The Combination Approach
by Norah Wickerson MCSP 2000-2007
… successfully tackling Fibromyalgia
From Suffering to Success
For over twenty years I suffered from increasingly severe, undiagnosed Fibromyalgia Syndrome. I was finally diagnosed in the year 2000. This was the year that I got myself back to better health than I could ever remember.
I studied for a diploma in Clinical Nutrition to discover how, primarily by changing my diet and lifestyle, I had made myself well. I used my then 20 years of experience as a Chartered Physiotherapist to develop a treatment plan which addressed all my remaining symptoms and issues relating to Fibromyalgia Syndrome. I felt that I had to take full advantage of being well and morally it felt the right thing to pass on my knowledge and expertise to help other sufferers get well.
Over the past five years I have been having great success treating patients diagnosed with Fibromyalgia and the related conditions of Chronic Fatigue Syndrome, Chronic Pain Syndrome and Chronic Myofascial Pain Syndrome, using what I call The Combination Approach.
It has been a very rewarding labour of love. I spend all my working time with sufferers, my evenings treating patients or answering phone calls and emails from new and existing patients and any 'spare' time is spent advancing my knowledge and expertise and writing articles or preparing talks. I still eat, breathe and live with Fibromyalgia but now it is on other peoples' behalf.
Back to the beginning
I feel a brief resumé of my life is pertinent to be able to appreciate the great improvement I achieved in my health compared to how ill I was.
As a child and teenager I never felt that I had the stamina of my peers. I enjoyed short bursts of activity but would struggle greatly with more prolonged activities. I always knew that I had to eat very regularly: if I didn't, I would feel ill and overwhelmed. In my teens I suffered with recurrent Glandular Fever and frequent migraines. In 1977, at the age of nineteen, while I was a student physiotherapist at Sheffield Hallam University I fell very badly down a very steep and icy slope and sustained numerous injuries to my lumbar spine that were not diagnosed at the time. Over the next five years, more troublesome symptoms appeared and I was seen by over twenty consultants in Sheffield, Derby and London. No definitive diagnosis was ever given, and I was made to feel like a neurotic hypochondriac and a medical oddity. Hence I gave up seeking a diagnosis and just learnt to live with my body and its limitations. Deep down I sensed that one day I would get to the bottom of my health problems and this gave me the glimmer of hope to keep me going for the next twenty-two years.
I always had the philosophy that life is not a rehearsal and as I was not a quitter, I decided to live life to the best of my abilities. I got married, had three children but consequently got worse and worse health wise and after the birth of my third child I was almost housebound for three years. I was not able to drive for fifteen years and felt like a prisoner in my body, serving a life sentence for a crime I did not commit.
Beginning to fight back
But this is not a tale of woe.
Fittingly, soon after the new millennium had dawned, I finally received the diagnosis of Fibromyalgia. At first I felt insulted, because to me, Fibromyalgia was just the new name for Fibrositis. I had certainly treated many patients with Fibrositis, but I had been led to believe that they just had muscle aches around their neck, shoulders and upper back region. Physiotherapy at that time was aimed at improving the range of movement of their neck and shoulders. I remember the disappointment of having yet another patient on my list with this troublesome Fibrositis, as the patients (mainly ladies) always seemed quite depressed, hard to motivate and always wanted to quit the exercises as soon as they could. Physiotherapy never seemed to help, and they were often discharged without any improvement. Indeed, comments like "Here's the pain in the neck that's a pain in the neck" were commonplace. Had I questioned the patients about other symptoms, I no doubt would have found that many had troublesome eye symptoms, headaches, bowel problems, generalised aches and pains and other manifestations now associated with Fibromyalgia Syndrome.
After a few weeks I decided to research Fibromyalgia Syndrome on the Internet, and the experience was literally hair-raising. I came across site after site that listed all of the symptoms that I suffered from. From that point, I never once looked back. I was able to begin to unravel the mystery wrapped in an enigma and make sense of all my odd and constantly changing symptoms.
Eating myself well again
I immediately took onboard all the advice about Reactive Hypoglycaemia – the condition I quickly realised to be one of the roots of my problem. I gave up all rice, pasta, white bread, potatoes, cakes, biscuits, sweets, chocolates, pastry, alcohol and caffeine. Within days I felt brighter mentally. Within weeks I was driving again and started doing my own shopping and cleaning.
As well as changing my diet, I called on all my Physiotherapy expertise and medical knowledge to improve or eradicate all my other longstanding troublesome symptoms. I researched tirelessly and amalgamated ideas from specialists and researchers in Fibromyalgia from all over the world, and incorporated many of my own ideas into what I called The Combination Approach.
I became like a 'man on a mission' to get myself back to as good health as possible. I called on the latent detective streak I had always possessed. I had to go it alone as I could not interest anyone outside my immediate family in my findings or ideas. It was very fitting that as I had only received unhelpful and sometimes outright disbelief about my symptoms from the medical profession that they played no part in my return to full health.
Within five months, I was back to better health than I could ever remember. I now knew what stamina was. I no longer felt dim. From the second of waking up to the second of going to sleep, I felt intelligent, creative and witty. I now had sustained levels of energy, and mentally and emotionally felt well-balanced. I was now able to do more in a day then in a month when I was ill.
Spreading the word
I was now well enough to move house, work full-time and study for a diploma in Clinical Nutrition. I needed to do this to answer my questions about how I had got myself on the road to recovery by changing what I was eating, but also to allow me to help other Fibromyalgia sufferers as my Physiotherapy qualification alone did not allow me to advise on matters of nutrition. In May 2002, I became the first (and only) Chartered Physiotherapist and Nutritional Advisor in the country. I have now treated over three hundred people from all over the UK (and beyond) using The Combination Approach, many with great success.
My Hypotheses
Roots of the problem
I believe Fibromyalgia Syndrome has many components and all need to be addressed to achieve lasting better health. The five main components are:
- Fibromyalgia
- Reactive Hypoglycaemia
- Dysfunctioning of the Autonomic Nervous System
- Myofascial Pain and Trigger Points in postural muscles
- Biopsychological Effects
The other components are:
- Problems with cognitive skills
- Breathing problems
- Eye problems
- Sluggish lymphatic system
- Poor immune system
Because of the ‘polypleomorphism’ of Fibromyalgia some sufferers will have other components. Personally, I believe that the deepest roots of the condition are the Reactive Hypoglycaemia (which many sufferers are not even aware that they have) and the dysfunctioning of the Autonomic Nervous System. Once these two systems are back into better balance, it becomes easier to improve the other components of the syndrome.
Homeostasis
When all the bodily systems are performing at their best, the body is said to be in a state of Homeostasis. I like to think that to maintain Homeostasis, the body has to stay on a path. Each person's path is a different width, so for some people it is a really wide path that is easy to stay on. These are the lucky people who can get away with overeating and over drinking and burning the candle at both ends, but stay healthy. For other people, this path is narrow, and they have to take care to stay well. For Fibromyalgia sufferers, the path is a tightrope.
So, to get back into Homeostasis, the Fibromyalgia sufferer needs to learn how to walk on their tightrope. To stay well and live an active life, they need to learn how to run and do somersaults on the tightrope. If they fall off, they have to learn how to quickly get back onto the tightrope again.
I think of my treatment as mental and physical preparation for tightrope-walking. The circus performer starts by walking along a line on the floor, then moves onto balance work, strengthening core muscles, training the eye muscles and lots of concentration techniques, long before he steps onto the tightrope itself. He wants to do this, so he puts in all the practice that is necessary. Most importantly, he believes that he can succeed. He can visualise himself successfully walking on the tightrope, and is already planning ahead the complicated routine that he has yet to learn. It would not be impossible for just about anyone to learn to walk on a tightrope, although this would naturally be harder for some than others. The biggest obstacles are lack of belief and inadequate practice. The idiom ‘fail to prepare, prepare to fail’ fits this situation as well as when a patient is starting on The Combination Approach.
