Yoga therapy for fibromyalgia syndrome: A case report

Abstract

Fibromyalgia is a rheumatologic syndrome leading to increased pain sensitivity, sleep disturbance, fatigue, stiffness, and tenderness of joints, muscles, and tendons due to dysregulation of neurophysiological functions. In the present case report, a 42-year-old, non-Indian, nonsmoking, nonalcoholic, female presented with complaints of severe difficulty in walking, joint pains, and generalized loss of balance of the body. The patient was an established case of fibromyalgia. The treatment plan for the patient included 9 months of yoga therapy. No concomitant allopathic medication was given during this whole treatment period. The patient was given special yoga postures to improve flexibility and movement of joints, daily 1 hour, 6 days/week in the morning, and evening for 9 months. The muscle fatigue, quality of life and sleep was assessed at the baseline, 3rd, 6th, and 9th month. The result of present case study demonstrated reduction in muscle fatigue and improvement in quality of life and sleep.

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© 2020 Journal of Family Medicine and Primary Care | Published by Wolters Kluwer - Medknow 435
Introduction
Fibromyalgia syndrome (FMS) is a rheumatologic syndrome
leading to increased pain sensitivity, sleep disturbance, fatigue,
stiffness and tenderness of joints, muscles, and tendons due
to dysregulation of neurophysiological functions.[1] Patients
with FMS have increased levels of tenderness to palpation and
additional symptoms such as disturbed sleep, stiffness, fatigue,
and psychological distress.[2] Nevertheless, FMS can be managed
well by lifestyle modication and primary care.[3] Antidepressants,
anticonvulsants, or muscle relaxants are the most common line
of treatment for FMS.[4] Since, no causal treatment for FMS
is available, interest in treatments aiming at primary care, and
improvement in physical function has increased. Therefore,
aerobic exercise and strengthening exercises are mostly
administered as primary care for FMS patients.[5] In fact, physical
training has shown improved aerobic tness and work capacity
in FMS patients.[6] Alternate therapies such as acupuncture is
available; although, extensive research is needed in this eld.[7]
However, currently the treatment options are focused on relieving
FMS symptoms and preventing are‑ups.
Therefore, a case study was planned in a patient suffering
from FMS who presented with severe pain and disability. Yoga
therapy showed positive results in minimizing the bromyalgia
symptoms individually in the past studies.[8] However, most of
the studies were conducted for a short duration. Thus, this study
was planned in order to examine the effect of yoga therapy for
a longer duration in treatment of FMS.
Case History
A family of four, comprising of husband, wife, and two
daughters arrived at Kaivalyadhama Yoga Institute on 30.07.17.
The husband had enrolled for 9 months of Diploma course
at Kaivalyadhama Yoga Institute. As his wife was suffering from
FMS, she decided to undergo yoga therapy at Kaivalyadhama
Yoga Institute. She was 42 year old, non‑Indian, nonsmoking,
nonalcoholic, with the complaints of severe difculty in walking,
joint pains, and generalized loss of balance of the body since
Yoga therapy for bromyalgia syndrome: A case report
Anita Verma1, Sanjay U. Shete1, Gururaj Doddoli2
1Scientific Research Department, 2Ayurveda Section, Kaivalyadhama Yoga Institute, Swami Kuvalayananda Marg, Lonavla,
Pune, Maharashtra, India
Abs tr Act
Fibromyalgia is a rheumatologic syndrome leading to increased pain sensitivity, sleep disturbance, fatigue, stiffness, and tenderness
of joints, muscles, and tendons due to dysregulation of neurophysiological functions. In the present case report, a 42‑year‑old,
non‑Indian, nonsmoking, nonalcoholic, female presented with complaints of severe difficulty in walking, joint pains, and generalized
loss of balance of the body. The patient was an established case of fibromyalgia. The treatment plan for the patient included 9
months of yoga therapy. No concomitant allopathic medication was given during this whole treatment period. The patient was given
special yoga postures to improve flexibility and movement of joints, daily 1 hour, 6 days/week in the morning, and evening for 9
months. The muscle fatigue, quality of life and sleep was assessed at the baseline, 3rd, 6th, and 9th month. The result of present case
study demonstrated reduction in muscle fatigue and improvement in quality of life and sleep.
Keywords: Fatigue, fibromyalgia, pain, quality of life, sleep disturbance, yoga
Case Report
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DOI:
10.4103/jfmpc.jfmpc_816_19
Address for correspondence: Sanjay U. Shete,
Scientific Research Department, Kaivalyadhama, Swami
Kuvalayananda Marg, Lonavla, Pune ‑ 410 403, Maharashtra, India.
