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Warm Water Pool Therapy for:
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Jeffery Allen PT. OCS
Board Certified Orthopedic Clinical Specialist




"Those who do not find time for exercise will have to find time for illness." -- Old Proverb

Immersion alone in those warm waters brings most fibromyalgia sufferers a sense of relaxation. But there's more to it than that. Allen Physical Therapy is offering fibromyalgia patients the best means to combat their symptoms: aquatic exercise.

Fibromyalgia Syndrome: What is It? [1]

In the U.S. alone, between six and Nine million people (predominately women) have a cluster of symptoms which are typical of what we now call "fibromyalgia syndrome" or FMS.

Approximately 20% of these people are formally diagnosed with FMS. These individuals experience a nightmarish combination of poor quality sleep, fatigue, anxiety, stress, whole body stiffness, and gastrointestinal complaints.

Unfortunately, the exact causes and pathophysiology of FMS are unknown. The knowledge deficit has contributed to much debate  over the concept of fibromyalgia syndrome. This dismissal of the condition has diminished over the last three decades, as the health care community has established a distinct protocol to assist in diagnosis of FMS.

Currently, an official diagnosis of FMS should not be given unless the patient has demonstrated widespread pain for three months or more, in combination with tenderness at eleven or more of eighteen specific tender point sites. Therapists interested in reading more about the diagnosis of FMS are directed to Wolfe et al's work. [2]

Treatment of FMS [1]

Historically, FMS has been a difficult disorder to treat in the rehabilitation profession. Success in the treatment of FMS is obtained only through a comprehensive and multidisciplinary approach. Dr. Irene Metro, MD is a board certified internal medicine physician and one of the area’s leaders in the treatment of FMS. She is the owner of Plymouth Intergrated Medicine (PIM). At PIM patients are examined in extreme detail with every aspect of the health being treated. This includes nutrition, vitamin supplementation, sleep management, stress management, physical therapy, acupuncture, trigger point injections, and appropriate medication. Of all the treatments Dr. Metro recommends beginning an exercise regiment is the most important. The most effective exercise for FMS is warm water pool therapy.

In the rehabilitative setting, traditional physical therapy has believed that FMS patient simply need more exercise. They are subjected to strengthening, stretching, and aerobic land exercises. All most invariably these programs make patients worse, sometimes debilitating them and they rarely stay in therapy long. Frequently, they chalked up as a mental case or being lazy and are dismissed by both their therapist and physician. 

Instead, Dr. Metro and Allen Physical Therapy are turning their patients on to the idea of exercise — in warm water. It has been demonstrated that aerobic exercise is a crucial treatment for the population of FMS patients since they tend to be physically deconditioned. This deconditioned state promotes a continued cycle of pain, fatigue, and decreased motivation, leading to further inactivity. Typically, the temperature of the water in health clubs and high school gyms will exacerbate the symptoms of a FMS patient, but water at 92 degrees or better can be affectively used to institute a exercise program that is both tolerated and beneficial the their symptoms. FMS patients who participate in a regular aquatic exercise program can break that pattern of inactivity, and recapture control over their own symptoms.

Aquatic Exercise and FMS

In a pool, it is possible to perform vigorous aerobic exercise without the weight-bearing and joint compression experienced on land.

Additionally, aquatic exercise is an excellent intervention for FMS patients due to the inherent properties of water itself. These properties include buoyancy, turbulence, viscosity, hydrostatic pressure, temperature, and surface tension.

Anyone interested in a thorough scholarly discussion of the evidence-based use of these hydrodynamic properties in the treatment of fibromyalgia are directed to the July, 1997 issue of The Journal of Aquatic Physical Therapy.[1]

Aquatic therapy for the fibromyalgia patient can cover the spectrum of therapeutic intervention. Patients who present with specific, treatable, musculoskeletal dysfunctions such as an inability to stabilize the spine, postural imbalance, poor spinal mobility, and weak trunk musculature may be treated 1:1 in the pool by a physical therapist. It also allows individuals to elevate their heart rates to aerobically work for 20 minutes or more which is known to be beneficial to FMS, but very difficult for most patients to achieve due to pain and dysfunction.[1]

After resolving specific dysfunctions, these patients are most often referred to a group class. Why?  Patients with FMS often do battle with the unbelief of the health care system, their coworkers, their spouses. People with fibromyalgia often "look fine" to the world. A group exercise class not only provides a means of routine physical activity, it also provides a support system and a sounding board.

Physical therapists who do not have access to a warm water therapy pool at their own facility should consider referral of FMS patients to another site which does offer  aquatic therapy.

Ideally, all FMS patients should be encouraged to participate in consistent exercise at least three times per week, even in the presence of fatigue and stiffness. Aquatic physical therapy can make this possible.

1. Poteat AL, Bjerke MD, Johnston TD, Mairs JP. Evidence-based aquatic therapy: building a case for use of aquatic physical therapy for fibromyalgia populations. Journal of Aquatic Physical Therapy. 1996;5(2):8-16.

2. Wolfe F et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum. 1990;33(2):160-172.

3. Dull H. "Watsu." In Ruoti RG, Morris DM, Cole AJ: Aquatic Rehabilitation. Philadelphia, PA: Lippencott-Raven; 1997.

4. Andrea Salzman, MS, PT Aqua Therapy Resources Network. Com

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