Retuning the body
I believe that Fibromyalgia is nothing more than a collection of symptoms indicating that the body is well out of balance. I do not say this flippantly, because I lost all my twenties and thirties to this condition.
Think of the body as a radio that is out of tune. You blame the radio for the very poor reception, but actually the radio is perfectly Okay. It is simply on the wrong wavelength to receive the station you want to hear, because the knob keeps getting knocked. By setting it to the right wavelength, followed by some fine tuning, you can receive your favourite radio station. By careful future handling of the radio, you can receive your favourite radio station all day and all night!
Sufferers of Fibromyalgia commonly blame their body. They wrongly believe that their body is letting them down. To stop the body ruling you, you need to work with your body, retune your body, fine-tune it for optimum performance, and then learn how to keep it in perfect tune. You will then be back in control of your body.
Cortisol
Cortisol is the main stress hormone. A small amount of Cortisol is beneficial to our well-being. It stimulates the heart, lungs and all major organs. It gives us alertness by causing a rush of oxygen to reach the brain. It releases white blood cells, which should help us combat infections. It helps the body make more amino acids, which are the building blocks for repair. It stimulates the thyroid gland, which will increase our metabolic rate. Overall, it enables our body to function at its peak performance.
However, if Cortisol is produced too easily and in excessive amounts, as in the state of chronic stress, then it has many harmful effects on the body. Cortisol is known to inhibit the action of certain enzymes. The more Cortisol the body is producing, the more enzymes may be inhibited. This is particularly relevant to the conversion of the omega oils, which are important for cognitive functioning and the nervous system in general, as well as being very important to our good health.
Too much Cortisol is linked to depression, fatigue, makes us prone to frequent infection and causes us to excrete proteins from the body. This in turn leads to dis-ease of the body, allowing it to succumb to disease. This could include Lupus, Chronic Fatigue Syndrome and Fibromyalgia.
Enzymes
Enzymes are biological catalysts which accelerate chemical reactions in the body. They are made of protein and all processes in cells need enzymes to keep these processes at the best rate. Enzymes speed up over 4,000 processes in the body, so are vital to our health and well-being.
Consider then, that modern eating habits and lifestyle habits could actually be damaging or inhibiting the action of some or many of these enzymes. Enzymes are vital for good digestion, effective removal of waste by the liver, conversion T4 to T3 for good metabolism and many other vital functions. Maybe the Fibromyalgia is partly due to many of the 4,000 processes being slowed down because many of the necessary enzymes are inhibited in their action.
Listed below are the factors that are thought to inhibit certain enzymes, such as delta-6-desaturase, an important enzyme for the conversion of omega-3 and omega-6 oils:
- Caffeine, cigarettes and alcohol
- Trans-fats and processed foods
- High sugar diet
- Too many additives and preservatives
- Viruses, e.g. Epstein-Barr
- Serious bacterial infections, e.g. Lyme's Disease
- B6 and B12 deficiency
- Zinc or selenium deficiency
In addition, I believe that very-low-fat diets can inhibit enzymes, as can some medications. The most important factor, though, is Cortisol, the main stress hormone.
When Fibromyalgia sufferers first consult me, they frequently have many if not all of the above factors, as well as very high levels of stress, with the implications of Cortisol, the main stress hormone, adding to their problems. The diet I recommend removes or addresses the issues above (including dealing with stress) apart from the factors relating to latent viruses or bacteria still in their body, often many years after the initial infection. Hopefully, though, if these are the only two factors left, the enzyme inhibition should be minimal.
Xeronine
I believe that this chemical is very important in Fibromyalgia and any recovery from the condition. Xeronine is necessary for the proper functioning of all cells in the body. It is actually thought to ‘kick start’ other enzymes and so improve their efficiency. I believe that a lack of this chemical could cause illness and increase the possibility of developing Fibromyalgia.
Xeronine regulates the shape and rigidity of many proteins such as in hormones, antibodies, connective tissues, neurotransmitters and enzymes. All of these can be dysfunctional in Fibromyalgia.
Negative thoughts and negative emotions are thought to suppress the production of Xeronine. Large amounts of this little known chemical are used up at times of great or prolonged physical or mental stress. Again these factors are all important aspects of Fibromyalgia syndrome. More Xeronine then needs be made from proxeronine and the enzyme proxeronase in the small intestine.
To increase the amount of Xeronine a sufferer needs to get engrossed in playing or listening to uplifting music. Mozart, Strauss or even Status Quo, various dance music and Irish Folk music such as ‘Riverdance’ work excellently for me. Enjoy finding which type of music uplifts your mood and play as frequently as you can. An alternative to music is involvement in art work such as painting with oils or pastels or even colouring mosaic patterns with vibrant felt pens.
The standard, discouraging response many sufferers receive from GPs and other medical professionals is the opposite of the positive lift that they need. Many get worse after receiving their diagnosis as any hope of improvement is snatched away.
Personality traits
Just about every Fibromyalgia sufferer I know fits into the category of being a 'people pleaser', and will have been all their life. Is this a cause or a symptom? Most Fibromyalgia sufferers have an uncomfortable relationship with their mothers. Often, although they love them dearly and think of them as a very good friend, they also describe them as a thorn in their side, that is, they still feel controlled by them even as an adult. This situation needs resolving and the 'child, parent, adult' technique can work really well here. When two people are in a difficult or confrontational situation, there are three ways that they can behave. The first person can behave as a parent, by belittling and admonishing the other person, and this makes the second person behave as a petulant child. The first person can behave like a child, by tackling the problem in an overly emotional and immature way, and this makes the second person fill in the role as their parent. By far the best way to handle the situation is for the first person to behave as a sensible adult, which in turn encourages the second person to respond as a sensible adult too. The sufferer's relationship with their mother needs to become adult-to-adult. The sufferer needs to feel as an equal and that their views, ideas and choices are worthwhile. This can greatly help self esteem and reduce stress levels which may have been exacerbated by any unhealthy relationships.
Fibromyalgia sufferers feel the need to please people, and avoid any confrontations, especially at home, school and work. They feel the need to fit in and follow the expected path, even if that is not what their heart tells them to do. Maybe this is why Fibromyalgia sufferers have low self-esteem and are over-sensitive to criticism from others, but are over-critical of themselves. If they are asked to do something, they find it very hard to 'say no'. Then, even though they did not want to do it, they feel the need to do it really well. Other people may take the attitude that they will only half heartedly do it so not to risk being asked to do it again. The personality of a Fibromyalgic sufferer, however, is one who takes the philosophy that if a job is worth doing it is worth doing well, even though they will not enjoy the task and actually get more stress than pleasure from it.
For a fibromyalgia sufferer to 'say no' also causes them stress because they then feel very guilty for letting someone down or basically risk displeasing someone who they wrongly think will then have a lower opinion of them.
Fibromyalgia sufferers are a contrary group. They can have this low self esteem but in some areas of their life, they actually can have a high opinion of themselves. This shows itself in several ways such as the fact that they feel the need to carry out most jobs themselves and do not like to delegate, maybe because they know the job will be done better by themselves. This becomes a problem as their condition worsens but they are not good at letting others help them or actually asking for help when they know they need it. In severe Fibromyalgia, this choice can be taken away leading to more frustration and even depression.
Sufferers of Fibromyalgia do not cope well with change. They can find changing school, starting University, moving house, bereavement and break up of a relationship much more stressful than most people. At the time of the stress, they appear to cope very well and even seem to thrive on it. They also make sure that everyone else is supported but ignore their own need to grieve. Unfortunately as they relax when the stress is reducing, that is when they become ill. Many will have a flare up of their Fibromyalgia symptoms which can debilitate them for days, weeks or even months.
Fibromyalgia sufferers are very intuitive and empathetic people who readily take on other peoples' problems and can end up like a sponge which is totally saturated. They are not good, however at sharing their own problems with others and consequently build up more chronic stress, produce more cortisol and end up with more troublesome symptoms to cope with.
