or the person next to you. 3. Who is funny and believes exercise should be fun. Thirty plus years ago I took my first yoga class. Although the stretching felt awesome, it wasn't the motivation that kept sending me back. It wasn't that I was thrilled to learn about meditation and my own journey. I chose yoga and stayed with it because I adored the instructor: he was gorgeous.

Whatever it takes to get you out of bed in the morning and move, find it, use it and pursue it. Namaste.

Pat Daniels, C.M.T.

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