PMR and physio/exercise treatments

Very gentle exercise is the best.  Walking as far as you can each day without pushing yourself.   Aqua Aerobics, Tai Chi.

It is the blood supply to the muscles that is lacking so gently does it and it keeps them going.   Never sit in one position for more than 1 hour, get up and walk around for 5 mins.

There is a list of exercises on the North East PMR website.

Be careful with physio's  unless they know exactly what PMR is and how it affects the muscles and if they say 'no gain without pain' WALK AWAY.

Bowen Technique works for so many of us,  you book three sessions, one hour per week for 3 weeks, if it does not work within those three weeks it is not going to work for you - and they will tell you that as well, they are just not into making money out of you.

 

I found exercise made me a lot worse but then again I had a physiotherapist who believed in no pain, no gain and pushed me beyond my limits. I have a TENS machine that I find helpful as well as moist heat therapy to my neck and shoulders. Walking is about only thing I can do when it comes to active exercise.

Walking.  I bought a pedometer when I started pred and make sure I get my steps in every day, even in the rain.  Long standing physio exercises for other skeletal problems (OA in spine most significant).  In fact it was when I started to lose ability to do these exercises, plus a little yoga I've been doing for many years, that I finally got to a doctor who diagnosed my PMR.  I'm starting to learn tai chi.  Agree with Lodger - don't stay still for too long.

My Rheumy at first said no exercising, then after few months sent me to physical therapist (as we call in USA) to learn about posture and to check my biomechanics...sure enough I learned about better way to stand and walk and especially how to engage bigger muscles help use my hips properly and taking away some of the pain when using them, I.e. Squatting. 

As well as my shoulders.

They claimed to know what PMR was, but I learned the hard way they did NOT!  They worked me out doing push ups to failure and since then my shoulder blade area has been hurting big time.

my Bowen gal has taught me more and my back pains are much less. She helped me see how often I tense up my shoulders, so now focusing on keeping them down has helped tremendously too. 

I still ill have my morning pains in PMR areas, but I can function now.

hope that helps. Oh, I was riding stationary bike for 20-30 minutes, but Bowen gal asked me to stop for a while, trying to get hip flexors to not inflame any more than PMR does. But thanks to her I can now walk more than 10 minutes! Yea! 

Keeping up with range in motion, especially in shoulders is good idea. So during day I'll stretch them, but not in impingement direction (internal rotation), if that makes sense. So...if it hurts...don't do it. 

HI tony,,

I've started back at the gym two weeks ago. slowly does it though. I Do 5 minutes vibration plate,15 minutes exercise bike, 15 minutes walking machine, 10 minutes cross trainer.going twice a week now down to 4mg of prednisolone. I did try the rowing machine but found this made my shoulders sore so miss it out for now. Will gradually build up as I continue to improve. I find using the heart rate/age formula good for monitoring and currently working at 70 % so as not to overdo things.

I had PMR for 5 years before being given pred - which produced a miracle in 6 hours! So for 5 years I lived with untreated PMR which was - to say the least - somewhat disabling. During that time I kept reasonably mobile by going to aquaerobic classes every day Mon-Fri. Some days they were at 9.30, other days not until lunchtime but the earlier in the day they were the better the rest of the day was. I had been a member of a gym when the PMR started - realised I was able to do less and less of the classes and the final crunch came when I went to start training for the winter ski season and couldn't do more than 2 mins on the cross-trainer without excruciating thigh claudication. I thought I was just totally unfit and it was due to getting older. I was just 52. I changed to another gym with a warm pool - rarely under 28C and often warmer.

I discussed it with the instructors and did the aqua class at my level. Initially there were things I couldn't do without considerable discomfort and being toally knackered - to put it bluntly. Over a year or so I was able to do more and more and eventually there was very little I couldn't keep up with. Once I had done the class I could manage an adapted Pilates or Iyengah yoga class - and both were instrumental in keeping posture and back muscle strength good.

Five years in I was stopped from driving for another completely different reason - a doctor who didn't listen to me and ask about my medical history - and I couldn't get to the gym, I could barely get there in the morning by car and it would have involved a couple of buses and a walk. I'd just had a major flare start so I was stuck and it was awful, not helped by living in a house where I had to go upstairs (on hands and knees) just to go to the loo. I managed to get here to my flat in a ski village where I had no stairs to cope with - all on one level and a lift - and after a week sleeping managed to get my ski gear up to storage at the bottom of the lift so I didn't have to carry it far. I soon realised that after doing 2 or 3 very short runs at the top I could walk home from the bus far far better than I had walked to it! Over the winter it got better and better. The same applied the following few winters. The hip movement in skiing is obviously ideal for koosening up the hips!