In order to get well, I need the Fibromyalgia sufferer to become more assertive, gain higher self esteem and become more self-centred, but for the right reasons. They have to put their needs and wishes as equally as high as others in the family, workplace or social situation. Many sufferers need to confront difficult issues with relationships at home, the wider family and the workplace. They may have deep rooted resentment, anger, grief and other negative feelings which are affecting their emotional system. This must be dealt with in order to achieve lasting good health.
Early development of Fibromyalgia
I believe that many young sufferers of Fibromyalgia have had unusually large amounts of Cortisol and other stress hormones passed to them through the umbilical cord while they were in their mother's uterus. This would be because their mother was under chronic stress at the time of the pregnancy. She too could have a dysfunctioning Autonomic Nervous System and be at risk of developing or already have diagnosed or undiagnosed Fibromyalgia. They are then born already with an abnormal response to stress hormones and possibly an already dysfunctioning Autonomic Nervous System. These are the people who I believe to be already on a tightrope. This means that as they come across more stresses (physical, mental, emotional, vaccinations, viruses and other illnesses) their body is less able to deal with them, so they will succumb more easily to diseases and become more out of balance until the symptoms of Fibromyalgia or Chronic Fatigue Syndrome become apparent.
My hypothesis is that if these people can be picked up early, then they can be on The Combination Approach right through their life and greatly minimise their chances of becoming more ill as they get older. I think it is possible that the babies born after receiving excessive amounts of Cortisol and other stress hormones may also have some of their own enzymes inhibited, as discussed earlier. This may explain why many Fibromyalgia sufferers (myself included) had jaundice as a baby, which took weeks or months to subside. Could this be because some of the liver enzymes which should break down the biliverdin and bilirubin are inhibited?
A common time for Fibromyalgia symptoms to become exacerbated is while the person is a student at college or University. This will be a stressful time – maybe leaving the family for the first time, finding the work very hard, partying more than they can cope with, but most importantly, changing their diet for the worse. While living at home, they have been eating good home-cooked food, with adequate protein and regular mealtimes. As a student, on a shoestring budget, they tend to live on cheap foods such as pasta, white rice, bread, pizza and lots of alcohol. There will be a deficiency of fruit and vegetables, wholegrain cereals and good protein. If they have the predisposition to develop Reactive Hypoglycaemia, it is likely to present itself now. They would then crave more of the aforementioned food 'baddies', and the downhill spiral of other symptoms of Fibromyalgia Syndrome could begin. They are particularly prone to the build-up of trigger points in their eye muscles, due to the strain from reading and using a computer for many hours a day.
Fibromyalgia later in life
A very common time for Fibromyalgia to become troublesome is at times of biochemical imbalance such as after having a baby or when a woman reaches the menopause. Often they will have had early signs that the body is not in perfect balance and had symptoms which wax and wane over the previous years. These can include ‘growing pains’, migraines, Glandular fever type viruses or recurrent tonsillitis, severe PMS, heavy periods, endometriosis or fibroids. Some will also suffer with RSI, tennis elbow and ‘frozen shoulder’ type problems. Many will also know that they have had unstable blood sugar levels for many years.
The contraceptive pill, mini pill, Mirena coil, hormone implants and especially HRT can cause more biochemical imbalance of the body in a person who is susceptible to Fibromyalgia and many patients have reported getting worse on these hormone changing medications. I recommend natural HRT whenever possible which works gently with the body’s own biochemistry.
Some diagnosed Fibromyalgia sufferers cope reasonably well with the condition until the onset of the menopause when their symptoms can suddenly worsen. This is because now they have to deal with two separate biochemical conditions that will aggravate each other.
A little bit of serendipity
Everybody deserves a little bit of serendipity and I certainly got my share in the very early days of my recovery. As I was strictly following the diet to control my newly-diagnosed Reactive Hypoglycaemia, I needed to think of some easy form of protein to have with my snacks. As I cannot tolerate nuts and I did not want to have a lot of high-fat foods like cheese, I decided to use cooked egg whites. I would have half an egg white followed by a pear or apple, and later in the day, the other half with a Ryvita. I would also have scrambled eggs or an omelette for lunch, consisting of two egg whites and 1 egg yolk. In total, each day I would have at least two egg whites, normally three.
Within weeks, my autonomic nervous system seemed to be working much better. I felt much less stressed, and did not suffer with the payback phenomenon as I used to. Sometime later, when researching more about the adrenal glands, I discovered that for these glands to be healthy and function normally, they need a non-essential amino acid called Tyrosine. This is found in abundance in albumen – egg whites. Now I knew why I had easily got my adrenal glands functioning much more normally. I recommend two cooked egg whites a day to my patients. Although the yolk contains good protein and ‘B’vitamins, it does contain quite a lot of saturated fat so should not be consumed in large amounts. I have more egg whites at any times of potential stress, such as giving talks about The Combination Approach. Many patients have told me how calm they feel when they have more egg whites. A Tyrosine supplement can be used if the patient is allergic to eggs, or is an ovavegetarian. Tyrosine helps to make dopamine, the ‘happy’ chemical in a more natural way than with medications. Tyrosine will also help the adrenal glands to produce the correct amount of adrenaline and then respond with the correct amount of noradrenaline. It also prepares the body to deal with stressful situations which do arise. As stress is a Fibromyalgia sufferer’s worst enemy, then Tyrosine can be thought of as a sufferer’s best friend.
The psychology of getting well
For me, one of the most frustrating parts of treating Fibromyalgia patients, is that so many are unwilling to commit to getting well. The reasons for this seem to be multifactorial.
- A relationship has survived the sufferer becoming ill and debilitated. Would it survive another change?
- Many sufferers fall into the role of the victim. They like to feel that they have just got to put up with the condition and fail to take any responsibility for its development and deterioration. They find it hard to believe and accept that any improvement could happen.
- Some sufferers have tried many prescribed medications as they have been developed. Each time, they have built up their hopes for the new drug’s success, only to be disappointed with either a very slight improvement, or more troublesome iatrogenic effects.
- Some sufferers are insulted by the idea that their condition, which they may have suffered from for many years, can be treated so simply, primarily by a change of diet and lifestyle. They seem to prefer a treatment that could be invasive and even dangerous, maybe to romanticise the seriousness of the condition.
- Some sufferers are reluctant to try the treatment, just in case it works, and they may risk losing their incapacity benefit and disability living allowance, or medical retirement pension.
- Some sufferers crave improvement for their health but are not prepared to strive for it. Taking lots of pills is the easier option chosen by many.
- Some sufferers feel that The Combination Approach is too much of a penance, especially with the strict diet. It must not be thought of as a penance, but as an enjoyable challenge. Some sufferers ask if they are allowed to break the diet occasionally for a treat such as chocolate or a glass of wine. I ask them how it is a ‘treat’ if they then feel sluggish, achy and miserable for the next few days. A treat is not a treat if it makes you feel worse.
For me to have a good idea as to whether a person is likely to be a successful patient for The Combination Approach, I need to know that they would be willing to eat slugs on toast if that was what was necessary in order to get well. I know I would certainly have done so!
A cure or not?
One of the most frequent questions I get asked is if The Combination Approach will 'cure' their troublesome Fibromyalgia or is it just a treatment. My answer is multifold. As I believe, as stated earlier, that Fibromyalgia Syndrome is a collection of symptoms which are just an indication that certain body systems are out of balance, so I do not think of it in the same light as a disease. If the body of a Fibromyalgia sufferer can be successfully brought back into balance and remain so, then the symptoms should improve themselves. Provided another condition such as Lupus or Osteoarthrosis is not present, then there should be no permanent damage left to the body, even if the condition has been of many years longstanding. Is this a cure or 'retuning' the body.
