Arthritis and Rheumatism Associates, P.C.

Rebecca Wagner, PT

FM – Turn Down the Volume

Fibromyalgia (FM) is defined as widespread musculoskeletal pain that can include achiness, tenderness, and stiffness. It often is accompanied by fatigue and psychological changes, such as depression. Current theory states this condition is caused by central sensitization; that is, increased sensitivity in the brain to pain signals. This sensitization includes a change in the levels of the neurotransmitters resulting in amplification by pain receptors in the brain. Normal stimuli are perceived as painful. Think of a radio with the volume blasting that needs to be turned down.

So far, the exact cause of fibromyalgia is not known. There are several theories regarding what can trigger the onset: physical trauma, surgery, viral or bacterial infection, significant psychological stress, hypermobility, immune system dysfunction, abnormal brain function during sleep. Symptoms can accumulate gradually over time without a triggering event. Women are more likely than men to develop this condition

Fibromyalgia is diagnosed by ruling out other conditions. A diagnosis of fibromyalgia includes widespread pain longer than three months and pain and tenderness at 11 or more of the 18 identified tender points on the body. In addition to the widespread pain, some of the frequent signs and symptoms include headache, TMJ disorder, irritable bowel syndrome and other GI disturbances, fatigue and sleep disturbances, poor concentration and memory problems.

Treatment for fibromyalgia includes managing it with medication and elements of self-care: exercise, stress management, healthful eating and good quality sleep.

Treatment for fibromyalgia includes managing it with medication and elements of self-care: exercise, stress management, healthful eating and good quality sleep. Medication that is managed by a health care provider can include analgesics, antidepressants, and anti-seizure drugs. Exercise should consist of a gentle program incorporating stretching, strengthening and aerobic activity with a gradual progression. Stress management can include coping skills and strategies: pacing oneself by modifying a schedule and/or breaking down activities, taking breaks, removing stressor(s), exercising and meditation. Utilizing sleep hygiene elements to ensure getting proper rest is an important component for managing the symptoms of fibromyalgia.

Successful management of fibromyalgia involves active participation and a take-charge attitude. Utilizing modalities (ice/heat) for symptom relief, developing coping skills and strategies to reduce stress and getting adequate rest and nutrition are key for successful management. As stated by a former patient, it can simply entail “resting when you’re tired; eating when you’re hungry.”

If you have fibromyalgia, consider consulting a physical therapist. Ask your rheumatologist more about physical therapy at ARTS in order to teach you how to better manage fibromyalgia and similar conditions.

Sleep Hygiene Strategies

Matthew Reed, PT, MPT, CMTPT

The health benefits of quality sleep, and risks associated with sleep deprivation, are wide-ranging and well-understood, and we cherish that feeling of rejuvenation after a night of productive sleep. Yet, for many, a good night’s sleep is hard to come by, and we often rise in the morning feeling unrested and lethargic. And worse, the hormonal disturbance caused by lack of productive sleep can have compounding effects and further reduce the prospects of achieving productive sleep in the future. This creates a vicious cycle that may have detrimental health consequences over time.

Sleep deprivation has been associated with increased risk for heart disease, stroke, cancer, serotonin deficiency and depression; imbalance of hormones that regulate appetite and difficulty managing weight; and decreased alertness, memory and cognitive function.

Sleep deprivation has been associated with increased risk for heart disease, stroke, cancer, serotonin deficiency and depression; imbalance of hormones that regulate appetite and difficulty managing weight; and decreased alertness, memory and cognitive function. Additionally, of consequence to many of our physical therapy patients, lack of sleep can lead to production of stress hormones that increase inflammation in the body and cause the body’s “engine” to run at high levels. This contributes to even greater difficulty sleeping, fatigue and lack of energy, delayed healing of tissues, and, potentially, development of persistent pain and sensitivity. Conversely, quality sleep can help manage and reduce pain and sensitivities by restoring hormonal balance and repairing tissues that have been damaged or altered by injury, chronic conditions, and even stress.

If you’re concerned about the potential health consequences associated with lack of sleep,or even looking to improve your ability to manage or reduce pain, here’s a checklist of practical tips to consider to improve the quality of your sleep and your ability to rejuvenate and heal overnight.

Your sleep plan:

  1. Aim for 7-9 hours of sleep at night
  2. Set a sleep time BEFORE midnight; you’ll get 2 hours’ credit for every hour slept before midnight
  3. Start “winding down” and quieting the house an hour before bedtime (phones off, lights out, house tidied)
  4. Do stretches, meditation, deep breathing, light reading, other relaxation techniques in the hour before bedtime
  5. Take a warm shower 1-2 hours before bedtime
  6. Keep your bedroom dark and cool for greater melatonin production
  7. No bed buddies (pets or kids)
  8. Stay hydrated during the day, but reduce water intake later in the evening
  9. Limit intake of caffeine and alcohol, especially later in the evening
  10. Limit naps during the day to 20 minutes to prevent sleep disruption at night
  11. Park your thoughts at night (make notes on paper of any thoughts and keep nearby to avoid thinking in bed)
  12. No TV, social media, work emails, or other screens or blue light before bedtime
  13. Maintain a consistent regimen of aerobic exercise
  14. Position pillows for body support and comfort when lying in bed
  15. Ask your doctor about melatonin supplements
  16. Try to sleep naturally (no noise makers)
  17. Your partner/spouse must leave the bedroom if he/she snores or moves around

Now, go to bed!

