Thirteen years ago, Christine Yovanovich came down with a severe case of flu-like symptoms. "My joints ached, and I could barely get out of bed," recalls the 39-year-old from Indianapolis. But the pain and fatigue didn't run their course as they would have with influenza. For weeks, then months, and eventually years, they waned from time to time but never vanished. "Some days I felt like I was dragging a corpse around," she says.
Desperate for relief, Yovanovich ricocheted from doctor to doctor. Each ran tests, but the results were always the same—everything looked normal. "I took every test under the sun," she says, "and still the doctors were baffled. "They would pooh-pooh my symptoms and tell me it was all in my head," she adds, "and after a while I believed them." Finally, in 2002, she visited a rheumatologist who immediately recognized what no other doctor had: Yovanovich had fibromyalgia.
Fibromyalgia is a chronic pain disorder that affects up to 10 million Americans, most of them women. It was identified in 1816 by a Scottish physician, but wasn't officially recognized by the American Medical Association as an illness until 1987. It manifests as pain in the fiber of the muscles, often throughout the body, along with unrelenting fatigue, headaches, and sleep disturbances. And it can mimic other ills, such as chronic fatigue syndrome or rheumatoid arthritis, which often leaves sufferers like Yovanovich spending years seeking a correct diagnosis. Because there is no definitive test for the condition, the diagnosis is tricky and some doctors continue to question its validity.
Fortunately, there is one diagnostic tool available if you suspect that you or someone close to you has fibromyalgia. In 1990, the American College of Rheumatology created a map of 18 "tender points," or places on the body that are most often tender to the touch in people with fibromyalgia. A person who feels pain in 11 of the 18 tender points probably has it.
While the exact cause of fibromyalgia is still a mystery, science is beginning to shed light on the disease. "There are genetic risk factors that make it more likely that you will, under certain circumstances, develop a chronic pain disorder like fibromyalgia," says Leslie Crofford, an expert in the disorder and chief of rheumatology at the University of Kentucky in Lexington. A person may be born with a risk factor, but it will remain dormant until it's activated by something like a car accident, a repetitive-motion injury, or osteoarthritis, Crofford says.
Stress is also a trigger. Yovanovich suspects that stress ignited her own fibromyalgia. When she first fell ill, she was struggling in a bad marriage, working at a challenging job, and finishing an advanced degree, all at once. "I was surrounded by stress at work, home, and school," she says. "There was no escape."
A breakthrough in understanding the condition has come via advances in medical brain imaging, which reveal that people with fibromyalgia process pain differently from those without it, due to a kind of hypersensitivity of the nervous system. For instance, pressure that feels mildly uncomfortable to the average person often feels painful to someone with fibromyalgia. "Basically, the volume control on pain is turned up as high as it will go," Crofford says.
Following her diagnosis, Yovanovich grew frustrated that Western medicine didn't offer any solutions and, like most other fibromyalgia patients, began exploring complementary and alternative approaches. She rid her diet of sugar because she is hyperglycemic and also to reduce yeast overgrowth in her gut, which many alternative health practitioners believe interferes with immune functioning. She took B vitamins to help restore her energy levels, and magnesium supplements to recharge her muscles.
But it wasn't until 2002, when she took a yoga workshop that focused largely on meditation and breathwork, that she felt a substantial shift. As she harnessed her breath and quieted her mind, she felt her muscles begin to relax and the pain lessen. She began to practice meditation and Pranayama at home and, for the first time in many years, started to make peace with her body.
"What I noticed in the beginning was the sheer terror I had about going into my body after I'd spent so many years running away from it," she recalls. "It helped me to accept my life with fibromyalgia."
Yoga's ability to shift the nervous system out of the stress response and into the relaxation response is vital to people whose central nervous systems are sensitive and naturally hyped way up, says Crofford. It also acts directly on the very muscles where fibromyalgia pain occurs. "Think of it like having a writer's cramp in all of your muscles at once," says Jacob Teitelbaum, medical director of the National Fibromyalgia and Fatigue Centers. First the muscles shorten, then they get stuck in the shortened position, and eventually they hurt. (The tender points are often located where cramps commonly occur.) "One of the beauties of yoga for people with fibromyalgia is that it returns muscles to their normal length," he says.