I like to think of my treatment for Fibromyalgia Syndrome in the same light as the treatment for coeliac disease. This troublesome condition can be totally and permanently controlled by a diet that totally eliminates gluten. Within weeks of diagnosis and religiously following a gluten free diet, the coeliac patient can be back to full health without the need for any drugs. However, their symptoms will return with a vengeance if they consume even tiny amounts of gluten in their food. Is this a cure? Or is it permanently controlling their condition by dietary means? I believe that once a Fibromyalgia sufferer has got well again, then they can permanently keep themselves well by keeping fairly strictly to the diet and the other lifestyle changes it needed for them to get back to better health.
Over the past five years, I have lost count of the number of diagnosed Fibromyalgia sufferers who have contacted me to come to Derby for my treatment but then cancelled the appointment. Let me explain. We have a prolonged, preliminary chat on the telephone about their symptoms and I explain briefly what my treatment will entail. They book an appointment which can be several weeks ahead owing to my heavy workload. In preparation of starting The Combination Approach, I strongly request that they give up all alcohol, all chocolate products and all hot and soft drinks containing caffeine. This must be done gradually to avoid very unpleasant withdrawal symptoms. Also to reduce the amount of simple sugars they consume and replace with oats and wholegrain cereals. A few days before their appointment date I get an apologetic but excited message, that they now feel so well that they do not think they need to see me! I conclude that these people were only slightly out of balance and removing all the stimulants and reducing the simple sugars was enough to retune their body into homeostasis. I suggest that they continue on this new way of eating and try and exercise more, especially walking. I also advise that they get back in touch with me if they relapse or feel the need to come and see me. Not one of these potential patients has got back in touch so I assume they have stayed well. Is that a cure? Or were they the lucky sufferers who were very easy to retune? Many other sufferers report that they are feeling a bit better by the time they come to see me just by following the above simple advice.
At the end of the day, surely the most important thing is that the sufferer feels well again and is able to live a much fuller and more active life and whether The Combination Approach is just a treatment or a 'cure' is academic.
Summary of hypothesis
I think of the above as my working 'working hypotheses'.
Some patients, myself included, can end up with better health than ever. This includes feeling better and fitter physically and stronger mentally and emotionally, and being more stable biochemically, by being totally in tune with their body (often for the first time in their life) so that they can recognise the first signs of any system starting to get out of balance and work at regaining that balance as soon as possible.
Components of Fibromyalgia Syndrome
Fibromyalgia
I believe that Fibromyalgia is a collection of symptoms indicating that various body systems are out of balance. The more systems that get out of balance, the more symptoms arise. The further each system gets out of balance the more intense the symptoms become. If a sufferer has been previously well, fit and active, i.e. their body systems have once been in the correct balance and they have not had irreparable damage to their body with drugs or surgery, then provided each system can be brought back into the correct balance, the symptoms of Fibromyalgia will steadily improve until they are totally gone.
I think of Fibromyalgia as the 'over-reaction-to-everything' syndrome. Sufferers over-react physically, mentally, and emotionally, and most importantly biochemically.
Reactive Hypoglycaemia
I believe that all Fibromyalgia sufferers have mild, moderate, or even severe Reactive Hypoglycaemia. This is a condition of low blood sugar that follows within two hours of a meal that is rich in simple carbohydrates.
Reactive Hypoglycaemia is not the same as a diabetic hypoglycaemic episode. Reactive Hypoglycaemia occurs about one or two hours after a meal, particularly a meal high in simple carbohydrates, when there is a rapid release of carbohydrates into the small intestine. A Fibromyalgia sufferer overcompensates for this rapid change (part of the 'over-reaction-to-everything' syndrome) by producing too much insulin, which results in a too rapidly dropping blood sugar level. As the blood sugar level is dropping so rapidly, the body responds by producing a burst of adrenaline to release some glucose from stored supplies and slow down this drop.
The symptoms are:
- Cravings for carbohydrates / sweets / chocolates
- Headaches, dizziness and visual disturbances
- Sudden fatigue
- Mild depression and nervousness
- Short term memory problems and poor concentration
- Phobias, panic attacks and feeling of being overwhelmed
- Palpitations and trembly sensations
- Sweating round hairline and neck and night sweats
- Deep anxiety and black thoughts
- Hunger pangs soon after having eaten
- Feeling sick, irritable and weak for food
- Weight gain and fat pad over stomach
By following the correct dietary advice Reactive Hypoglycaemia can be totally controlled within about eight weeks. By then the sufferer should be free of many if not all of the troublesome symptoms listed above. I do believe that if the sufferer goes back to their original diet then the Reactive Hypoglycaemia would gradually return.
Dysfunctioning of the Autonomic Nervous System
I believe that dysfunctioning of the autonomic nervous system is a key aspect of Fibromyalgia Syndrome. Restoring correct functioning of this system is an essential aspect of recovery from Fibromyalgia Syndrome.
The autonomic nervous system is responsible for regulating those actions of the body that are not controlled consciously, such as digestion, the beating of the heart, and the operation of endocrine glands.
The autonomic nervous system consists of two parts – the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system is responsible for providing the responses and energy needed to cope with stressful situations such as fear or intense physical activity. To do this, it secretes the hormone adrenaline to stimulate the heart to beat faster, dilate the bronchioles to improve oxygenation of the blood, increase blood pressure, dilate the pupils, and more. The sympathetic nervous system originates from the spinal cord in the mid-thoracic area – exactly where almost all sufferers have a combination of pain, stiffness, previous trauma, and poor posture or muscle spasm which can all irritate the nerves arising from here.
Once the stressful situation has past, the body needs to recover and rebuild its energy reserves. The parasympathetic nervous system now takes control. It acts as a peacemaker in the body by lowering the heart rate and blood pressure. This conserves energy but makes us feel lethargic.
Dysfunction of the autonomic nervous system could explain the sudden waking episodes that many Fibromyalgia sufferers complain of. During deep sleep the parasympathetic nervous system secretes calming hormones. A few seconds before waking there should be a small surge of sympathetic activity to prepare for activity. With a Fibromyalgia sufferer this sympathetic activity is excessive, and may occur several times a night. The sufferer wakes up feeling wide-awake or even 'stressed' but with no good reason. I believe these inappropriate surges of adrenaline production are a direct response to the blood sugar level falling rapidly during the night because of a high intake of simple carbohydrates during the evening.
In Fibromyalgia sufferers, the sympathetic nervous system is almost always hyperactive but then hyporeactive to stress when it actually happens. To understand this, imagine the sympathetic nervous system to be the goalkeeper in a football match. All through the game, the goalie is doing star jumps, muscle stretches and running on the spot. He is being hyperactive. But when called upon to make a save, he carries on with his exercises and he cannot actually react in time to stop the ball going into the goal – that is, he is hyporeactive.
Patients who give up tea, coffee, cigarettes, chocolate, caffeinated soft drinks and especially alcohol often suffer much less pain. All these are stimulants which cause the production of adrenaline. Conventional wisdom is that adrenaline can induce pain in Fibromyalgia sufferers. I believe it is the over-production of noradrenaline in response to the adrenaline which actually causes the pain.
The autonomic nervous system controls body temperature, blood pressure and heart rate and influences the immune system. The autonomic nervous system links the mind and body. It links to the central nervous system via the hypothalamus and it works with the endocrine system (the 'glands') via the 'hypothalamic-pituitary-adrenal axis'.
The Autonomic Nervous System is responsible for immune system. The Hypothalamus influences the immune system by controlling all the endocrine glands, e.g. pituitary and adrenal glands. If the Hypothalamus is slightly dysfunctioning then the immune system will be under par resulting in low resistance to infections, swollen glands, sore throats and sinusitis.
Dysfunction of the autonomic nervous system may also be to blame for the dry mouth and cold extremities that sufferers have, which is called 'pseudo-Raynaulds' phenomenon. Many sufferers will have been misdiagnosed with Raynaulds Disease when younger.
The autonomic nervous system is important in the production of growth hormone – so often thought to be low in Fibromyalgia sufferers. This could be the cause of the ‘growing pains’ so many sufferers get when young. For a healthy child growing spurts should not be painful.
