Physical Therapy Combo for Fibromyalgia

by Kristin Thorson, Editor, Fibromyalgia Network
Posted: December 29, 2011

 Weekly Ultrasound Plus TENS Cuts Pain in Half

The two most common treatments for musculoskeletal pain used by physical therapists are ultrasound and transcutaneous electrical nerve stimulation (TENS). Ultrasound works by emitting sound waves from a hand-held wand that penetrates between 1 and 2 inches deep into soft tissue, such as your muscles. These sound waves can increase heat and improve circulation in the region, relax muscles, and heal tissues. TENS units work by applying two pads placed on the skin across a painful area. The small unit emits an electric signal believed to ease discomfort by activating the natural opioid pain-relieving system in the spinal cord.

A research team led by Felipe Azevendo Moretti, P.T., of the Universidade Federal in Sao Paulo, has found the combination of both therapies have been somewhat successful at reducing the muscle aches and disturbed sleep of fibromyalgia.* However, that is based on using this combination therapy during 12 sessions over a one month period. Each of the treatments was applied for two minutes at each painful tender point (typically averaging 14 per patient), making this approach very time-consuming. Whereas insurance companies may not approve such frequent visits.

But the real question answered by the Moretti’s recent study is whether there was any difference in effectiveness if sessions were once or twice weekly over a duration of 12 weeks. This means one group of 25 fibromyalgia patients received 12 treatments while the other group received 24 treatments. Moretti looked at their pain, sleep and physical function measures before and after the 12 weeks, and found the effects of combined ultrasound plus TENS was the same regardless of whether it was given once or twice weekly.

Before the current study, patients were asked to rate their level of pain on the first day of the study and over the previous week, as well as their sleep, and overall quality of life. They also noted their number of tender points (one group averaged 15 while the other averaged 14).

After 12 weeks of treatment to tender points, patients’ scores in all areas dropped dramatically. Those receiving treatment once a week reported pain in half as many tender points, and pain scores fell from 7.6 (on 10 a point scale where 10 represents worst possible pain) to 3.1. Pain experienced over the first seven days compared to the last seven days of the study dropped from 9.5 to 3.3. Sleep problems and quality of life scores also improved at least 35%. Similar changes in scores were obtained by the twice weekly study group.

“Based on these results, we can observe that the combined therapy was effective not just in the improvement of the musculoskeletal symptoms, but also helped the patients with sleep and quality of life,” said Moretti. “Once the patients have a reduction in the number of tender points, the subjective feeling of pain is diminished.”

A greater than 50% drop in painful symptoms of fibromyalgia for patients not taking any medications or using other treatments is substantial. In addition, none of the patients experienced intolerable side effects, which can be a turnoff when trying a new drug or other approaches.

Moretti believes this combination therapy along with medications and other forms of treatment, such as water exercise or walking, can be added to each patient’s care to create more substantial benefits. How long the combo ultrasound plus TENS therapy lasts beyond the three-month treatment was not determined by this study. Regardless of its lasting effects, this approach can certainly help patients increase activity levels while minimizing the potential for added discomfort.

“This study helps professionals who work with fibromyalgia patients know that it is possible to obtain symptom improvement with only one weekly application of the ultrasound and TENS therapies,” said the physical therapist. “Clearly, it is important to offer the most efficient treatment solution for the least amount of money.”

* Moretti FA, et al. Physiother Res Int Nov 24, 2011, doi: 10.1002/pri.525. [Epub ahead of print]

(Keep in mind this is a research study to show the effectiveness of TENS. Understandably, 12 PT treatments could be costly, but a therapist can help you with the proper use of a TENS unit that can be purchased and applied as needed. Units range from $40 to $70.)

52 Responses to Physical Therapy Combo for Fibromyalgia

  1. Donna Lee says:

    I am in Physical therapy now from an injury to neck, back and lower back. Even though the Dr. wrote script for tens and ultrasound, all I get is Physical Therapy exercises. I am told to just relax my muscles first before I start the excersies, which I’ve known from an injury 10 years ago.
    Why don’t they teach PT’s to do tens and ultrasound on fibro patients, they have the equipment right there?
    I want get better w/out all the drugs and even w/drugs my sleep is disrupted. I still do what I already know works for me.

