During my last placement I was referred a ?fibromyalgia patient from a rheumatologist. The referral just asked me provide the patient with a gentle exercise program. I wasn't 100% sure what to expect when the patient walked through the door and to my surprise it was one of the nursing assistants from the hospital. The patient seemed perfectly healthy and it wasn't until I questioned her further that I found she was anything but. She complained of pain and weakness all throughout her lower limbs and stated that she had recently had 3 weeks off work as she just couldn't walk around anymore. She told me that her rheumatolgist had prescribed her with NSAIDS which enabled her to walk again but by the end of her working day she just collapses and finds it too hard to walk around anymore.
On objective exam the patient was found to be TOP all through her LL's and to have reduced muscle strength throughout. Everything else was normal including neural testing. I was unsure of what I could do for the patient because if I gave her a strengthening program I feared it would impede her ability to work. Therefore I suggested some light exercise in a hydrotherapy pool and she agreed that this sounded like a good idea. I told her to try it every 2-3 days and then come and see me again in 2/52 to monitor her progress.
The situation made me feel helpless in a way as there was nothing we learnt at uni that could help this type of patient and I don't even know if there is anything to help.
Does anybody else have any suggestions or experiences with such a patient that they could share with me?
Depending on how she responds to this treatment I think I would take a similar course in future.
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Hey Adam, I think you made a good move by recommending a Hydro program to your pt. The exercise is light enough and you could always progress the pt when she gets better. The warm water in the pool would also help her muscles to relax and not fatigue so easily. You could also suggest exercises while in bed (since she finds it too hard to walk). It doesn't have to be strengthening exercises but maybe just some simple ROM exercises to start with, and slowly progressing it to against gravity. Nevertheless, I think you managed the pt well! Great Job!
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