I believe that the 'pay-back phenomenon' which plagues a Fibromyalgia sufferer's life is due to the build up of neurotoxins, mainly the waste products of adrenaline and noradrenaline. They produce adrenaline and noradrenaline all too easily but are not as good as normal people at getting rid of them and their waste products. This is partly because of their sluggish lymphatic system. Noradrenaline in particular causes the anti-climax feelings Fibromyalgia sufferers get so often after any form of excitement or extra activity. I use the analogy of two boxers, very closely-matched, coming to the end of a contest that is to be decided on this final round. Both boxers will have large amounts of adrenaline being pumped out, so that their muscles can constantly be used to full extent. The bell goes and the referee holds up the arm of the winner. Look at the loser. His body will have immediately pumped out a large amount of noradrenaline to balance the large amount of adrenaline in his body. He will now feel every bruise and cut, he will feel dejected, very low in mood, lethargic and far from his best state of health. He is now in a state of sudden anti-climax. This is not just because he lost the match but because of the marked changes in his biochemistry.
I believe Fibromyalgia sufferers suffer this sudden anti-climax because they produce far too much noradrenaline for the small amount of adrenaline they have produced. A sufferer may well respond like this after an evening out. Imagine they are going out with friends who they feel totally at ease with. They do not have any alcohol, the music is not loud, and they are back home by 10.30pm. During the evening, they will release a small amount of adrenaline which makes them more sociable and happy. As soon as they are on their way home, subconsciously they will sigh and feel relieved that the evening is over but has gone well. This is the trigger for the body to produce noradrenaline to counterbalance the adrenaline produced. Unfortunately, people with Fibromyalgia Syndrome seem to over react and produce far too much noradrenaline. They will go to bed and find it very hard to go to sleep. Any music, any conversations will be going round in their head. By the next morning they will feel like they have done three rounds with the boxer during the night! Physically they will feel exhausted and in more pain, mentally they will feel overwhelmed, and emotionally they will feel low or even depressed. Why is this? They had a lovely evening out. Any happy memories of the evening are spoilt by feeling so bad for the next few days as their body struggles to clear the neurotoxins from so much noradrenaline. I propose that the name for the symptoms of imbalance of the autonomic nervous system, including the over-production of noradrenaline, should be Reactive Adrenal Syndrome. The right amount of noradrenaline acts as a peace maker to allow all the body systems to return to their normal states but the over-production of noradrenaline inappropriately makes a person feel lethargic, hungry, emotional, unwell and in a state of 'anti-climax'.
Over time, stresses can overload the autonomic nervous system in susceptible people. Stress can be physical, mental, emotional, trauma, or even infections, parasites, vaccinations and the added stress caused by other illnesses. These 'susceptible people' are the most likely candidates to develop Fibromyalgia Syndrome.
The autonomic nervous system can be thought of as the gateway between the central nervous system, the organs of the body and the musculoskeletal system. It provides the necessary communication between these systems. When we are busy and active our autonomic nervous system should organise a steady release of stored energy to supply our musculoskeletal system and so sustain our activity. In Fibromyalgia Syndrome, this does not happen as well as it should. This is the most likely cause of the characteristic lack of stamina.
Some Fibromyalgia sufferers have once had reasonable stamina, while others have never even had stamina as a child. Any attempt to get fit normally fails, as their muscles are not simply deconditioned. The sufferer is unable to cope with more than minimal exercise unless their autonomic nervous system can be helped to function more normally, so that it will supply the steady release of energy necessary to sustain the action of muscles.
Correcting imbalances in the autonomic nervous system leads directly to great improvement in health and well-being. The Combination Approach aims to sort out problems with the dysfunctioning of the Autonomic Nervous System.
Myofascial Pain and Trigger Points
Chronic Myofascial Pain occurs because of mechanical failure, such as repetitive stress, injury, trauma, or long-standing illnesses such as Fibromyalgia and arthritis. Chronic Myofascial Pain is characterised by extremely sore points ('trigger points') or ropy bands of hardened myofascia that can be spread throughout the body. The myofascia is the lining around muscles, ligaments and tendons. Generally in Fibromyalgia Syndrome it is only the myofascia of postural muscles which is affected. I believe this is because postural muscles have a relatively poor blood supply and very poor lymphatic drainage compared to exercise muscles, so that 'waste' products can easily collect in postural muscles. Over time the waste products form the trigger points and fibrous bands so common in Fibromyalgia patients.
Any pain can cause a muscle near the pain to contract to ‘guard’ the area. This muscle is then in sustained tension (muscle spasm) and so produces more waste products than normal, which accumulate to result in more trigger points.
I believe that most Chronic Myofascial Pain trigger points and bands can be broken up and eliminated by various deep massage techniques. However, these work much better once the patient’s Reactive Hypoglycaemia is controlled by diet. The diet should ensure that there will not be a new build up of these waste products in the future by removing all food items that their body cannot deal well with.
Biopsychological Effects
Explained simply, this is how negative thoughts affect the whole body. This is not to say that Fibromyalgia Syndrome is in the sufferer’s head. Rather, as with any chronic pain condition, psychological effects will play a significant part.
An essential part of The Combination Approach is to help sufferers regain the psyche of a ‘well’ person. This is necessary for becoming a ‘well’ person. The 'trick' is to learn how to limit the production of these ‘negative’ chemicals.
I have come across many people now with this frustrating condition and just as many attitudes to the condition and the possible recovery from it. Some people cope by pushing themselves to the limit and then can literally become 'burnt out' mentally or physically or both. Some people fall into 'victim' role very early on in the condition and even appear content with their limited life. Some never give up hope of improving and strive hard to improve their knowledge of the condition and treatment available. This last type of sufferer is generally perfect for the Combination Approach. The person needs to be suffering enough to really want to change things but still have enough fight and mental energy left for the hard work ahead. I do believe that many of the medications prescribed, often routinely to Fibromyalgia sufferers can, over time, dampen their spirit, and make recovery much more difficult.
Many sufferers wrongly believe and therefore accept that there is nothing they can do to help their condition. When browsing the Internet, people tell me that mine is the first web site that they have come to that has anything positive to say about recovery from Fibromyalgia. Many sufferers have had any glimmer of hope of improvement dashed, either by their GP, consultants in Rheumatology and pain management, and other medical professionals whom they have consulted along the way. Because of this, I have to convince a sufferer that there is a chance that they can get well. They really do have to believe that this is possible, to be able to achieve success.
I need to change a pessimistic person into a positive person. I need to change a worrier into a warrior. I need to change somebody who is full of woe into somebody who is full of 'go'.
Problems with Cognitive Skills
These can cause some of the most frustrating and life-affecting symptoms of Fibromyalgia. A sufferer can change from being an intelligent, articulate and sociable person into somebody who feels downright dim when the 'Fibro fog' looms. 'Fibro fog' is different for each sufferer, but often includes disturbance of short term memory and poor concentration. Sufferers struggle with depression and mood swings. They complain of dizziness and headaches, and have difficulty finding the right words, especially in social situations. Some patients develop phobias and even paranoias. The Combination Approach aims at dealing successfully with all these symptoms.
The Combination Approach
'10 Point Plan'
1. Understanding Fibromyalgia Syndrome
The first step of The Combination Approach is to give a comprehensive explanation of the main aspects of Fibromyalgia Syndrome detailed above. It is important that the sufferer understands their condition very well and finds out exactly what they can do to help get their body systems back into balance. I think of it as empowering the sufferer with the knowledge of how to get themselves back on track to better health and also how to keep well and avoid any future flare-ups of the condition. Ways of dealing with future stressful situations need to be discussed since stress of any form is a Fibromyalgia sufferer's worst enemy. Ironically the condition itself causes a sufferer a great deal of stress because of the dismissiveness of many doctors and health professionals and the lack of understanding by family, friends and employers. This is mainly because there are often no obvious outward signs of the condition. Add on top the pessimism of most literature and web sites about Fibromyalgia Syndrome. Most sufferers think that there is nothing they can do to improve their health and well-being and have accepted that the only course of action is medication or some other treatment aimed only at treating their symptoms. The Combination Approach is aimed at the root cause of the problems. It uses:
- No drugs
- No expensive supplements
- No radical dietary changes
- No intensive exercise regimes
The Combination Approach involves simple, straightforward yet very effective advice, exercises and lifestyle changes. It does, however, require determination, dedication, full co-operation and downright hard work.
