A Workout Without Working (Much)
Could the muscle pain in fibromyalgia and chronic fatigue syndrome be due to chronically activated muscles?
Feel like you just ran a mile after walking a block? Do your muscles feel tight and contracted? How’s your flexibility and coordination? If I’m reading this right this fibromyalgia study might be able to help explain why these problems are occurring.
We recently saw a study which suggested that something as simple as mental stress tests (math test) or eating or other sympathetic nervous system activators can activate the back muscles of people with fibromyalgia. That study suggested FM patients muscles could be in state of almost continual activation.
Now we look at the muscles of people with fibromyalgia under load; that is. when they’re being exercised….and find that much the same thing is occurring – only magnified.
The Study
In this study people with fibromyalgia and health controls carried weights in their hand and then flexed their arms back and forth for 3-5 minutes while researchers measured the electrical activity using in their biceps.
Results
Endurance – Normal; Everything else – Abbey- normal.
The study found that endurance in this short muscle test was normal but virtually every other test result was abnormal in the FM patients.
Wired and Tired Muscles as Well…
One might have thought that strength and frequency of the electrical signals would have been reduced in these exertion challenged FM patients but as so often happens, the opposite was true; the electrical signals in their muscles were, oddly enough, going banana’s, putting them were into a hyper-active state.
Electrical signals trigger the muscle contractions we use to produce force but those signals should diminish in between the muscle contractions. They did in the healthy controls but not in the FM patients whose muscles were being constantly prodded to contract.
This didn’t mean they were supermen or women in disguise; far from it – the inability to turn their muscle activity off and allow them to rest – suggested their muscles were chronically tensed, not strong. (Shades of the wired but tired problem in ME/CFS).
“It has been demonstrated that patients with FM have sustained muscle activity between contractions, that is, they are unable to relax..”
When put under load the muscles in fibromyalgia appear to be overwhelmed by signals telling them to continuously contract
Several things can cause this kind of unremitting electrical activity but in this case it appeared that alterations in the ‘muscle fiber membrane’ or ‘ sarcolemma’ were responsible. Unusual in cellular membranes which generally prefer to stay on the surface of the cell, the sarcolemma dives deep into the big muscle fiber cells where it transfers electric signal that tells them to contract. The muscle fiber membrane , then, plays a key role in energy production.
Muscle ‘Arrythmias’ Anyone?
The authors believe this continued state of activation left the muscles in a state of something called ‘after depolarization’. Depolarization simply refers to a change in the electrical status of a membrane. If I have this right, the membrane should switch from positive to negative regularly – allowing electrical currents (ions) to contract, relax, contract, relax, etc. the muscles. In a state of depolarization a state of confusion reigns interrupting that regular pattern of ‘depolarization’, leaving the membranes in a twitchy, unsettled state. In heart muscle after depolarization can cause tachycardia or arrythmias.
It just so happens that after depolarization causes the muscle membrane to send the ‘contract’ message more easily. What’s causing this state of affairs? The authors didn’t say but depolarization is a function of ion channel (Ca, K, Na, CL) activity and the autonomic nervous system may be involved as well.
Because the tests were done in muscle areas that did not have tender points they believed this pattern applies bodywide.
Conclusion
With your muscles in a continually contracted state every time you put them under load it may be that you are running a marathon for every mile you walk. This study suggests that exercise may throw the muscles of people with FM in a state of confusion in which muscle rest breaks disappear leaving the muscles chronically activated (and in an arrythmic state?). Given the worsened exertional problems in ME/CFS, it’s possible the same or worse applies in that disorder.
The ongoing sympathetic nervous system activation, the possibly increased glutamate activity, the NK cell burnout, the inability to turn off attention to innocuous stimuli and now the ongoing electrical activity/muscle contraction in FM all suggest chronically activated systems play a role in this disorder.