    • Esperanza Abinsay says:

      If you go for physical Therapy as part of your treatment for Fibromyalgia, ask your therapist if she/he can get you a TENS Unit to use at home. Sometimes we, as patients, need to ask them, as it is not always offered to us by the therapist.

    • K. F. Hibdon says:

      I’ve had fibro since 1990 & use a large bag of tricks to stay out of a pain cycle. In addition to body-wide fibro pain & whiplash-area pain, I have multiple associated illnesses including fibro fog, sleep apnea, insomnia, IBS, light & heat sensitivity, allergies, chronic depression, etc. More recent symptoms include autoimmune skin disorder, gastroparesis from taking yrs of rx anti-inflammatories & chronic severe constipation.

      When pain gets acute, I get a rx for P.T. that includes ultrasound, e-stim, “spray & stretch” myofascial pain release (pioneered by Dr. Janet Travell), & hot pack therapy in combination. When needed, I receive trigger point injections by my knowledgeable rheumatologist.

      Self therapies I use at home are: warm, moist heating pad (or hot packs, which can be purchased at medical equip. stores), or ice packs, rx Ultram, self spray & stretch at home w/rx spray, gentle stretching, warm shower, Tylonel Pm for sleep/pain, sleep rx, talk counseling w/prof., etc. TENS unit only works for me in conjunction with combo P.T. therapy.

      P.S. Most P.T.’s don’t know how or are too lazy to actually do myofascial release b/c it take physical strength & is hard work. Hope this helps someone else. Good Luck

      • Erik Digby, PT says:

        In response to KF Hibdon, PTs typically do not learn advanced techniques of myofascial release (MFR) in their program, but rather learn it through advanced continuing education after graduation. A PT is free to choose his/her own continuing ed and may opt to not learn those treatment methods. So I would be inclined to say that a PT “doesn’t know how ” vs. “is too lazy ” to perform them.

    • Donna B. says:

      The best advice I’ve ever received was from a physician who told me that I would need to be my own advocate, educate myself about my conditions and general health, and learn to speak up for myself. Sad to say that he was right.
      As others have mentioned, we each have to ask our medical care providers about treatments that may be helpful. Sometimes, we even have to push to get them on a trial basis. We have the right to ask for a different medical care provider (doctor, physical therapist, etc.) if we don’t have a positive experience with our current provider. I’ve worked hard to give myself time and experience with each provider so that I’m not simply “hopping” from one to another. But if I’m truly not getting the results I can reasonably expect, then I look for another provider.
      In my case, my insurance carrier rented a TENS unit until I’d been using it successfully for several months. Then it became mine. My personal experience has been that the TENS works for quite a while and then becomes less useful. I stop using it for a long while, then restart it. Its effectiveness and my body’s response to it seem to come in cycles, in a way like some of the pain medications I’ve used.
      I hope if you feel frustrated with your situation that you’ll find something useful in my scribbles. Stay hopeful!

    • Lisa Giusty, DPT says:

      Research is constantly changing in the medical field. The results from the above study are new, so your physical therapist might not be aware of the positive results gathered from this study regarding the use of ultrasound and TENS with fibromyalgia. If you have concern about receiving the treatment above, you could print off the article and bring it in to discuss with your therapist. Please note though that long term benefits have not been studied yet.

    • Keri Lewis says:

      You will need your doctor to write a prescription for a tens unit. Sometimes the physical therapist will write one and fax it to your doctor to sign and then they order through your insurance company and then they can show you how to use it and for how long and where to place the electrodes. I have a TENS/Electrical Stimulation unit that works good. It does help some.

  2. Kathy Mele says:

    Once again insurance companies decide who will be helped and who will live in pain. When a proven treatment is discovered it is nauseating to me to know that people can’t be helped because insurance companies have the final say. This is exciting information that will end up helping very few people even though it should be helping everyone with this problem.

  3. Ann Scollins says:

    I’ve tried physical therapy b4 for other problems. Heat, tens and ultrasound were used. Also excercise. I found that while the heat and tens helped for a very short period of time, in order to achieve a more lasting relief, I believe that all areas of the body would need to receive the treatments as it is all areas that hurt.