Remember: more dedication means less medication.
The advantages of The Combination Approach over other treatments currently used for Fibromyalgia Syndrome are that it is:
- Totally non-invasive and under a sufferer's own control
- Easy to understand and simple to follow
- Effective for newly diagnosed as well as long standing sufferers
- Suitable for mild, moderate and severe sufferers
- Harmless even when not successful
- Suitable to follow even if other treatments have failed
- Treats the whole person not just a symptom
- Effective for all symptoms of Fibromyalgia Syndrome
- Effective physically, mentally, emotionally and biochemically
2. Dietary Advice
The diet to control Reactive Hypoglycaemia is absolutely crucial to the success of The Combination Approach and must be followed as near to 100% as possible at least for several months. Often the foods the sufferer craves the most e.g. potatoes, bread, pasta, sweets and chocolates will need to be excluded or greatly reduced. These foods contain a large amount of the simple carbohydrates that raise blood sugar levels quickly. They need to be substituted by plenty of wholegrain cereals such as oats, millet, rye and quinoa which breakdown more steadily over time and therefore maintain blood sugar levels at a more constant rate.
Advice on the consumption of more vegetables, adequate protein and good fats such as the omega oils which are essential for a healthy nervous system is also included. The diet is individually tailored to meet nutritional needs and lifestyle. It may include the recommendation of some basic vitamin and mineral supplements if indicated by the presenting symptoms. It can be adapted to suit vegetarians and faddy eaters.
Many Fibromyalgia sufferers complain of IBS, Leaky Gut Syndrome or Candida. The diet to control the Reactive Hypoglycaemia is often very successful at improving these other troublesome symptoms.
The recipe booklet entitled More Bakes Less Aches is now available from the Nottingham and East Midlands Fibromyalgia Support Group (www.FibroFocus.org.uk) and contains plenty of ideas to make following the diet to control Reactive Hypoglycaemia much more interesting and enjoyable. The diet must never be thought of as a penance but as a very straightforward and successful way of helping to get your body back into better balance by controlling blood sugar levels and allowing other systems to be brought back into their correct balance and so reducing and hopefully permanently freeing you of your troublesome Fibromyalgia symptoms.
Not all the recipes will be suitable for everyone. If you know you are sensitive to a particular type of food e.g. nuts, eggs, wheat etc then you must avoid the recipes with these items in. If you are prone to candida avoid mushrooms and do not have too much fruit. It is as important as to what you do not eat as to what you do eat.
If you are a vegetarian or vegan then you can replace the meat or fish with quorn mince or pieces. If you need to be dairy free then you can use Soya, goat's milk products or oatmilk instead.
Try adapting some of the recipes with your own ideas and then swap your ideas with others at support group meetings.
Guidelines to the diet
- To get best results from your efforts of following the diet to control Reactive Hypoglycaemia you also need to remove all stimulants including alcohol, caffeine, chocolate, glucose energy drinks and nicotine. This is best done gradually to avoid severe withdrawal symptoms.
- You need to eat breakfast or a balanced snack within 20 minutes of getting up.
- You need to eat a balanced meal or snack every 2 to 2½ hours even if you do not feel hungry.
- You must never feel hungry or too full.
- Adjust size of meals and snacks to how active you are and how much weight you need to lose.
- Avoid all artificial sweeteners, sweets, cakes, biscuits, pastries and pizzas.
- Do not add sugar to your food or drinks. (use small amounts of 'fruit sugar' if needed.)
- Avoid additives, preservatives and colourings as much as possible.
- Avoid monosodium glutamate completely (no Chinese meals.)
- Fruit must not be eaten at the end of a meal because it can ferment and give off more sugar.
- Avoid all puddings and desserts.
- Aim to have your largest meal in the middle of the day.
- Do not eat a large meal late in the evening especially if you need to lose weight.
- Drink plenty of water between meals and snacks.
- Eat a balanced snack as a supper about 1 hour before bed.
Welcome to your new, healthy and enjoyable way of eating which should help you to feel and look better and reshape as you lose excess fat.
3. Eye Exercises
Many Fibromyalgia sufferers complain of frequent headaches and migraines, dizziness, vertigo, eye strain, eye pain, dry, itchy, achy or watery eyes, blurred, changing or double vision as well as poor night vision, dislike of bright lights, checked or stripy patterns and difficulty reading for any length of time.
I believe that all these symptoms can be greatly reduced or totally eradicated by some very simple eye exercises.
There are six postural muscles that are responsible for moving each eyeball. These are postural muscles. Postural muscles do not have a good blood supply and subsequently have poor lymphatic drainage so waste products can accumulate over time, especially in Fibromyalgia sufferers. I believe this is why the characteristic Fibromyalgia eye problems listed above can arise. The waste products, from foods that they cannot deal well with, act like tiny 'knots' in the eye muscles which reduce their ability to contract and relax effectively.
The good news is that these knots are like slip knots, which means that if the eye muscles can be stretched long enough and hard enough the knots can be released. The eye muscles are then able to work normally, and equally importantly, relax normally. The troublesome eye symptoms and headaches gradually recede as the knots are released. This normally takes one to six weeks of once-a-day eye exercises which take about two minutes to perform.
Please note that if a Fibromyalgia sufferer does not follow the dietary advice recommended as part of The Combination Approach then over time it is likely that these knots will gradually return, along with the troublesome eye symptoms.
4. Re-education of correct breathing patterns
Most sufferers of Fibromyalgia have a poor pattern of breathing. They will easily over-breathe and show a type of mild chronic hyperventilation syndrome. The commonest symptoms they experience are:
- Feeling out of breath after even minimal exertion, making exercise unpleasant
- Reduced diaphragmatic breathing, commonly due to obesity
- Struggle to walk and talk at the same time
- Feel dizzy and ill during or after walking up hills or lots of steps
- Excessive sighing and yawning even when not particularly tired
- Palpitations after gentle exertion
- Frequent unexplained light-headedness
- Paraesthesia in upper limbs and around mouth and nose
- Tightness in chest after sneezing or yawning
- Difficulty holding notes when singing
- Awareness of frequently snatching breaths when talking
- Out of breath upon going to answer a telephone, even if nearby
- Poor colour of skin, often marbling effect
- Easily feel cold, especially hands and feet
- Asthma type symptoms
I believe that the main reasons for poor breathing patterns in Fibromyalgia sufferers are:
Trigger points in the intercostal muscles. The intercostals are postural muscles which need to be able to stretch enough to allow the lower ribs to move out and upwards in a characteristic 'bucket handle' action. Trigger points act like knots in a piece of elastic. They limit the extent that these muscles can stretch. The lower ribs cannot then move as far as they should. Therefore the lateral bases of the perfectly healthy lungs cannot be utilised as fully as they should be. As a result, if a person needs more oxygen to supply increased needs during exertion, e.g. when climbing stairs and walking up inclines, then if they cannot breathe deeper they have to breathe faster.
A normal range of expansion of the lower rib cage, depending on age, sex, fitness, height and weight, should be three to five inches. I have found that most sufferers of Fibromyalgia have less than two inches difference between inhalation and exhalation. It is not unusual for this to be less than one inch, and a handful of patients have even shown paradoxical breathing movements where their inhalation measurement is less than their exhalation measurement. This is incredible since they have no evidence of actual lung disease. Again if they cannot breathe deeper they have to breathe faster.
