Exploring Fibromyalgia: What Is It and How Can Yoga Help?
The rise of functional illnesses in the UK, particularly in women
Modern life, global pandemics notwithstanding, could generally be said to present us with less immediate stresses than life would have done in previous ages. In millennia past, humans had to chase down their food, were at risk from predators; more recently, before the discovery of penicillin or immunisation, a bad bout of influenza, or an infected wound, or a now-immunisable disease, could kill with little warning. Again, considering a pre-COVID-19 world, humans are generally living longer with less risk of infectious diseases or malnutrition, but more and more people report to be feeling ill (35 percent of people in a 2002 UK survey, and similar numbers across Europe). Modern society is changing at a rate far greater than previous generations have had to face, with resulting uncertainty and challenges to self-confidence. [1]
Functional illnesses are defined as those which impair normal functioning of bodily processes, but remain largely undetected under examination.
There is a higher prevalence of functional illnesses, particularly gastrointestinal disorders, in women over men [2]. There can be said to be greater demands on the modern woman to have it all: to be a responsible mother, but also to be sexually assertive, to compete with men in the workplace, while being less protected by them. This lack of balance in female lives is played out in fluctuating bodily symptoms, most obviously in areas of eating disorders and bowel function. Feminist writers such as Susie Orbach theorise that anorexia nervosa can even be a rebellion against male dominance via suppression of eating and sexuality. [1]
One example of functional illness, Chronic fatigue syndrome (CFS), affects 0.5% of the population, again mostly women, in the age bracket 20-40 years. Sufferers often evidence extremely busy lives combining child-rearing, employment, and maybe also extra study and caring for an elderly relative. A desire for success according to modern societal criteria has often left these women overextended and fragmented:
“Superwomen who have struggled to the cultural imperative to do it all [..] seem quite literally to work themselves into a standstill, but instead of being able to negotiate some help of relief in some of their roles, they let the illness do the negotiating for them.” Nick Read [1]
I can really feel this, being very much of the ‘I want and need to be able to do everything!’ personality-type, and struggle with fatigue challenges myself.
Women’s fight for agency and autonomy
Women’s bodies and sexual organs have long been ‘disputed territory’; society has always sought to control women’s bodies, as has been demonstrated with the recent repeal of the Roe vs. Wade ruling in the US. (See also my blog posts Gender and Caste in the History of Yoga and Reclaiming Persephone's Agency.) This may help to explain the preponderance of functional illness in women: despite the feminist revolution giving women control of their own sexuality and property, and created dramatic shifts towards equal opportunities in employment, life for women is much more complicated [1], even before the recent retrograde step of the US Supreme Court. This complication has created more opportunities to feel confusion, lack of identity, guilt and failure at being unable to meet expectations.
Primarily perhaps, women generally want and need to express themselves in a more emotional way, and despite advances, this can still be branded ‘hysterical’ or over-emotional by society. This cultural dissonance between society’s demands, and what women need in order to express themselves emotionally, creates the opportunity for functional illnesses to occur in the body.
What do we know about functional illness Fibromyalgia Syndrome?
Fibromyalgia Syndrome (FMS) is a chronic condition typically presenting in young or middle aged females, with symptoms falling in the following categories [9]:
Physical discomfort and pain (e.g. muscular, bone and joint pains, tenderness, morning stiffness);
Sleep problems (inability to sleep or sleep disturbance or feeling unrefreshed by it);
Mood disorders (anxiety and depression, extreme stress response);
Cognitive and memory disorders (‘fibro fog’);
Numbness and tingling of hands and feet, and ‘restless legs’;
Headaches and sensitivity to temperature, bright lights and loud noises;
Painful menstrual periods.
Although not deemed a life threatening, deforming, or progressive disease, FMS sufferers often experience functional impairment of daily living activities [4]. It may occur concurrently with chronic inflammatory diseases such as rheumatoid arthritis, osteoarthritis, and lupus (which has a similar set of symptoms as FMS, plus fevers, rashes, oedema, pleurisy, hair loss, seizures, sores, Raynaud’s phenomenon [10]), and/or other disorders characterised by persistent or recurrent pain and emotional distress, such as IBS, TMD, ankylosing spondylitis, and painful menstrual periods. FMS is not considered an autoimmune disease [3]. There is not yet a definitive test to diagnose FMS. [7] The cause of fibromyalgia may be genetic [7], but this has not yet been confirmed.