    • Esperanza Abinsay says:

      I just finished my 4-week seession of Physical Therapy with Electric Stimulation, Heat and Massage 3x/week, coupled with my heated pool exercises 2x/week. I experienced a considerable relief of pain, although it’s not 100% gone, but I am in less agony and I have more mobility. Pain relief sometimes is not achieved by just one type of treatment, but a combination of different modalities. Pain medications provide temporary pain relief. Physical therapy provides more lasting beneficial results, although you don’t feel it right away. Just be diligent and patient.

  4. mary wagner says:

    I have used a portable tens unit for 2 years, several days of the week, on my upper back and shoulder blades. It helps quite a bit. I had a rx from the doctor, and ins paid the 79.00, but they are available online too. I use an ultima 3 unit. It takes a 9 volt battery. Hope you all have better health in 2012.

  5. Rebecca Frith says:

    My pain management doctor just ordereed a tens unit for me and it was approved by Medicare. I’m just learning how best to place the leads for best affect. I also have impinged nerves from arthritis. After reading your article, I am encouraged that the tens will be helpful with the widespread pain as well.

    • Amanda C says:

      My P.T. Lady told me that wherever it hurts, to suround that area with your tens pads. Put the pads at least 2 inches away from the hurt area, and don’t ever let them touch your spine. My doctor ordered the P.T. for me when I was first diagnosed. I only had it for a month, but it really helped. I continued with a self pay system through the P.T. health center to use there pool. Luckily it only cost me $5 a visit. I highly recommend pool therapy. I do exercises for at least 20 minutes and use the water jets to help relax my muscles. I also continue to use my tens unit at least twice a week. I found my tens second hand. My insurance wouldn’t pay for it.
      Hope this info helps someone ;)

  6. dot wheelwright says:

    I found it interesting on tens for relief. I tried it a few years ago, plus ultra sound on my back, helped somewhat but not available other areas. I am going through a terrible FMS attack since Christmas, the worse I have dealt with in years. Nothing is helping this go around, bed rest and pain medicine is what I am doing for my at this time

    • sharon king says:

      I felt sorry to read your comment.
      Take it easy and rest. I really hope you feel better soon.

    • Esperanza Abinsay says:

      I have found out that the right massage therapist is very beneficial when the rest of my other treatment modalities don’t give me desired pain relief. I have many trigger points especially on my shoulders. My muscles get very tight so easily, and if the knots are not released as soon as possible, they become very tight like ropes and it becomes very very painful. So therapeutic massage and trigger point release is very helpful

    • Kitty Cash says:

      Thank you everyone, one all the helpfull infomation on the tens unit. I really don’t know what they are. But I will discuss this an option with my pain mgt doctor for home use. I have been in a severe 3 week flair and am at my witts end. I am desperate for some pain releif. First I have to get a new PCP to refer me to pain mgt. since I changed ins. MISTAKE. The new PCP does NOT beleve in FM! so I have to wait untill Monday to look for a new one. Does anyone know a good PCP that is good with FM patients in the Phoenix/Peoria or/Glendale/Sun City/ Arizona Area? Hoping for a Internal Medicine doctor . I have several medical problems. Thank you God bless and Gentle Hugs

  7. Diane T. Walker says:

    Having lived with FMS and a plethora of associated things which may/may not accompany FMS since 1995, I can honestly say my TENS unit has tremendous value to my pain relief. Also, my treatment has included ultrasound treatment, followed by stretching (myfascial manipulation), TENS tx, ending with heated, moist packs. This initial treatment protocol was after several orthopaedic surgeries to help reduce my pain and enhance/improve my very limited mobility. The FMS developed AFTER the 3rd major surgery. Fortunately I have a wonderful rheumatologist and primary care physician. They DO work in concert to keep me moving and trying to stay focused on sleep, little fatigue and NO FOG………unfortunately, it never goes away, but DOES wax & wain. Never give up—keep working to find wonderful doctors (like I have had from the beginning) and therapies which work. Several years ago my Mother happened to find a Chinese Medicine Doctor who is a licensed acupuncturist. Encouraged by my family members to try it, I found it to be the most successful of ANY of my pain management techniques. Although my insurance would not pay for it, it WAS tax-deductible; therefore, it was well-worth the cost of having the treatments and my doctor had package plans for us. Even my grown children decided to send me gift certificates for those treatments. So trying other therapies beside medication alone is wise: ask your doctor for recommendations for massage therapists, acupuncturists, water exercise programs, etc., for you to try. Just keep going—-get your rest, eat healthy, small meals, work if you can, and keep seeking answers to help yourself.