On palpation of the intercostal muscles there are often obvious areas of very painful to the touch nodules. These are the 'knots' that stop the intercostals allowing the normal 'bucket handle' action of the lower rib cage.
Habit and stress can perpetuate the condition. It becomes normal for the sufferer to feel out of breath, increasingly so as they become more anxious or stressed. This happens very commonly with flights of stairs. The sufferer has become breathless, dizzy and fatigued many times when climbing stairs. At the bottom of the flight they may then anticipate unpleasant symptoms, which causes them to feel stressed and slightly panicky. This, unfortunately, exacerbates their over breathing with even more unpleasant consequences. A vicious cycle is set up.
Poor posture adds to poor breathing patterns in several ways. A hunched over posture, which is very typical of Fibromyalgia sufferers, impedes good, deep breathing. This adds to pain and muscle spasm around the mid thoracic area and can limit basal expansion.
The inactivity of many Fibromyalgia sufferers means that they are not naturally calling on 'good deep breaths' very often. Many sufferers say that they have not had good breath control for many years. This, ironically, puts them off doing more exercise because they easily feel out of breath, e.g. when swimming or cycling.
The Combination Approach includes steps to address all these breathing problems as an important part of the overall treatment:
- A full explanation of the importance of correct breathing patterns and of what they have been doing wrong for so long.
- Deep massage techniques to reduce and remove trigger points in the intercostal muscles. When appropriate a sufferer is also shown how to do this on him or herself at home.
- Deep breathing techniques such as silent counting of inhalation and exhalation aiming to double the length of exhalation compared to inhalation. A count of 5 seconds in and 10 seconds out is often the starting point. As basal expansion improves a target of 9 seconds in and 18 seconds out should be achievable. At this point the sufferer will be getting out of breath much less easily and the other symptoms will have greatly improved.
- Towel exercises can be taught to stimulate lateral costal breathing by providing resistance to inhalation.
- Diaphragmatic breathing is taught if this is found to be limited
- The patient is taught how to apply the 'new' breathing pattern to activities of daily living.
5. Posture and Core Exercises
A good posture is essential for good breathing control, good digestion, and strong core muscles, and to protect the muscular skeletal system from unnecessary stresses and strains.
Most Fibromyalgia sufferers have very poor posture in sitting and standing. Many will have had increasingly poor posture for most of their life. This can be for several reasons:
- Pain and aching in the scapular and upper thoracic area, previously referred to as 'fibrositis' but which is now synonymous with Fibromyalgia.
- A self-conscious attitude about their height, weight or shape can make a Fibromyalgia sufferer stoop to be less noticed. Most sufferers lack assertiveness and try to blend into their surroundings (part of a 'people pleasers' nature).
- Previous trauma to the thoracic spine e.g. whiplash.
- Previous pathology of the spine e.g. Scheurmann's Disease, congenital or acquired kyphosis or scoliosis.
- Poor tone of core muscles due to lack of exercise when younger (maybe because of lack of stamina).
- Habitual bad posture results in gradual adaptive changes making it harder for the sufferer to correct their posture.
- Genetic predisposition to poor posture e.g. a Dowager's hump.
The Combination Approach includes:
- Core exercises to strengthen all muscles of the trunk and pelvic areas. A gym ball is a super way to do this. A sufferer can start by just sitting on a gym ball for increasing lengths of time, and then more advanced exercises are taught as appropriate. This is an excellent piece of equipment for the sufferer to have at home.
- Stretching, twisting and bracing-back exercises are good for gently self-mobilising the usually very stiff mid thoracic spine. These start off very gently but get harder as their condition allows.
- Advice on positions to adopt for better posture when sitting, standing, walking, exercising and laying down.
6. Body Working Techniques
There are several basic hands on physiotherapy techniques which help to break down fibrositic nodules or ropey bands. These techniques work much better once the diet to control reactive hypoglycaemia has been followed for a few weeks. The nodules and bands will gradually have built up in postural muscles, and can continue to build up unless the sufferer eradicates simple carbohydrates, food additives, artificial sweeteners and other chemicals in their diet as advised in The Combination Approach.
The body working techniques which can be used are:
- Deep tissue massage
- Deep kneading
- Deep frictions
- Gentle stretching
- Gentle mobilisation techniques
Modified versions of these techniques can be taught to the sufferer or a partner and continued at home on a weekly basis if tolerated.
After any body working techniques it is important for the patient to exercise the treated areas gently but regularly. They should drink plenty of water afterwards to flush out any toxins. Alternate use of warm and cool packs can help relieve post treatment soreness and help to improve both deep and superficial circulation. This can help to improve lymphatic drainage in the affected areas.
7. Exercises to improve the Lymphatic System
The lymphatic system is one of our waste removal systems. It is part of our immune system, and is responsible for removing toxins from the body. The lymphatic system has become sluggish in most Fibromyalgia sufferers.
This could be because of:
- Low level of physical activity because of aches and pains, and lack of stamina.
- Poor circulation, which may lead to slowing of the thoracic duct pump behind the sternum, which is activated when the heart pumps enthusiastically as during exercise. The thoracic duct pump is responsible for pumping lymph around the lymphatic system.
- Dysfunctioning of the autonomic nervous system which helps to regulate the lymphatic system.
The state of a sufferer's lymphatic system is indicated by:
- Thick 'fluidy' looking legs out of proportion to the sufferers overall weight.
- Puffy feet and ankles, although other signs of a heart condition are absent.
- Acute tenderness is evident on palpation of the upper lateral aspect of the chest, below the axilla. This can be apparent on both sides but is worse on the left side. Tenderness of the lymphatic vessels is a sign that they are engorged and possibly varicosed, which will make them sluggish and ineffective. Lymphatic vessels can become varicosed just like veins. The slow movement of the lymph causing pooling in the lymphatic vessels which stretches their walls. The valves within these vessels are then unable to close fully so there will be back flow of the lymph fluid. This in turn stretches the vessel walls even more and so more lymph will then pool in this area and the vessel walls will eventually varicose.
- A general feeling of puffiness of hands and face.
- Puffiness around the eyes can indicate sinus drainage problems.
- A recurrent postnasal drip, frequent runny nose or catarrh can all indicate sinus problems.
The Combination Approach uses simple exercises to improve the lymphatic system:
- Exercises designed to increase the working of the thoracic duct pump to help increase the speed at which lymph travels round the body.
- A rebounder, which used in short bursts, should not aggravate painful arthritic conditions which can co-exist with Fibromyalgia Syndrome.
- Self massage techniques from axilla and chest areas working towards the area of the clavicles. Even very painful varicosed lymphatic vessels can be improved with just a few weeks of these massage techniques and getting the pump working more effectively.
- Exercises and techniques are taught to improve drainage of the facial sinuses. Correct drainage of all the facial sinuses is very important to help eliminate toxins at a quicker rate. Repeated sinusitis, a deviated nasal septum or previous trauma can all result in inadequate sinus drainage.
- General exercises, especially walking with the arms swinging, to improve circulation which will also improve lymphatic drainage.
8. Improve functioning of Adrenal Glands
There are certain non-essential amino acids that are known to be important in the healthy functioning of the adrenal glands. Foods containing a substantial level of these amino acids are incorporated into the diet I recommend for sufferers of Fibromyalgia. Over time these can naturally help the adrenal glands to perform more normally.
Equally there are certain food substances which can over stimulate the adrenal glands and so need to be eliminated from a Fibromyalgia sufferer's daily diet. These include alcohol, nicotine, caffeine, ginger, artificial colourings, additives and preservatives and all artificial sweeteners as well as any stimulant drugs.
There are several very simple self-help exercises which have been shown to be effective at 'relaxing' the adrenal glands. These can be performed at times of stress, when a sufferer recognises that their adrenal glands are working overtime. They can be beneficial before bedtime to aid more restful sleep and during the night when a sufferer cannot get back to sleep.