That's what yoga did for Anita Murray, a health coach in Waupun, Wisconsin, who was struck by fibromyalgia after being in a car accident in her early 20s. Now 45, Murray says she was nearly crippled by muscle pain for years after the crash. "My muscles were so stiff I could hardly walk; the biggest step I could take was heel to toe," she says. "I was in chronic pain, but the doctors said there was nothing they could do for me."
When she came across a book on hatha yoga three years after the accident, she decided to give it a try, and she noticed a difference in her body right away. "My range of motion increased, my chronic pain decreased, and I started sleeping more soundly," she says. "I could finally take normal steps again."
Yovanovich had a similar experience when she incorporated movement into her routine. "After I started an asana practice, my symptoms became a lot less frequent and a lot less intense. I got my life back."
One of the few certainties about fibromyalgia is that it affects everyone differently, and a yoga practice should reflect that. Some people may want to follow Yovanovich's path, bringing awareness back into the body with meditation and pranayama before starting an asana practice. Others may benefit from going to a restorative yoga class. Experienced yogis may thrive with a vigorous practice. The key is to find the right type of class and teacher for you.
Shoosh Lettick Crotzer, the author of Yoga for Fibromyalgia, recommends that beginners do a gentle practice that enhances relaxation and that they avoid strenuous poses until they know they can move into them without triggering a pain reaction. Murray discovered this firsthand. "At first I would go too far into poses and be in so much pain the next day that I couldn't move," she says. "So I learned to go into a pose until I felt my muscles start to stretch, and then I'd back off."
Crotzer suggests yoga styles that focus on alignment, relaxation, or therapeutics, such as Iyengar, Kripalu, or Viniyoga. She also advises working with instructors who have at least 10 years of teaching experience and letting them know before class about your condition, so they can be ready with appropriate modifications.
Yovanovich still uses yoga to keep her symptoms in check. "I'm always fighting fatigue, so I do a lot of backbends, like supported Setu Bandha Sarvangasana (Bridge Pose), to bring energy into my spine. And when I'm feeling anxious, I naturally move into Uttanasana (Standing Forward Bend)," she says. For her, yoga has made life with fibromyalgia worth living. "I lost almost everything before yoga," she says. "Now I have a quality of life that I never thought possible."
Easing the Pain
People with fibro-myalgia often have chronic tension in the upper back, shoulders, and neck—places where 10 of the 18 tender points are located. All three areas are easily targeted with a few simple yoga poses. "A favorite pose for many of my students is seated Garudasana (Eagle Pose), because it stretches the muscles around the shoulder blades in the upper back," says Shoosh Lettick Crotzer. She also recommends Bhujangasana (Cobra Pose) to extend the back while opening the chest as well as gentle head rotations to relieve tension in the large muscles on the sides of the neck. She also offers this advice: Stay warm, because cold can tighten muscles; move slowly; breathe into painful areas; and work both sides of the body evenly to maintain balance, even if the pain is only on one side.
People in chronic pain often default to short, shallow breathing, which can set off the body's fight-or-flight response and trigger the release of stress hormones like cortisol. Breathing deeply counters stress by stimulating the vagus nerve. Running from the brain to the diaphragm, the vagus nerve activates the parasympathetic nervous system. That's why breathwork is crucial for people with fibromyalgia, says Shoosh Lettick Crotzer. She recommends what she calls the "healing breath" to help assuage the pain.
To try it, lie in a supported Savasana (Corpse Pose). Inhale and exhale slowly, focusing on how the air feels as it passes through the nose, into the body, and back out. Think of the breath as the gift of prana, or life force. Visualize this healing breath filling the whole body. Let each new inhalation bring energy to expand and soften, cleanse and release. With the exhalation, let the tension and heaviness of the pain flow out of the body. Continue until you feel quiet and more relaxed. Come out of the pose when you are ready.
Catherine Guthrie is a freelance writer and yoga instructor in Bloomington, Indiana.