Thanks for yet another interesting article. I have this weird hobby…whenever I learn a new word, I look for a connection to my favorite TRP channel: TRPA1. So, I tried “sarcolemma and TRPA1”, and this is what I found: “TRPA1 channel activity hyperpolarizes the sarcolemma” from page 5 in this article:
Endothelium-Dependent Cerebral Artery Dilation Mediated by TRPA1 and Ca2+-Activated K+ Channels
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966339/
TRPA1, autonomic dysfunction (POTS) and altered cerebral blood flow are connected….and cerebral blood flow is reduced in chronic fatigue syndrome http://www.ncbi.nlm.nih.gov/pubmed/21167506
hm…..
I like your hobby Helle! It hyperpolarizes the sarcolemma…Isn’t that something….Thanks!
I am here researching answers to my FM/CFS suffering, and I ran across your comment. I happen to have a diagnosis of POTS as well…
This was shown on my 1st sleep study for obstructive sleep apnea, back in 2005! While using the CPAP, there were still over 100 small arousals on the data strip, which my pulmonologist attributed to continuous muscle activation due to my fibromyalgia. I was already aware of being tired and wired, though!
There are some other factors to consider as well I believe. Nitric oxide is being dysregulated in fibromyalgia and it plays a fundamental role in muscle contractility.
http://www.pnas.org/content/100/25/15229.abstract?ijkey=c28e250dd414a8e609310b61ae89be95b830be72&keytype2=tf_ipsecsha
Here is some information on nitric oxide and fibromyalgia.
Arginase, NOS activities, and clinical features in fibromyalgia patients.
Cimen, O.B., M.Y. Cimen, Y. Yapici, H. Camdeviren. 2009. Pain Med. 10(5):813-8.
“We found that NOS activity was significantly higher…”
Hypoxia can also lead directly to muscle depolarization. Fibromyalgia patients have low muscle oxygenation.
http://www.jappl.org/content/102/6/2379.full
Muscle tissue oxygen pressure in primary
fibromyalgia.
Lund, N. A. Bengtsson, P. Thorborg. 1986. Scand J Rheumatol 15(2):165-73.
“The conclusion is that in patients with primary fibromyalgia, the muscle oxygenation is abnormal or low…”
A molecule of iron is needed to make an essential component of red blood cells called hemoglobin. Hemoglobin is a protein that carries oxygen in the red blood cell.
The following study, published in the European Journal of Clinical Nutrition, found a significant difference in serum ferritin levels between healthy people and those with fibromyalgia. The researchers concluded that low ferritin created a 6.5 fold increase to the risk of fibromyalgia.
Association between serum ferritin level and fibromyalgia syndrome.
Ortancil, O. A. Sanli, R. Eryuksel, A. Basaran, H. Ankarali. 2010. Eur J Clin Nutr. Mar;64(3):308-12. doi: 10.1038/ejcn.2009.149. Epub 2010 Jan 20.
The low levels of intracellular magnesium and dysregulated calcium found in fibromyalgia patients could be factors as well.
Magnesium deficiency in fibromyalgia syndrome.
Romano, T.J., J.W. Stiller. 1994. Journal of Nutritional and Environmental Medicine Vol. 4, No. 2, Pages 165-167.
“Since patients with either fibromyalgia syndrome (FS) or low magnesium (Mg) levels can have fatigue, sleep disturbance and anxiety, it was necessary to determine if some patients with FS also have low Mg levels… FS patients had significantly lower RBC Mg levels.”
Fibromyalgia patients also have low ATP and this is related to muscle depolarization, as well.
http://www.ncbi.nlm.nih.gov/pubmed/8782098
Use of P-31 magnetic resonance spectroscopy to detect metabolic abnormalities in muscles of patients with fibromyalgia.
Park, J.H., P. Phothimat, C.T. Oates, M. Hernanz-Schulman, N.J. Olsen. 1998. Arthritis Rheum 41(3):406-13.
“patients had significantly lower than normal…ATP levels…in the quadriceps muscles during rest.”
Thanks Annessee…It looks like there are alot of possibilities for poor muscle functioning in fibromyalgia. I was aware of the muscle oxygenation problems but not the others. I didn’t know that hypoxia could lead to depolarization problems. I was just preparing a blog on oxygen delivery to the muscles in FM – thanks for helping out with it 🙂
NOS activity is being explored in studies underway in ME/CFS as well.