  8. Melody Stiles says:

    I could not live without my TENS unit, so I completely believe in the credibility of this study. Now to find a PT with a laser…

  9. Karen says:

    I have a TENS unit in the past it has helped a little, my problem is I am single and I can’t get the Leads in the right place, I can’t reach it. The other problem I had when I have used it was my own fault I forgot where my settings were supposed to be and I set it to high.

  10. KK says:

    I am currently receiving utrasound and electical stim because of a fall injuring my back. Quite honestly my most debilitating pain is not in my back from the injury but in my buttocks, hips and thighs due to fibromyalgia. Years ago I was a sales rep. for a medical supply company and sold TENS units. With the info I’ve seen on this website, I believe I’ll scrounge around in my basement and see if I can’t dig up one of those old units! I’d like to hear more from patients who have had success using TENS therapy. It makes little sense for an insurance company to continue to pay for ongoing PT when a home unit costs less that a couple of therapy sessions..of course after being instructed in it’s proper use by a therapist.

  11. Candy Sanders says:

    I have used this combo but have found it is very easy to send me into more spasm and more pain. At times the weight of the heat packs were even too much for me to bear. I just wanted to share my perspective.

  12. Tricia says:

    My insurance sent me one about 5 years ago (tens) but I can’t find the sticky patches that you attach the machine to. Does anyone know how to find those without going through insurance as I now have a ded of $750 to meet this new year?
    It does help alot along with a heating pad!

    • patti says:

      Google “tens electrodes”. There are even videos about placement of pads. I haven’t purchased any online, so I can’t recommend a particular site but Amazon even sells them.

    • Delores says:

      I’ve had tens and laser therapy with a chiropractor about 7 years ago and it really didn’t work. I currently have a tens unit that my insurance paid for about 5 years ago. I haven’t used it in awhile and think that I should probably try using it again. My problem with that at home unit is that I can’t do a lot of moving around with it as I try to stay as active as I can. Yes, you have to be your own advocate and I even have gotten to the point where I print articles for my pcp to read. I am currently taking yoga classes in the warm water pool at a gym which my insurance pays for through my medicare advantage plan and it is wonderful. I really feel the difference in my pain levels and sleep habits since the weather here in philly has gotten cold and I haven’t been to the gym because of the coldness. This whole FM stuff is a bummer and you have to keep trying different things until you find something that works for you. Keep trying and don’t give up… Feel Better

    • Delores says:

      Oh I sorry Tricia, you should be able to get the sticky patches from any medical supply company. Good Luck

  13. Jan says:

    The TENS interests me, but does it only help in the area where the patches are placed? Most of the time I hurt all over and feel fluish???

  14. Jo Anne Scott says:

    I have been using a muscle stimulator from the co. RS MEDIAL, LOCATED
    at P.O. BOX 4656
    Vancouver, WA 98662 PH: 1(800-935-7763)

  15. Jo Anne Scott says:

    I have been using a muscle stimulator from the co. RS MEDIAL, LOCATED
    at P.O. BOX 4656
    Vancouver, WA 98662 PH: 1(800-935-7763)

  16. Celeste Cooper says:

    I could not live without my TENs unit. Also, previous studies have shown that ultrasound might help break up resistent myofascial trigger points. I can’t wait to share this article with my PT who does active release therapy. Not all PTs are specialized in this type of work, so you have to check around. A practice that is sports injury related is a good place to start.

    Though my TENs unit does not treat MTPs, it does block the painful impulses, not only for the bodywide MTPs but for carpal tunnel symptoms, pelvic floor dysfunction and especially migraines. There are times it is the ONLY thing that will get my migraine to subside, even after two doses (max) of Imitrex. In my opinion this is very important information to share with others who may be experiencing the many comorbid conditions that also have a myofascial and centralization component.

