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Fibromyalgia: How Physiotherapy Affects the Brain for Symptom Improvement

Abstract: Fibromyalgia is now known to be a neurosensory disorder of central sensitization with hereditary components related to chronically low serotonin levels. Exercise therapy has long been established as a treatment to mitigate the symptoms of fibromyalgia. Recent research demonstrates exercise therapy’s normalisation effect on the connectivity of brain areas related to the subjective processing of pain.

In the past, some have regarded the fibromyalgia diagnosis with some scepticism due in large part to a limited understanding of the disease’s pathophysiology. However, a growing body of clinical investigations and a growing expert consensus now points to neurophysiologic bases for fibromyalgia, leading to its classification as a central sensitivity syndrome. Supporting its categorisation as a neurosensory disorder is research connecting fibromyalgia with abnormalities in connectivity of cardinal sensorimotor regions involved in pain processing2 and with genetically influenced, abnormally low serotonin levels.3 Research has also largely ruled out the theory that fibromyalgia can be induced by physical trauma.3

Exercise therapy has long been established as a potent treatment for fibromyalgia - comparable to pharmacological interventions.4 A review of 34 randomised controlled trials covering a sum of 2,276 patients finds medium to large effects in standard mean difference (SMD) for a number of outcomes: pain (SMD 0.81), global well-being (SMD 0.49), physical functioning (SMD 0.66), depression (SMD 0.54), and reduction in tender points (SMD 0.76).5 Exercise therapy for fibromyalgia commonly involves graded exercise characterized by a baseline achievable goal, followed by negotiated, incremental increases. Physiotherapists can provide reassurance that the exercises are safe and effective while also monitoring for and implementing the upgrades in physical activity designed to maximize results.

Advanced Physiotherapy provides the added advantage of consultation with our accredited exercise physiologist. Studies have connected poor diet with exacerbation of fibromyalgia symptoms - possibly resulting from impaired glycolysis and carbohydrate metabolism.3 Our exercise physiologist can provide nutritional advice and direction in addition to exercise therapy. Our exercise physiologist is also available to supervise group exercise sessions that can lower healthcare costs while encouraging adherence to therapeutic exercise plans. Advanced also makes available aquatic therapy, which has been demonstrated to be an effective form of rehabilitation for patients with fibromyalgia.6

It has been established that exercise therapy can modulate central nervous system activities related to the processing of pain. Recently, researchers from Stockholm and Gothenburg published the first investigation of exercise-therapy-induced resting state changes to functional brain connectivity in fibromyalgia.7 They used functional magnetic resonance imaging to demonstrate that a supervised exercise therapy intervention normalizes connectivity between the brain’s right anterior insula and the left primary sensorimotor area. The degree of change was greater among patients with fibromyalgia than among patients serving as healthy controls. The insula serves as an important component in pain processing, and the anterior portion of the insula in particular has been connected with the subjective rating of pain. This latest research further supports the role of exercise therapy in mitigating the effects of central sensitisation disorders such as chronic fatigue syndrome and fibromyalgia.



  1. Burgmer M, Pogatzki-Zahn E, Gaubitz M. et al. Altered brain activity during pain processing in fibromyalgia. Neuroimage. 2009; 44 (2): 502-8.
  2. Schmidt-Wilcke T, Ichesco E, Hampson J. et al. Resting state connectivity correlates with drug and placebo response in fibromyalgia patients. Neuroimage Clin. 2014; 6: 252-261.
  3. Diamond H. How much do you know about fibromyalgia? Medscape. July 18, 2016; #866186.
  4. Clauw D. Fibromyalgia: a clinical review. JAMA. 2014; 311 (15): 1547-1555.
  5. Gustafson J, Hostetter J. Does physical therapy improve symptoms in fibromyalgia? Evidence-Based Practice. 2015 October; 18 (10): 10-11.
  6. Bidonde J, Busch A, Webber S, et al. Aquatic exercise training for fibromyalgia (review). Cochrane Database of Systematic Reviews. 2014; 10: art no. CD011336. DOI: 10.1002/14651858.CD011336.
  7. Fodin P, Martinsen S, Mannerkorpi K, et al. Normalization of aberrant resting state functional connectivity in fibromyalgia following a three month physical exercise therapy. Neuroimage: Clinical. 2015 December 31; 9: 134-139.

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