Hypoxia and NO….I am back with TRPA1:
“Nitric oxide (NO), a vasoactive gaseous molecule, regulates TRP channels directly via cysteine (Cys) S-nitrosylation or indirectly via cyclic GMP (cGMP)/protein kinase G (PKG)-dependent phosphorylation. Recent studies have revealed that changes in the availability of molecular oxygen (O2) also control the activation of TRP channels. Anoxia induced by O2-glucose deprivation and severe hypoxia (1% O2) activates TRPM7 and TRPC6, respectively, whereas TRPA1 has recently been identified as a novel sensor of hyperoxia and mild hypoxia (15% O2) in vagal and sensory neurons. TRPA1 also detects other gaseous molecules such as hydrogen sulfide (H2S) and carbon dioxide (CO2).” from
TRP channels: sensors and transducers of gasotransmitter signals
http://www.frontiersin.org/Membrane_Physiology_and_Biophysics/10.3389/fphys.2012.00324/abstract
I have written about hypoxia here: http://followmeindenmark.blogspot.dk/2013/03/trpa1-hypoxia-and-me.html
And my new buzz word is “lipid rafts”. If lipid rafts in the sarcolemma are affected, something with signal transduction will go wrong. More about my new buzz word:
Is ME autoimmunoreactive IgGs against lipid raft-associated proteins? http://followmeindenmark.blogspot.dk/2013/04/is-me-autoimmunoreactive-iggs-against.html
What can one do to help the muscles receive oxygen?
Very interesting. It certainly feels like I have run a marathon after trying to walk down the street and back. I just started taking baclofen after reading so much about glutamate. It will be interesting to see what affect it has overall. Thank you Cort for this blog! It helped me as I gathered some information to take to my doctor. I have had CFS/ME and I am not giving up on finding a way to get better. Keep up the great work! It is appreciated and it is making a difference!
Thanks Holly,
Good luck with the new protocol and your search for wellness. 🙂
The above should say “I have had CFS/ME for 16 years and I am not…..”
I sometimes think of what could be the perfect description of FM, just to try to explain my body experience to people. One feeling I get in my body is that I have walked to the top of some ancient Mayan temple or the Buddha in Hong Kong. Almost any high structure. That feeling you get at the top, when even the healthiest have to stop to let the muscles recuperate. Also when you see marathon runners with hands on knees at the finish line. That is it for me. So yes, this study makes sense.
I think that those of us with POTS and EDS can definitely say this is an issue. Before being DX’d with EDS the doctors said it was FMS. But, I think there is a fine line between the two –at least as far as symptoms are concerned. With EDS we are in a constant state of being tensed up to hold ourselves together and upright. Throw in some exercise (for those that can with POTS) and you have an even more over tensed body and along with that much pain. With the high heart rates that go along with POTS (as if we are constantly on a treadmill) no wonder many of us also feel totally fatigued and worn out. We feel as if we are on a hamster wheel running with all our strength – even while sitting still. Too bad we don’t get the tone from the exercise our autonomic system puts us in. LOL! We’d be some buff bodied people.
Issie
I love your explanation of being tensed up to hold yourself together in EDS Issie. I’d never heard of it that way before and I look forward to learning more about EDS.
I don’t appear to have EDS but I think something similar may be happening to me…I have this odd habit of falling apart when I get really good energy boosts. When my muscles feel loose and relaxed and the my chronic muscle tension disappears and I start feeling good I just fall apart; my joints start popping, I get really jittery, have trouble completing my sentences and eventually get really fatigued. Its as if the muscle tension I feel is holding me together….
Hi. I’ve been working really hard this last year to loosen up the tightest of the neck and shoulder muscles and it seems to be working, but, I do get the weird jittery bubbly feeling going through my arms now and sometimes my neck – I sense you are having the same kinds of feelings. I’m hoping that it eases off as the core muscles gets stronger and pick up the load that the neck has been doing for years.