    Caution should be used with TENs units, there are some contraindications. It is also important if you are using it at home to always have the unit set on pulsating, despite the temptation to crank it up, yes, been there done taht. Putting the muscle in a sustained contraction does not allow the impulses and blood flow in to rid the toxins that have built up in an untreated myofascial trigger point. Myofascial pain syndrome is a common comorbid condition that is often overlooked, especially by rheumatologists. There are PTs, and specialized myofascial trigger point therapist out there,, but as everyone echo’s here, insurance is limiting, which limits our access to these helpful treatments. Healing, harmony and hope, Celeste, author, patient, advocate

    • Traci Mersch says:

      So thankful for this conversation. I have a TENS unit and it’s been a long time since I have pulled it out and used it. I am pulling it out today, using it and putting my heating pad over it. Can’t wait to try it again and am hoping for the best!! Thanks Fibro Friends…..AND Celeste for always being there!! Traci Mersch ((hugs))

    • Joke says:

      This is a neat suarmmy. Thanks for sharing!

  17. Teresa says:

    I work with a massage therapist who has several patients with fibromyalgia. I go once every 2 weeks. At first, I went every week. It has made a world of difference with my pain level…it is much lower now.

  18. Jackie Malic says:

    I have never tried the Tens, the only ultrasound I had was for my shoulder but only help for a little while. For the past 3 month I been going to have a massage once a week of my whole body. This guy is great but have to say that the first two times the pain was really bad, yet by the 3 rd week I was feeling much better. I stop for two weeks and I notice right away the stiffnes and the pain. Now I am going every week, that is the only way I can move around and sleep better.

  19. dev says:

    Wow. I have had fibro for 20 plus years and am glad for this website. I was at a crossroads at what to do next. I live in the northeast and winters are a challenge and I am getting tired of taking care me. Various chiros have been used over the years offering different modalities. I am going back to chiro with ut and tens after reading this issue. Physical therapy in heated pool has been a priority for last two years. I need to drive 20 minutes each way to pool and now fibro has settled in shoulder area and neck making driving difficult. Whiplash in July complicated my life further. I now look forward to getting rid of this complication with combination ut and tens. Wish me luck and I wish you the same in working through and overcoming these flares.

  20. marsha call says:

    I have had fibro for 17 yrs. My best treatment is massage, yoga and walking.
    A recent sleep study showed I had a severe sleep apnea and I now nightly use a CPAP. If you have not had a sleep study, I urge you to do so. What a difference a year makes in better pain relief.

  21. Jody says:

    I tried the tens years ago but didnt see any improvement but after all of these comments I will try it again. I agree with the massage comments, fortunately I have one that has exp with Fibro and she is able to tune into my body to release the knots. I am curious to ask if any of you have the sensation that your muscles have a fine tremor? It’s like they are spasming or jumping so fast that it is wearing me completely out. If so has the tens helped with that or did it make it worse? Fibro is so frustrating, so many symptoms but no definate solution yet.

  22. Niki says:

    You can get TENS and ultrasound machines on the internet now – but I do with someone would do a comparative study. I’ve been considering purchase, but it’s difficult to know what the signs of quality are. I had fantastic P.T.s in Colorado who worked in many modalities and took a creative approach to my symptoms. Since I’ve moved to NY (and experienced the gradual decrease in quality of health insurance everyone else has). I’ve found P.T. less and less effective. I’ve noticed therapists don’t have the time or energy to release muscles before asking me to activate them, which tends to injure me further. Combine that with the physical drain of getting to and from the office, and the overall effect of going to is no longer positive. Since I’m a massage therapist, myself, I get most pain my relief from trading massage with others.

    So an at-home regimen with these would be welcome. I do have a TENS machine, but have noticed it sometimes irritates tissues already inflamed. I’d like to try ultrasound at home.

    Heading for an epsom slat bath. Peace, everybody. Thanks for posting.

  23. gina says:

    Just wanted to share something I have had fibro since 97 and have been giving all different meds. Most causing side effects and side effects ( which could have made things worse) that you could never really know if it was the fibro or the pills?????? Alot are the same. I stoped all meds even the sleep ones……(which I was on three for this alone) and started the suppliment route. I feel better then I have ever felt. The brain fog, tired , sleep , energy and neck and shoulder pain is sooooooooooooooo much better. I have also started walking and plan to join a gym soon something I would have never have done it before I couldn’t even do day to day stuff before. I feel like I’m getting my life back. FINALLY!

