Chronic Fatigue & Fibromyalgia

Fibromyalgia and chronic fatigue syndrome are two related but distinct conditions that can significantly affect day-to-day quality of life, causing widespread pain, profound exhaustion, and a range of other symptoms that don’t always fit neatly into a single diagnostic category. Both are complex conditions, and while physiotherapy doesn’t cure either one, it can play a meaningful role in managing symptoms and improving function alongside the broader care your GP or specialist provides.

Because symptoms overlap significantly with other conditions, an accurate diagnosis — usually made by your GP or a rheumatologist — is an important first step before physiotherapy treatment begins. Andrew’s role sits alongside this diagnosis, focused on the practical, day-to-day management of pain, stiffness and deconditioning rather than on diagnosing the underlying condition itself.

What causes fibromyalgia and chronic fatigue syndrome

Fibromyalgia is characterised by widespread musculoskeletal pain, thought to relate to how the nervous system processes and amplifies pain signals, alongside fatigue, poor sleep, and often tingling in the hands and feet or difficulty concentrating (sometimes described as “brain fog”). Chronic fatigue syndrome (myalgic encephalomyelitis) centres on persistent, often debilitating exhaustion that isn’t relieved by rest and can be worsened significantly by physical or mental exertion. The two conditions overlap considerably and sometimes occur together, and the exact underlying mechanisms of each remain an area of ongoing research — which is part of why individualised management matters more than the specific label.

When to see a physiotherapist

If you haven’t yet had a formal diagnosis, seeing your GP first is the right starting point, since fibromyalgia and chronic fatigue syndrome share features with a number of other conditions that need to be ruled out or identified — including some, like inflammatory arthritis or thyroid dysfunction, that need their own specific treatment. Once a diagnosis is in place, physiotherapy can be a useful part of ongoing management. It’s worth flagging any new or different pain, a sudden marked worsening of symptoms, or features like unexplained weight loss or night sweats to your GP promptly, since these warrant medical review rather than being assumed to simply be part of the underlying condition.

Physiotherapy treatment for chronic fatigue and fibromyalgia

Treatment is built around your specific symptoms and, critically, paced carefully — exercise or manual treatment that’s too intense too soon can flare symptoms significantly, sometimes for days afterward, so getting the dose right matters more here than in most other conditions Andrew treats. His approach typically draws on:

• Exercise rehabilitation — a graded, carefully paced exercise programme that starts conservatively and builds gradually, aimed at improving capacity and function without triggering the post-exertional symptom flares that are common in both conditions.
• Dry needling and trigger point therapy to help ease areas of widespread muscular tension and pain, which can be a significant contributor to overall discomfort.
• Manual therapy to address stiffness and improve comfort, particularly in areas carrying persistent tension.

Treatment is coordinated alongside your GP or specialist’s broader management plan, not in place of it — physiotherapy addresses the musculoskeletal and functional side of these conditions, while medical management addresses the diagnosis and any medication-based treatment.

What to expect from treatment

Andrew will spend time understanding how your symptoms behave — what triggers a flare, how you recover from one, and what your current baseline level of activity looks like — before building a programme around that, rather than a generic exercise sheet. Progress with fibromyalgia and chronic fatigue tends to be gradual and non-linear, with some setbacks along the way being a normal part of the process rather than a sign that treatment isn’t working. Being upfront with Andrew about how you’re responding session to session helps him adjust the pace appropriately.

A common early focus is simply establishing a sustainable baseline — a level of activity you can maintain consistently without triggering a flare — before gradually increasing it. This is sometimes called pacing, and it applies as much to daily activities and work as it does to structured exercise. Progressing too quickly from this baseline, even with good intentions, is one of the more common reasons people find their symptoms worsen rather than improve, which is why Andrew tends to err on the side of a slower, more sustainable build.

Living with fibromyalgia and chronic fatigue day to day

Because both conditions are long-term and can fluctuate significantly, ongoing self-management matters as much as in-clinic treatment. This typically means continuing a paced approach to activity and exercise even once symptoms improve, recognising your own early warning signs of an oncoming flare, and maintaining open communication with both your GP and Andrew as your symptoms — and what helps them — change over time.

Sleep quality, stress levels and general life demands can all influence how fibromyalgia and chronic fatigue symptoms present day to day, and while physiotherapy can’t address all of these directly, Andrew can help you understand how they interact with your physical symptoms and, where relevant, suggest when involving other members of your care team — such as a GP, psychologist or occupational therapist — may help with the parts of management that sit outside physiotherapy’s scope.