I learned my heart is in amazing condition– a cardiologist told me my heart was like that of an experienced endurance runner (even though I can barely walk a block.) So I think the exercise our autonomic nervous system puts us in does give some of us invisible tone. It is nice to know that when I get better I will have a very fit heart.
Hi, can you send me the link to the study referenced?
Thanks
Jeez…I did it again. Forgot to put the link to the study in the blog…Here it is – http://www.ncbi.nlm.nih.gov/pubmed/23055314
Please can you tell me where the study itself is published so that I can refer my doctor to it? Thank you.
I just put a link to it in the blog and here it is as well – http://www.ncbi.nlm.nih.gov/pubmed/23055314
Muscle Nerve. 2012 Nov;46(5):738-45. doi: 10.1002/mus.23382.
Muscle fiber velocity and electromyographic signs of fatigue in fibromyalgia.
Klaver-Król EG, Rasker JJ, Henriquez NR, Verheijen WG, Zwarts MJ.
Department of Neurology and Clinical Neurophysiology, Ziekenhuis Groep Twente, Morshoekweg 3, 7552 PE Hengelo, The Netherlands. eklaver@planet.nl.
They did another study after that with similar findings – http://www.ncbi.nlm.nih.gov/pubmed/23191983
Clin Exp Rheumatol. 2012 Nov-Dec;30(6 Suppl 74):44-50. Epub 2012 Dec 14.
Abnormal muscle membrane function in fibromyalgia patients and its relationship to the number of tender points.
Klaver-Król EG, Zwarts MJ, Ten Klooster PM, Rasker JJ.
Do you know if any studies have been done about Adhesion’s forming because of FM I have been diagnosed for more then 5 years and have a big problem with my shoulder blades adhering to my back causing alot of problems with my shoulders and pain. My medical massage therapist is able to partially break them loose when I can afford to see her but my doctors dont have a clue why it happens. Also I have some sort of autoimmune disorder but no one can figure out what it is and I cant go to Mayo as insurance wont cover it any info would help thanks
Interesting Cort. Yes indeed in my own case the muscles (even without exercise) can go into “freeze” and it is simply no good trying to excercise them to gain more movement, no response. Yet some days the usual (but limited) mobility returns. My Neurologist did think neurological problems were involved.Thinning of the myelin sheath was one suggestion from another Doc.
Very interesting article Cort. Not really posting these days (extended nasty relapse), but I had to add this: When I had my heart biopsy, they discovered auto-antibodies to endothelium, endocardium, and (wait for it…. ) sarcolemma. I meet all the CCC for M.E., and just barely do qualify for the FM umbrella too.
Too bad more folks don’t have immunohistochemical biopsy results – of course it’s not for trying & begging. Heaven knows many patients would LOVE to have more robust testing, and I am optimistic that such a time will come. It will be interesting as the research unfolds, to learn how many M.E. patients have clinically significant levels of auto-antibodies to sarcolemma, or whether I am an outlier. And of course it’ll be interesting to see if auto-immunity ultimately fits in our disease, and if so, if auto-antibodies to sarcolemma are part of the pathology.
Thanks for the info and the laugh with the Young Frankenstein reference!
I wondered if I was dating myself…probably was…certainly one of the classic movie scenes ever. Thanks!
This is due to the fact that myofascial pain syndrome is a common comorbid disorder in FM, but frequently overlooked. It is also present in some ME/CFS patients. Those writing the criteria for ME/CFS understand this, however, much to my chagrin, even after communicating with the authors of the 2011 FM diagnostics, it is not considered in FM. This is despite research to the contrary(on my website). Until this is recognized, any research on FM and muscles is going to be confusing. I literally wrote the book on this, 400+ pages. Fortunately other FM experts, Robert Bennett, MD, Roland Staud, MD and others agree that MPS is a huge peripheral pain sgenerator to the centralization of pain in FM.
TY Cort for bringing this to the forefront. Awareness is key so that study participants are screened appropriately. MPS co-occurs in IC, piriformis syndrome, spinal disease, migraine, IBS, RLS, cardiac arrythmias, etc. These overlapping disorders are not coincidental.
Down to one hand, shoulder surgery, or I would write more.