Written By: Ionie Moragahakumbura, PT, DPT

Cooking without pain

Living with chronic pain can be difficult in all stages of life. In order to maintain your independence with regular activities, including cooking and taking care of your house, some modifications may be necessary to minimize exacerbation of symptoms that you may regularly experience.


We all must eat at some point in our day for energy. While appetites vary, a certain amount of meal preparation is required prior to eating a meal. Some suggestions related to pain-free cooking include incorporating regular rest breaks and making smaller tasks out of cooking a large meal. For a meal that usually takes one hour to make, divide it up into sections. Initially start with vegetable and meat preparation, including washing, cutting, and seasoning followed by a rest break or a stretching break. Next, partake in the cooking process. Finally, save clean-up for after another break. Many people want to push through, but slow and steady wins the race in this situation.

Other modifications might include performing some pre-preparation in a seated position or with one foot resting on top of a stool to minimize weight on a painful joint. Pulling up a stool next to the stove is also an option for dishes that need more attention like frequent stirring or adjusting heat. The upcoming fall and winter holidays often mean more cooking for those who traditionally host gatherings. Don’t hesitate to ask for help, create a potluckstyle menu or have friends come over earlier to spend time with you as your sous chef. This also applies to requesting a group effort to help clean up dishes, pack away extra food and do other clean-up after dessert is finished.

As a busy mom of a young family, I look to one-pot meals (including crockpot, stovetop, and sheet pan in the oven). This results in decreased clean up and decreased standing time waiting for food to be cooked. While my motives may be different, I save time on cooking to spend time on other things I wish to enjoy. The internet is a huge source of recipes for easy and
simple meals. Cooking shows, bookstores, and even YouTube have insightful tips to simplify cooking as well.

It is important to have an open dialogue with your therapist about the goals you wish to achieve in your course of care. Therapists are a wealth of information to help advise you not only in exercises but also with ideas about how to perform different tasks in different postures or positions to decrease your pain.

Bon appetit, or should I say, Bon a PT!


back exercises

Joshua Costa, PT, DPT

Exercises are a key component in rehabilitation that allows the body to improve range of motion, strength, balance, mobility, endurance, coordination and posture. Exercises can vary in intensity and repetition, and can be performed in various positions, all for specific goals. Certain exercises promote flexion (bending) of the spine, such as bringing your knees to your chest or when rounding your back. These exercises often are prescribed when treating osteoarthritis, spondylolisthesis (slipping of one vertebrae on another) and spinalstenosis. Other exercises promote extension (straightening), such as lying on your stomach and pushing up onto your forearms or extended elbows. Generally speaking, extension exercises can be helpful with a posterior disc herniation, ankylosing spondylitis and osteoporosis,to name a few. Depending on one’s diagnosis these exercises can be helpful or harmful.

A physical therapist will perform a thorough evaluation and, based on findings, the order from the referring doctor and the patient’s subjective report, will develop a specialized plan of care that is customized to the patient’s needs. This plan of care may include treatments such as manual therapy, exercise, neuromuscular reeducation, gait training, electric stimulation, ultrasound, dry needling and more.

The exercises prescribed by a PT are specific to the individual and generally should not be performed by others unless directed by a medical professional. It is very important to know if an exercise is appropriate for you before performing it. Of course, form is always a critical part of any exercise. The physical therapist will emphasize the importance of proper posture and avoiding compensatory movements when exercising.

The goal of this education is to improve technique, body awareness and function, minimize overuse injuries and halt the worsening of symptoms. A therapist’s ultimate goal is to restore a patient’s function and empower the patient to be independent. Exercises are a key component of any physical therapy intervention but should be treated like a prescription for the individual and not performed without specific direction.


Does someone in your family have osteoporosis (thinning of the bones) or a history of hip fracture? 

Angus B. Worthing, MD, FACR, FACP

“According to the National Osteoporosis Foundation, one in two women and one in four men over age 50 will have an osteoporosis-related fracture in their life. Osteoporosis can develop when the natural microscopic remodeling process inside bones, which normally consists of constant extraction and replacement of calcium, is disrupted. It is crucial to perform a careful interview and physical exam, followed by a state-of-the-art screening test much like an x-ray (“DEXA” test), which Arthritis & Rheumatism Associates, P.C. (ARA) has on-site for your convenience. This will clarify if your bones are healthy, or if you have osteopenia (a milder form of bone thinning) or osteoporosis. Also, simple blood tests can make sure your calcium and vitamin D levels are healthy.”

View Angus B. Worthing, MD, FACR, FACP Qualification

In recent years more and more studies are being conducted by top medical universities. In an effort to encourage more people to be well educated on the topic the University of Rochester Medical Center created a short quiz to test one’s knowledge on the condition. Click here to begin the- What Do You Know About Osteoporosis Quiz?

Do you have additional questions? Gather more informative information by reading Washington Arthritis article Do you have Osteoporosis? Curiosity is a wonderful part of the human mind. Feel free to contact us with any follow up concerns by calling our call center 301-942-7600.

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