    • C M says:

      Gina, could you share with us what supplements you are taking? I too am tired of all the side effects of the RX and am depending more on supplements.

  24. Marnie says:

    Not sure what a TENS unit is but I recently purchased a Pinook digital mini-massager, low-frequency bionic therapy. I use it 3+ times a week, whenever I have a sore spot. I find my worst areas are lower back and shoulder blades into neck (constant discomfort and/or pain in neck area); therfore I can usually get the pads fairly close to where I need, enough to get the job done. On occasion I will ask my daughter to place them if I need it closer.

  25. Jan says:

    My question is also to Gina as to what supplements she has found helpful. Also to the person who experiences spasms, I also find that as my stress level increases, I will first get eye tics and then spasms in other places. Regular gentle massase has been the most helpful.

  26. sheri says:

    I would love to try the TENS. My sister just told me that her physical therapist uses it on her–she is recovering from a stroke and she says it has helped her to move her fingers on left side

  27. Lainel says:

    My physio. ordered me a TENS machine, which I does help with painful knotted areas in my thighs. The TENS machine runs on a battery, but since I have so many sore, tender, areas in my thighs, I find the battery soon runs out, so have to recharge the batteries often.
    Does anyone else suffer greatly with pain after walking, especially uphill?
    I am in pain for a week afterwards. I live near a beach and would love to be able to walk to the beach, without all the pain afterwards.

  28. Kendra Hemmen says:

    I purchased a 4 in 1 unit for home that has Tens, Muscle Stimulator, Interferential & Microcurrent but I’m not sure what setting to use for any of them and the company that I purchased from has limited information to give me and says to get my doc or PT to help me. I have been out of PT since Dec. so I have not pursued asking her and my doc did not tell me to get one and I bought it without a prescription.
    Does anyone know where I can get general information on the recommended settings for various body parts? My unit is the (4 in 1 Therapy LG-SuperQuad Combo) purchased from . The manufacturer has limited info on their site as well on this particular unit, but has more info for other units that are not quads.
    Please help if anyone knows where I can get some info on this unit

  29. Terri Collins says:

    Living in the southern part of Louisiana (Lake Charles), I find the humidity is sometimes unbearable with my FMS. I purchased the physician list from this network and saw several from Lafayette, LA (which is about an hour drive for me – driving a long distance, for some reason, seems to kick in FMS). Does anyone know of a Rheumatologist here in Lake Charles, LA or a physician that works with FMS

  30. Debbie says:

    I use to use both,and received a lot of relief. Now I do no use because I received a pacemaker. What can I do?

  31. Lucy says:

    I have two TENS units – one with pads and another that looks like an oversized pencil. The larger one has a point that can be placed directly on the spot for several seconds. Very handy and convenient and really helps. Insurance paid for some of the cost with a prescription from my Dr. Also acupunture 2 X a week, which includes electrical stimulation (TENS). MAJOR improvement and help.

  32. T. E. Hieatt says:

    I prefer EMS. It is wonderful for chronic myofascial pain & trigger points. Some are misinformed about the difference between FMS and CMP. TENS will interrupt the CNS pain signals of FMS for a short time and gently stimulate the muscle that is affected by the pain, while EMS is physically therapeutic for CMP in an intense way, since it is retraining and exercising the muscle. 

  33. chris says:

    I agree 100% with all of you. i go to pt 2x wkly. out of pocket of coarse, not like ins would pay for more than 15 visits. Anyways, i would suggest all of these things everyone has discussed. I do the aquatics 1st and then they do all of the other things after. However, just to say it doesnt last forever but it does buy you a few days of peace and some comfort. Mentally, its sooo worth it.

  34. James Dann says:

    I fell one story at work breaking my skull and collar bone, about a year later i developed fibromyalgia, I went to physical therapy for a 18 months, 3 times a week, where i received ultra sound treatments. It was very painful for a very long time, i don’t have fibromyalgia anymore!

  35. Nelson says:

    Hi there! I could have sworn I’ve been to this website before but after reading through some of the post I realized it’s new to me. Nonetheless, I’m definitely happy I found it and I’ll be bookmarking and checking back frequently!

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