My Favourite Two Strategies to Relieve Muscle Pain and Prevent Flare-ups
By Katarina Zulak
Muscle pain is perhaps the most characteristic symptom of fibromyalgia. It's right there in the name: fibro means 'fiber' in Latin (connective tissue) and myalgia means 'muscle pain', derived from Greek. For me, muscle pain is the most frustrating aspect of living with this illness. My neck and upper back muscles are often in revolt, throbbing, aching, and sometimes referring shooting pain up into my head. This is the most limiting of all my pain, because it largely prevents me from typing (hello voice dictation!), holding books to read, chopping or cooking, doing most housework, many arts/crafts, and, sitting in most chairs (princess and the pea syndrome). I also get deep aching in my glute muscles, which in turn angers my sciatic nerve and SI joints. Functionally, this pain prevents me from (again) sitting in most chairs, standing for long periods of time, or walking a significant distance. Over the years, through trial and error, I've landed on two main strategies that help me to manage my muscle pain, to make life more comfortable, and to do more.
Musical Chairs: Variety is the Spice of Life
In the first few years after my diagnosis, I searched high and low for the perfect chair, the perfect pillow, and the perfect mattress. I thought that if I could find the most comfortable possible surface and position to sit or lie down in, I could overcome muscle pain flare-ups. These efforts made a big initial improvement in my muscle pain, but what I had failed to consider was that any position becomes uncomfortable after too long. While I love my adjustable office chair with all its levers and knobs, after several hours in a row, it can start to feel like a torture device. My physiotherapist explained to me that the reason is because, when you have fibromyalgia, your muscles are easily strained or overused, which is what happens when you stay rigidly in place for a long time.
During one upper back flare, it became almost impossible to sit upright, so I was forced to lie down most of the time. In frustration, I asked my husband to move a semi-comfortable dining room chair and put it beside the office chair in front of the television, so I could watch my favourite show, moving from one chair to another when I became uncomfortable. With apologies to interior decorators everywhere, the strategy of moving between both chairs every hour or so has been highly successful in reducing both neck and shoulder spasms, and aching glute pain. Although I put a backrest on the dining room chair, it isn't as comfortable as the office chair. However, simply shifting position in this game of musical chairs relieves my pain. I haven't had as severe of an upper back flare since I implemented this strategy.
Similarly, rotating between sitting, lying down, and standing can help to reduce muscle pain by varying position. During bad flares I sometimes set a timer to remind me when I should stand up or lie down. Walking around the perimeter of a room occasionally can also significantly reduce muscle pain. Increasing blood flow and range of motion by taking a few steps, or rolling your neck, shoulders, wrists, and other joints, can help to prevent joint stiffness or muscle trigger knots from forming. Variety is the spice of life, and changing up your position is no exception!
Mixed Messages: Hot and Cold Therapy
What do you instinctively do when you hit your funny bone? You rub your elbow. This helps to relieve the pain sensations travelling from your elbow to your brain by overwhelming them with sensations of touch and pressure from rubbing. The gate control theory of pain explains a process in which non-painful sensations can override pain sensations. Nerve 'gates' in the spinal cord either allow pain signals from the body through to continue on their journey to the brain, or halt them. Large nerve fibres carry sensations like touch, pressure, temperature, etc., while small nerve fibres carry pain sensations. When large nerve fibres are active, they shut the pain nerve 'gates', stopping pain signals from being sent via small nerve fibres to the brain. The sensations of rubbing, carried along the large nerve fibres, inhibit the pain signals carried along small nerve fibres. This may partly explain why massage is an effective treatment. However, I am not suggesting that rubbing painful areas will relieve fibro pain. However, you can harness the principle of the gate control theory of pain to lessen you discomfort.
Menthol, which activates cooling, tingling sensations, can temporarily override pain signals because these are carried via large nerve fibres. It can also stimulate blood flow to the affected region, which improves pain and tissue healing. Similarly, products that increase warming or tingling sensations, like camphor or capsaicin (which additionally targets the pain messenger 'Substance P'), can also temporarily overwhelm pain sensations.
I like to apply menthol after taking a hot shower in a 1-2 punch strategy to knock out pain. As you already know, heat can help to relieve muscle pain by stimulating blood flow, which, in turn, promotes tissue repair, removes lactic acid build-up, and allows muscle fibres to relax. Doing gentle neck stretches or range of motion activities in the shower can enhance the benefits of heat in relieving stiffness and loosening muscle tension. After the shower I apply a menthol product like Biofreeze to my usual trouble spots. I find the tingling and coolness caused by the menthol to be much more intense after a hot shower. It acts like an 'off switch' for mild to moderate muscle pain. Often I do this twice a day, energy permitting. Hopefully you find these strategies equally effective for managing your muscle pain at home!