Pilates and Yoga for Chronic Pain and Fibromyalgia

Exercise is a crucial component to optimally managing fibromyalgia symptoms. However, exercise as it is commonly prescribed, often results in a flare of pain, fatigue, poor sleep and low mood. Two recent studies report that the average 40 y/o with fibromyalgia has fitness findings expected for a healthy 80 y/o.  The good news is that the spiral of deconditioning can be reversed without inducing a symptom flare. The fibromyalgia research team at OHSU are pain researchers and clinicians who have developed and tested multiple exercise programs for people with chronic pain and fibromyalgia over the last 3 decades. We film real patients completing the exercise routines and offer them to you for home exercise on DVD. Our latest DVD is Pilates and yoga.

Five research studies, including one from our team, support modified Pilates and/or yoga for fibromyalgia. Over 25 studies in other chronic pain conditions support Pilates and/or yoga. Pilates was developed by Joseph Pilates early in the 20^th century as a means of rehabilitation and strengthening, originally for injured dancers and athletes.

The method seeks to develop controlled movements from a strong “core”—the abdomen, lower and upper back, hips, buttocks, and inner thighs, also called the “powerhouse”. All movements begin from the center and flow outward to the limbs, following the principle that energy originating from the center should coordinate movement of the extremities. Hence, Pilates is referred to as “controlled movement from a strong core”. The method, as tested and demonstrated in the DVD, is a home-based mat routine, meaning that expensive equipment is not required. The exercises are performed by sitting in a chair, standing or lying on a mat. Research has demonstrated the following benefits of Pilates in fibromyalgia and chronic pain: reduction in back and tender point pain, improved mood and sleep quality, reduced body fat, and an overall improvement in fibromyalgia symptom severity and physical function. Pilates is philosophically congruent with many ancient traditions of yoga and thus they are often taught together.

The Sanskrit word yoga means “union” - the union of mind and body in awareness. When someone has chronic pain, sometimes the mind and body struggle against each other in fruitless attempt to ignore or reduce pain.

Yoga is a mind/body discipline that over several millennia had been practiced primarily for the purpose of deepening and broadening one’s awareness - especially awareness of personal choices contributing to mental and physical wellbeing vs. suffering . Historically, meditation has been the primary yoga practice for developing such awareness. In recent decades, however, as the physical exercises of yoga have become popularized in Western countries, the term “yoga” has largely become identified with this single practice. Nonetheless, meditation, breathing exercises, and other strategies to enhance awareness remain central to the traditional practice of yoga. The yoga poses in our DVD are modified, gentle versions of physical poses, strong emphasis is placed on meditation, breathing exercises, and principles of yoga philosophy.  The practice targets pain (eg, specific breathing techniques), fatigue and sleep disturbance (eg, “yogic sleep” meditation), and emotional distress (eg, calming fear of pain by briefly observing pain sensations to see if they shift). Practicing gentle stretching, strengthening and relaxation offered in the Pilates/yoga DVD will help improve your ability to move throughout the day with less pain and fatigue.                             

While yoga is a generally beneficial and gentle therapeutic modality, some poorly trained yoga instructors may demand unrealistic poses for their students, especially those who are more elderly or suffering from arthritis or fibromyalgia etc. Then there are some novice students, the "aggressive over-achievers", who do harm to themselves by trying to do too much too soon.

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