Alongside the exercise - which I could do because I worked freelance as a translator and could arrange my day to suit me - I visited an osteopath and a Bowen therapist regularly - about every 5/6 months, not every week/month. I have realised now that they helped me manage what I now call the "PMR-add-ons". Something called myofascial pain syndrome is very commonly found alongside PMR. It takes the form of trigger spots alongside the spine in the shoulders, at rib level and in the low back. The trigger spots are concentrations of the same cytokines that cause the inflammation in PMR and can usually be felt as hard knots of contracted muscle fibres - the trigger spots themselves. They can be dealt with using local steroid injections - but my osteopath and Bowen therapist also were able to keep them under control so they didn't add to the other PMR pain.

As the others have said, walking is good but may have to be limited if you develop trochanteric bursitis - which affects the hip joints and is made worse by walking and stairs in particular which was why moving here to the flat allowed that to fade. It was still there but it was better. Some movement helps it, too much makes it worse. It can be dealt with VERY effectively with steroid injections into the hip area, not necessarily into the joint. Bursitis is a recognised part of PMR whatever a doctor may try to tell you.

Exercise to failure has, as Layne has said, no place at all in PMR. All that will happen is that the exhausted muscles will take days, even weeks to recover. It is thought by a few experts that really overdoing some forms of exercise can actually be the final trigger for PMR developing - they are OK under a normal load but doing excessive activities may lead to claudication that isn't relieved soon enough by resting and real damage is done to the muscles. Any physio who tries to make you do too many reps so the muscles really hurt has no idea what they are doing. Avoid them like the plague. The same applies to fitness instructors - no pain, no gain is likely to cause trouble, for anyone but especially for us. 

You have to learn your limits and stay within them - by building up slowly you will be able to increase what you can do by a lot but it must be in tiny steps - 5 mins more a week not a day. If you use the equipment in the gym do very light weights (if any) and few reps - say 5 not 10 and only once to start with. Increase by 1 extra at a time. Ignore any instructor who tells you you must do more. Repeated or sustained actiosn are what lead to the pain - they reduce the blood flow to the muscle in question, there is a lack of oxygen supply and the build up of lactate isn't being removed as it should be. So a small amount of exercise that you managed no problem pre-PMR will now leave you with sore muscles as if you'd just run a marathon with no training which will take far longer to go away. Training is due to muscles developing tiny tears during exercise which, when they heal, leave the muscle stronger. In PMR that healing process is slowed as well as far less exercise being required to make the muscle hurt. 

Whatever you choose to do you will find you can do far more if you do 5 min and have a 5 min rest, With time you'll build up to 10min  and 10 min, even later to maybe 10 min and 5 min rest. At first I could barely walk into the village, a couple of hundred yards. I built up by going further each week until now we always do the full circular walk in the village. At first it took 45 min to do the shorter version, now we do the long version in under half an hour. Yesterday I walked into town, wandered around a bit to do stuff, and walked back, stopping to do some grocery shopping on the way - well over 2 hours walking with no rest as the weather turned unexpectedly threatening so there was no reward of a beer'n'a Birdie in an outside cafe :-(  Today I am a bit stiff but it is improving as the day goes on.

That's my experience - both on and off pred. Exercise definitely helps and there is about to be a study on managing PMR using the "Dead slow" reduction approach together with setting targets for exercise in the form of walking numbers of steps (not stairs steps!). Both pacing and resting are important - but to sit and do nothing all day because it hurts to move just makes things worse. For some things, mainly the muscles, the exercise gets the blood flowing better and that will reduce the pain and stiffness. Care is required if you have bursitis or tendonitis or if you have spasmed muscles - but they can be treated successfully too. Exercise in a warm pool is particularly good because the water supports the joints and the warmth improves the blood flow to the muscles - a cold pool will do the opposite.

Tony,

i do vinyasa flow hot yoga almost everyday, walk my dogs, and 1-2 times a week eliptical. I am newly diagnosed (mid September) and currently take 17.5 mg of prednisone. I have always been active and my doc encouraged me to keep it up.