9. Improve Sleep and Cognitive Skills
There are many simple and safe but effective ways to help achieve better sleep without the use of prescribed medications. Time needs to be taken to analyse the type of sleep problem e.g. difficulty getting to sleep because of over-active body, frequent waking during the night, frequency of micturition disturbing deep sleep, or waking up in the morning feeling nauseous, nervous and apprehensive or totally unrefreshed mentally and physically. Each type of sleep problem needs addressing to gain the good, deep, natural sleep which is vital for good health and well-being.
Some sufferers who are fairly inactive all day wrongly think that if they try to sleep for 10 to 12 hours a night then they will feel better. Instead they get more stressed that they only manage 5 or 6 hours of good sleep but because they are resting so much during the day, this may be perfectly adequate.
A sufferer needs to take on the 'psyche' of a 'well person' and behave as much as possible as a 'well person' i.e. they should get up no later than 8am and try not to retire before 10pm. By getting up very late and going to bed very early they are expecting their blood sugar levels to stay fairly constant for up to 16 hours. This is far too long. As their blood sugar level falls adrenaline will be produced which may cause too much noradrenaline to be produced (the Reactive Adrenal Syndrome – see Dysfunctioning of Autonomic Nervous System). The sufferer can then wake up feeling ill, lethargic, hung-over (without having had any alcohol the previous day), hungry but nauseous, and totally overwhelmed at the thought of coping with the day's tasks feeling like this.
The parasympathetic nervous system secretes hormones to keep us in deep (stage 4) sleep. A few seconds before waking up a Fibromyalgia sufferer may have an excessive surge of sympathetic activity which causes the sufferer to wake up suddenly and feeling stressed without knowing why. This dysfunctioning of the Autonomic Nervous System needs to be addressed to regain better sleep by allowing the parasympathetic nervous system to stay in control over night so that more time will naturally be spent in the deep sleep when many of the 'happy' hormones are produced to further benefit the Fibromyalgia sufferer.
Included in The Combination Approach to help improve sleep are:
- Eating a balanced supper about an hour before bedtime helps to stabilise blood sugar levels during the night reducing the risk of inappropriate adrenal activity
- Use of omega oils, especially EPA supplements, can help to induce and maintain deep sleep
- Techniques of how to turn over and move around in bed without firing off painful trigger points and causing the sufferer to be in more pain which makes going back to sleep harder
- Relaxation techniques for mind and body including a short session in the early evening of thinking through and dealing with any 'little worries' that may otherwise be on the one's mind when trying to get to sleep
- Techniques to help prevent troublesome 'pins and needles' and 'banana fingers' waking the sufferer in the middle of the night
- Advice on bladder re-training to prevent frequency of micturition disturbing sleep
- Use of two or three drops of relaxing and soporific essential Lavender oil on pillow
- Drinking soporific teas at bedtime e.g. Valerian tea and Camomile tea
- Use of breathing exercises to induce sleep
- Adrenal exercises to relax the adrenal glands
- Advice on posture in bed when reading etc.
- Advice on the correct bed, mattress, pillow and bedroom conditions to aid better sleep e.g. a cool pillow and a very dark bedroom can help greatly.
Cognitive skills generally improve with the dietary changes of The Combination Approach. One of the reasons for this is the increase in omega-3 and omega-6 oils, as are found in nuts, seeds, oily fish and EPA supplements. Another reason is that as the sufferer starts to feel better and less stressed, they often find their levels of concentration and short-term memory greatly improved. Better breathing techniques help, as do maintaining stable blood sugar levels, because the brain is the most sensitive organ to the rapidly changing blood sugar levels that the sufferer was experiencing prior to following The Combination Approach.
10. Other self-help techniques
There are a multitude of self-help techniques and a whole host of self-help hints that I give to Fibromyalgia sufferers to help regain and maintain better health.
These include:
- Advice on graded exercise as their condition improves.
- Encouragement of walking, swimming, cycling and joining a gym if appropriate.
- Regular wet or dry skin brushing to help remove toxins through the skin. The patch of skin over the triceps is a good indicator of toxin levels in the body. If this area is pimply and blemished, or very dry and flaky, this is indicative of high levels of toxins in the body. As patients get well, this area improves until it feels as smooth and soft as a baby's bottom.
- Encouragement to the sufferer to return to work, retrain or take up new hobbies, depending on their age, other medical conditions and level of improvement.
- Even part time or voluntary work is excellent for moral and mental well-being and social factors and is encouraged. Some sufferers are understandably very cautious of taking more things on in case it sets them back but with support and understanding many return to useful employment of some sort.
- Basic visualisation techniques can be extremely beneficial to a sufferer. For many years they may have visualised themselves as getting worse physically. The pessimism of many people, including most medics and health professionals only reinforce a sufferer's 'doom and gloom' about their condition. They are frequently told by Consultants in Rheumatology and Pain Management, GPs, Therapists, Advisors at Job Centres and fellow sufferers that they have just got to accept the condition and live with it. This will cause some sufferers to give up and not even look for ways of helping themselves. While ever a sufferer allows himself or herself to be a victim, they will be. Simple visualisation techniques like the ones used by gymnasts and other serious sports people to see a successful outcome can be taught in minutes and help the sufferers to see a more positive, healthier future.
- Techniques to help a sufferer become more assertive are often beneficial. Most Fibromyalgia sufferers are people pleasers and may need to learn to 'say no' and not then feel guilty.
- Most sufferers need to learn to put their needs, aspirations and opinions higher up the list. They need to become more 'selfish' but for the right reasons. This is often alien to them but can be beneficial if they are encouraged to do so.
- Many sufferers will have experienced severe traumas or prolonged stressful times in their past, prior to becoming ill. Many demonstrate mild Post Traumatic Stress Disorder. This needs to be addressed to regain a healthy emotional system which works hand-in-hand with our physical systems. I have adapted some simple techniques to 'desensitise and reprocess' past thoughts and experiences which may be enough to deal with certain stressful events. A few sufferers may need professional counselling or psychotherapy.
- Advice on dealing with stressful situations that life throws at us. I explain how to keep the Autonomic Nervous System from becoming dysfunctional, which could result in a return of the troublesome symptoms.
- Advice on future situations which could possibly throw their body out of balance. These include dental procedures, minor or major operations (especially if they involve a general anaesthetic) and the onset of the menopause or pregnancy.
Comments from successful patients
Here is a selection of my favourite comments from patients of The Combination Approach.
- “I have now forgotten that I have Fibromyalgia.”
- “If this is as good as it gets, I’ll be happy, but if this is just the start then ‘Wow!’”
- “A big thank-you: you have given me hope where there was none.”
- “Today I feel better than I remember ever having felt, even before having glandular fever.”
- “For the first time in my life, I feel in control of my destiny!”
- “Thank you for giving me my life back.”
- “It isn’t an immediate miracle cure. You have to work hard at it, and be sensible, but if you keep it up, there are no limits to its benefits.”
Conclusion
In conclusion, for a condition where the received wisdom is that there is very little that can be done by the sufferer or the medical profession, to the contrary I have put together a whole host of simple, effective, non-invasive techniques which have had a very positive outcome for the majority of sufferers who have tried The Combination Approach.
It is hard work getting well, it is hard work staying well, but it was hard work being ill and certainly not as enjoyable.
I had to wait over twenty years to get well which took great patience, perseverance and persistence. I hope it will not take this long to make Fibromyalgia sufferers, the medical profession and the general public aware of this frustrating and life-affecting condition and how much a sufferer themselves can do to improve their state of health. I believe it will take courage, charisma and conviction to convince people about The Combination Approach, but I feel that I have plenty of all three qualities.
Provided the Fibromyalgia sufferer is prepared to commit fully to the treatment programme with its necessary dietary and lifestyle changes then I am indeed Successfully tackling Fibromyalgia.
Copyright 2006 T.N. Wickerson M.C.S.P.
A Word document of this article is available here if required for printing.
 
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