FMS is often triggered by a stressful event, including physical stress or emotional/psychological stress, such as:
an injury
a viral infection (a chronic viral infection may exist in the muscles of some FMS patients [7])
giving birth
having an operation
the breakdown of a relationship
being in an abusive relationship
the death of a loved one
However, in some cases, fibromyalgia does not develop after any obvious trigger.
How can yoga offer a better quality of life for people with fibromyalgia?
A 1999 clinical study found that a program of gentle yoga stretches and mindfulness meditation reduced pain and improved patients' ability to cope with FMS [8]. Yoga and yoga therapy have strategies for the management of all of the core fibromyalgia symptom groups, for example:
Gentle mobilisation and asana (physical postures) for the musculoskeletal discomfort and pain, and potential accompanying arthritis joint symptoms;
Restorative yoga for sleep problems, headaches, painful menstrual periods, restless legs, IBS symptoms;
Gentle mobilisation and asana along with pranayama and meditation for mood disorders;
Calming, parasympathetic nervous system-stimulating practices such as meditation / pranayama / visualisation / yoga nidra for overactive pain response, cognitive and memory disorders, numbness and tingling, and any accompanying rheumatoid arthritis symptoms;
Specific therapeutic strategies for chronic pain management help the sufferer to move toward acceptance of primary suffering and away from any secondary suffering, and becoming aware of the present in a realistic and compassionate way, opening up choices, heightening the sense of empowerment, and boosting self-esteem and confidence.
These approaches can help:
Monitor energy levels from day to day and practice at an appropriate level, using restorative yoga on days of low energy.
Learn to work through pain when appropriate. Much of the pain caused by fibromyalgia appears to be due to inappropriately amplified nerve signals. It’s important, therefore, to differentiate between the dull discomfort that comes from stretching tight muscles, which is safe to work with, and the sharper pain that comes from compressing a joint or straining a ligament.
Keep a journal. Reflect on the experience of practice and its effects on energy levels and symptoms. This provides feedback on the efficacy of the practice. (This is svadhyaya, or self-study, in yogic terms.)
Try a diverse practice of yoga targeting all the koshas, i.e. a spectrum of practices which operate on physical, mental, emotional and spiritual levels. (Read my blog post about the koshas.)
Find a sangha or community: a like-minded group can help us feel supported, witnessed and seen, without judgement. [8]
Non-medication therapies are the cornerstone of treatment for fibromyalgia. With them, many patients improve and may not require medication. Moreover, without focusing on sleep hygiene, stress reduction and exercise, it is difficult to improve, even with medication. [9]
Yoga techniques can be key to helping FMS sufferers to manage and improve their symptoms; and with symptom improvement, along with the improved self-confidence and the sense of empowerment that self-knowledge and pain management can bring, even if a complete recovery is not possible, comes hope.
Thank you for reading! If you would like to work with me for yoga for functional issues, or immune conditions such as Crohns disease, please contact me, I’d love to help!
References
1. ‘Sick and Tired - Healing the Illnesses Doctors Cannot Cure’ by Nick Read
2. Mayer EA, Naliboff B, Lee O, Munakata J, Chang L. Review article: gender-related differences in functional gastrointestinal disorders. Aliment Pharmacol Ther. 1999 May;13 Suppl 2:65-9. doi: 10.1046/j.1365-2036.1999.00008.x. PMID: 10429743.
3. US Department of Health and Human Service FAQ on Autoimmune diseases
4. Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management, by Jahan et al, Oman Medical Journal, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/.
5. Pathophysiology of Fibromyalgia by Bradley, Oman Medical Journal, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821819/.
7. Fibromyalgia Symptoms, Diagnosis and Treatment, OnHealth
8. Managing Fibromyalgia by Timothy McCall