Fibromyalgia: definition, causes and treatment

Fibromyalgia: definition, causes, prevention and treatment

Fibromyalgia is a widespread pain disease that is characterised by 11/18 tender points (9 pairs). These tender points are in the neck, shoulder, chest, elbow, the lower back, the hip and the inside of the knee.

There are psychological deficits associated with fibromyalgia. These includes fatigue, depression and sleep problems.

There are also some physical symptoms:

-irritable bowel


The cause of fibromyalgia is thought to be because of the brain interpreting stress and pain signals abnormally. It may be due to the effect of the pain signals on the central nervous system and the secondary changes it makes to the brain.

Stress Hormones

Abnormalities in the hypothalamic pituitary adrenal (HPA) axis can cause fibromyalgia. The HPA axis is responsible for the stress response (fight or flight), depression and sleep.
Lower levels of norepinephrine and cortisol are seen in people with fibromyalgia and this is linked to inappropriate stress responses to:

– Infections
– Accidents
– Stress
– Hormonal disorders such as Cushings
– Medications

Central sensitisation

Some research suggests that in people with fibromyalgia, the brain interprets pain differently to non – fibromyalgic people. Overactivity of the pain processing areas of the CNS have been seen in people with fibromyalgia, as well as high levels of substance P which is associated with a high level of pain awareness.


Food such as eggs, cheese, pineapple, tofu, turkey, nuts and seeds and salmon can boost serotonin levels. Sun, exercise, probiotics and a positive mental attitude can also increase serotonin.

CBT (cognitive behavioural therapy)

Cognitive behavioural therapy is is a form of treatment for being with mental health issues such as depression and anxiety. It focusses on changing dysfunctional, habitual, subconscious thought processes into healthier ones in order to effect behaviour positively.
In fibromyalgia, behaviour and what action is taken (I.e exercising) is crucial to recovery. Altering maladaptive thought processes which stop people from exercising, may relieve fibromyalgia.


Emotional trauma is a potentially a cause of fibromyalgia, therefore psychotherapy may be beneficial in dealing with unresolved conflicts in the psyche. It may also act as a preventative treatment.

Massage, Physical therapy, Yoga and Pilates

As physical injuries can trigger fibromyalgia, physical therapy from an osteopath, chiropractor, physiotherapist or sports masseuse may be of great benefit in preventing fibromyalgia from occurring. Yoga and Pilates taught by a recommended instructor may also act as a preventative.


Disc bulges: symptoms, causes and treatment

A disc bulge is a spinal injury. It is also known as a protruded/slipped disc. When the bulge is significant enough to cause the gel-like fluid in the centre of the disc to come out – this is called a herniation.

It can occur anywhere in the cervical spine (the neck), the thoracic spine (mid back) or the lumbar spine (lower back).

What is a disc?

The spinal discs are rings in between the vertebra which act as shock absorbers.

The outer area of the disc consists of fibrocartilagenous fibres (the annulus) which surround a gel like glycoprotein centre (the nucleus).

Disc injuries include:

  • strains
  • internal derangements
  • mild to moderate bulges
  • complete rupture and herniation of the nucleus through the annular wall.
  • If the annulus is injured, the nucleus can press or irritate the exiting spinal nerve through the weakened annular wall. This can cause:
  • pain
  • pins and needles
  • cramping in the legs, feet, arms and hands

The cause of bulges can come under 3 headings:

Repetitive Microtrauma

This is when the discs are put under repeated pressure. The best example of this is through posture. The way you sit, stand and walk can effect the outer fibres of the annulus, causing them to overstretch and become weak. Osteopathic postural correction can help prevent bulges and aid healing of an existing bulge. Research shows that changing your posture very 15 minutes is more effective than having  perfect posture constantly.

Sudden load

A sudden load when catching something heavy or heavy lifting with poor posture, can cause the annulus to rupture. It is important to lift in a safe way while maintaining your core stability.

A road traffic accident can also cause the annulus to rupture by a sudden unexpected force.


You can be genetically predisposed to disc injuries. Higher amounts of elastin in the fibrocartilagenous component of the annulus are thought to make it more susceptible to tearing. This can be passed down in our genes.

Environmental factors that are known to have an effect are excessive abdominal fat, poor core strength, poor buttock and leg strength and occupation (one which requires heaving lifting or pulling).


  • Pain in the back legs or feet which is aggravated by sitting, sneezing, coughing, straining, bending forwards or lifting.
  • Pins and needles
  • numbness or weakness in the legs are suspected by more serious injuries.
  • Bowel and bladder problems (diarrhoea or incontinence)  are caused by severe nerve compression. Immediate medical attention is needed in this case.


An osteopath, chiropractor or physiotherapist will diagnose your back condition based on your:

  • symptoms
  • signs
  • special tests results
  • general movement test
  • MRI or CT scan (X rays will not show a disc bulge) They do however show degenerative disc disease and disc narrowing.


Good news – the annulus can heal. Treatment with an osteopath, chiropractor or physiotherapist aims at encouraging you fluid back into the disc which will allow fibres of the annulus to knit back together.

A back brace or support belt may be given to you to help keep your spine in the best position to allow healing. This will help scar tissue form the correct structure. This may take 6 weeks, so avoiding aggravating postures, exercises and positions is important.

Ice therapy will reduce inflammation.

When the pain has subsided, your therapist will turn the focus on realigning structures by doing certain techniques such as stretching, soft tissue massage, joint mobilisations and adjustments. They should try and find the root cause of the problem.

Core stability is crucial in prevention of disc bulges. Contact a recommended Pilates instructor. A god osteopath should be able to provide you with core stability exercises.

Please contact me if you have any questions.