E‑mail: sanjays@kdham.com
How to cite this article: Verma A, Shete SU, Doddoli G. Yoga therapy
for bromyalgia syndrome: A case report. J Family Med Prim Care
2020;9:435-8.
This is an open access journal, and articles are distributed under the terms of the Creative
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For reprints contact: reprints@medknow.com
Received: 23‑09‑2019 Revised: 16‑11‑2019
Accepted: 21‑11‑2019 Published: 28‑01‑2020
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Verma, et al.: Yoga for bromyalgia
Journal of Family Medicine and Primary Care 436 Volume 9 : Issue 1 : January 2020
18 months. The patient could walk only using a walker or a
stick. The patient also complained of nausea/vomiting, ankle
pain, knee pain, poor vision, fatigue, and sleep disturbances.
Patient was suffering from vertigo and was an established
case of Hashimoto’s thyroiditis and FMS. The patient was on
B12 injections and thyroid medication at the time of arrival.
The case was subsequently admitted to the Health Care
Centre, Kaivalyadhama Yoga Institute on 30.07.17 for yoga
therapy for 9 months. Written informed consent was taken from
the patient for publication of this report.
Therapeutic focus
Looking at the patient’s complaints, therapy was primarily focused
on strengthening of the muscles and stress relief through yoga
practices. No concomitant allopathic medication was given during
this duration. The patient was given special yoga postures to
improve the exibility and movement of joints, 1 hour/day for
6 days/week in the morning and evening under the supervision
of trained yoga therapist for 9 months. Timeline of the case and
intervention details have been presented in Table 1.
Assessment
According to the symptoms of the patient, following standard
tests were administered at the baseline, 3rd, 6th, and 9th months.
Hand steadiness
Hand steadiness was assessed by using an apparatus that consists
of a metal plate with nine holes of decreasing size. Patient was
instructed to avoid the contact of stylus with the sides of the
plates while performing the test. Total errors were counted on
electronic counter.
Grip strength
Hand grip strength of both hands was assessed using hydraulic
hand dynamometer (Saehan, Korea).
Fatigue
Finger tapping board was used to assess fatigue. The patient
was asked to tap the metal bar as many times as possible for
30 seconds.
Back leg strength
A calibrated BLC dynamometer (Baseline, USA) was used to
assess isometric muscle strength. The patient was asked to pull
as hard as possible on the chain and straighten the legs.
Flexibility
Sit and reach test (Baseline, USA) was used to measure hamstring
and lower back exibility. With the palms facing downward, and
the hands‑on top of each other, the patient was asked to reach
forward along the measuring line as far as possible. The score
was recorded to the nearest centimeter as the distance reached
by the hand.
Quality of life
Quality of life (QOL) was evaluated using WHO
QOL‑ BREF questionnaire. The scale provides a measure of an
individual’s perception of quality of life for the four domains: (1)
Table 1: Timeline of the case
Relevant medical history and interventions
Date Summaries from initial and follow‑up
visits
Diagnostic testing Interventions
30.07.2017 Severe difculty in walking, joint pains,
and generalized loss of balance of the
body since 18 months.
Could walk only using a walker or
a stick. Complained of nausea/
vomiting, ankle pain, knee pain, poor
vision, fatigue and sleep disturbances.
Hashimoto’s thyroiditis and bromyalgia
syndrome.
Initial reports done on 30.05.2017:
TFT, B12, Ca, RA, Anti‑CCP, Vit.
D
B12 injections, thyroid medication.
After admission patient was advised to follow yogic diet and
yoga practices.
30.07.2017 Discontinued medication. Advised to take only thyroid
medicines
Yoga practice module under supervision of yoga expert.
14.09.2017 Follow‑up
Follow‑up
Follow‑up
Follow‑up
Hand steadiness, grip strength,
fatigue, back leg strength, exibility,
quality of life, Musculoskeletal
pain, Sleep rating
Shavasana (Corpse Pose); Ardhahalasana (Half plow pose);
Makarkridasana (1‑2) (Crocodile pose); Niralambasana
(Neck stretching pose); Bhujangasana (Cobra pose);
Ardha Shalabhasana (Half locust pose); Ardha Vakrasana
(Half twisted pose); Parvatasana (Mountain Pose);
Marjariasana (Cat Pose); Tadasana (Palm‑tree Pose ); Lateral
Chakrasana (wheel pose); Kati Chakrasana (Spinal twist
pose); Bramhamudra (Neck rotation); Anulom‑ vilom
Pranayama (alternate nostril breathing); Omkar (3 rounds);
Gayatri Mantra (3 rounds); Bhramari Pranayama (Humming
bee breath) (10 rounds); Shavasana (Corpse Pose) (15‑25 min.).