Here are a few studies on the effect dysregulated nitric oxide has on the sarcolemma.
Am J Respir Crit Care Med. 1998 Nov;158(5 Pt 1):1656-63.
Diaphragm sarcolemmal injury is induced by sepsis and alleviated by nitric oxide synthase inhibition.
Lin MC, Ebihara S, El Dwairi Q, Hussain SN, Yang L, Gottfried SB, Comtois A, Petrof BJ.
SourceRespiratory and Critical Care Divisions, McGill University Health Centre, Respiratory Muscle Biology Group, Meakins-Christie Laboratories, McGill University, and Centre Hospitalier Université de Montreal, Montreal, Québéc, Canada.
“These changes appear to be mediated, at least in part, through the pathway of increased nitric oxide production.”
Fibromyalgia pateints do have dysregulated nitric oxide, so perhaps this is why there are anomalies in the sarcolemma.
Arginase, NOS activities, and clinical features in fibromyalgia patients.
Cimen, O.B., M.Y. Cimen, Y. Yapici, H. Camdeviren. 2009. Pain Med. 10(5):813-8.
“We found that NOS activity was significantly higher…”
http://www.ncbi.nlm.nih.gov/pubmed/9817721
http://www.ncbi.nlm.nih.gov/pubmed/7545544
http://link.springer.com/article/10.1007/BF00417866#
Thanks Cort, nice article 🙂
It would be interesting if the researchers also studied the muscles when at rest with no exercise. I have ME/CFS and FM and I feel a constant contraction in them all the time accompanied with the feeling that they have been exercised to muscle failure. (burning from lactic acid build-up, weakness and shaking if I try to put a load on them).
When I get a good massage, it cuts down on the burning just for a couple hours, and it is the only time that I feel the muscles relax a bit.
I thought I had great muscles when the truth is they are always contracted! I would show my bicep muscles to anyone who would tolerate me and look at them. I believed I had developed muscles from carrying heavy laundry baskets, heavy laptop, gallons of water to fertilize my containers, lifting my 18 pound dog several times a day, and so on.
Think I’ll try the baclofen that’s been sitting around here untouched. Maybe I can get rid of some of the shoulder and back pain which is probably due to the fact that my arms aren’t really strong. LOL
Thanks for the explanation. My muscles always feel tense, even at rest. The only thing I’ve found that releases the tension is massage. It doesn’t need to be a deep muscle massage, just a gentle soothing relaxing massage does the trick. My husband saw what a great response I had to massage and learned to do it well enough to give me a simple relaxing massage every day. Works wonders. Helps release the tension enough so I can get to sleep more easily.
Hello, I have found another article that I think you guys will find very interesting. Apparently, there is this doctor in Santa Monica who is developing a blood test that he claims can accurately diagnose fibromyalgia. I found it quite intriguing, as I know that diagnosing fibromyalgia can be really difficult. Honestly, this is one of the most promising things I have read in regards to improving the diagnosis of this medical condition. The article is available here: http://www.clinicaltrialsgps.com/news/santa-monica-new-blood-test-fibromyalgia/
I have recently had my book published by Findhorne Press, describing ten years’ work with many different medical conditions, which I believe are all caused by ‘Neurological Wave Syndrome’. My theory is that excess electricity, generated by the brain, can follow any nerve of the body. This excess electricity discharges into one area, causing a symptom in that area. The book is entitled, ‘Chronic Pain and Debilitating Conditions Resolution’ and it describes how the evidence for this theory slowly emerged as I worked with clients with migraine, backache, Meniere’s Disease, Irritable Bowel Syndrome, fibromyalgia, chronic fatigue, and many other common ailments.
Hi Cort
Very interesting. My daughter has POTS, neurally mediated hypotension, hyper mobility.m, and TMJ. Not diagnosed with FM but I do wonder about that. She has always thought she slept well but of course is always tired. We have recently discovered that taking 0.25mg Ativan at night and she sleeps better, wakes refreshed, and has more energy, but her hips feel like they want to pop out of joint and her jaw shifts slightly dislocates.
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