All the asanas were maintained for 30 sec to 1 min.
14.11.2017
12.01.2018
13.03.2018
Final outcome Patient showed an improvement in all the parameters and was able to walk without support and
perform her day to day activities independently.
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Verma, et al.: Yoga for bromyalgia
Journal of Family Medicine and Primary Care 437 Volume 9 : Issue 1 : January 2020
physical health (2) psychological health, (3) social relationships,
and (4) environmental health.
Musculoskeletal pain
Orebro Musculoskeletal Pain Questionnaire was used to assess
the degree of work disability due to musculoskeletal pain.
Sleep rating
Self‑rated sleep quality was assessed using the Sleep Rating
Questionnaire (SRQ) which consists of one open‑ended (item
4) and six close‑ended items.[9]
Follow-up and outcomes
All the variables were assessed at the baseline, 3rd, 6th, and
9th month. Upon follow‑up, patient reported improvement in
physical tness and quality of life. Pain, stiffness and fatigue were
reduced and mobility was improved signicantly. The results of
musculoskeletal pain, grip strength, back leg strength, exibility,
hand steadiness, and sleep quality have been presented in Table 2.
Discussion
The result of present case study demonstrated reduction in
muscle fatigue, pain, and improvement in quality of life and sleep.
The patient showed improvement in nocturnal sleep, decrease
in sleep onset, and reduced day time sleep. The patient was able
to walk without support and able to perform her day to day
activities without exhaustion.
FMS is characterized by widespread musculoskeletal pain and
associated with multiple other symptoms which can be treated
with primary care.[5,10] The yoga therapy administered to the
patient showed positive results in improving sleep quality,
which may be due to increase in parasympathetic activity and
decrease in sympathetic activation.[11] In fact, benets of yoga
practices include increased muscular strength, exibility, sense
of well‑being, decreased pain and improved sleep quality.[12]
The result of present case study is in accordance with previous
research studies.
Yoga, being inexpensive and easy to incorporate in day to day life, is
one of the most promising therapies for primary care of FMS.[10,13]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient
consent forms. In the form, the patient(s) has given her consent
for her images and other clinical information to be reported in the
journal. The patient understands that her name and initials will not
be published and due efforts will be made to conceal her identity,
but anonymity cannot be guaranteed.
Acknowledgement
The authors are grateful to Swami Maheshanandaji, Director
of Research, Kaivalyadhama, Shri O. P. Tiwariji, Secretary,
Kaivalyadhama, S. M. Y. M. Samiti and Shri Subodh Tiwari, CEO,
Kaivalyadhama for giving constant encouragement to complete
research activities. Authors are thankful to yoga teachers of
Kaivalyadhama for providing dedicated yoga sessions.
Table 2: Results of muscle tness, quality of life, and sleep at the baseline, 3rd, 6th, and 9th month of yoga therapy
Variable Baseline 3rd month 6th month 9th month
Muscular tness
Hand steadiness (errors) 113 85 81 54
Grip strength (right) (Kg) 27 32 33 35
Grip strength (left) (Kg) 29 31 32 34
Muscle fatigue (number) 100 260 322 699
Back leg strength (Kg) 82 137 142 153
Flexibility (Cm) 32 36 36 39
Psychological
WHOQOL
Physical health (Ts) 38 44 56 63
Psychological (Ts) 69 75 81 81
Social relationships (Ts) 69 81 81 75
Environment (Ts) 69 75 81 75
OMPQ (pts) 131 125 113 103
Sleep rating
Q.1 Time taken to fall asleep (min) 30‑‑90 min 30 min 5—60 5‑‑30
Q.2 Total duration of sleep during night (h) 7‑‑9 h 7‑‑8 7—8 7—9
Q.3 Number of arousals during the night 2‑‑10 time 1‑‑4 2‑‑4 2
Q.4 Reason for waking up Pain/sick Pain Pain Pain
Q.5Feeling of being rested in the morning No Yes Ye s Ye s
Q.6 Sleeping in the day Ye s Yes Yes Yes
Q.7 Day time sleep (min) 15 min‑‑2 h 20 min 20‑‑90 20 min
WHOQOL‑ World Health Organization quality of life; OMPQ‑ Orebro Musculoskeletal Pain Questionnaire
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Verma, et al.: Yoga for bromyalgia
Journal of Family Medicine and Primary Care 438 Volume 9 : Issue 1 : January 2020
Financial support and sponsorship
Funding: Institutional.
Conflicts of interest
There are no conicts of interest.
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