Lifestyle Measures for Polymyalgia Rheumatica

Question: I am an 86-year-old woman who developed polymyalgia rheumatica about a year ago (after many years of having osteoarthritis). While my condition is being treated with steroids and painkillers, I am still experiencing a lot of pain and stiffness, and I understand this could continue for a while. Would lifestyle measures such as yoga or massage be safe and helpful for me? As a side effect of one of the medicines I’m taking, I also have thin skin and bleed easily.

Answer: Polymyalgia rheumatica (PMR) is an inflammatory condition that can cause aches and stiffness, usually occurring on both sides of the body and often affecting the shoulders, neck, upper arms, buttocks, hips, or thighs. PMR is often treated very aggressively, because in some cases the inflammation can affect blood vessels in the head, which increases the risk of a stroke. The good news is that it is usually a temporary condition that lasts for several months up to two years, and then spontaneously resolves.

Nonsteroidal anti-inflammatory drugs such as ibuprofen (brand name Advil) tend not to be helpful in treating the symptoms of PMR, so it is typically treated with a steroidal anti inflammatory such as prednisone. Some precautions need to be observed for massage therapy or yoga to be safe when using steroids, especially since every person has a unique reaction to these medicines. Rigorous massage may temporarily exacerbate inflammation, and the long-term use of steroidal antiinflammatories can lead to other problems: Thinning skin can be an issue, and so can some level of bone thinning, fluid retention, and reduced resistance to infection. Using steroids in combination with painkillers can interfere with pain signals, which makes it easier to accidently overtreat with massage. Although these potential problems shouldn’t keep you from exploring massage therapy, any massage therapy you receive to alleviate the symptoms of your PMR should take these risks into consideration.

I am happy to say that it is very likely that you can receive massage therapy that safely addresses some of your lingering pain, as long as your massage therapist is knowledgeable about the side effects of painkiller and steroid use and can design a treatment session that maximizes the benefits of massage while minimizing your special risks. Likewise, I expect that a gentle yoga program, led by a well-informed instructor, will help you with stiffness and pain. Congratulations on your search for an active solution to your challenges!

Want to learn more about polymyalgia rheumatica? Read “Polymyaglia Rheumatica Increase Risk for Vascular Disease” and “Giant Cell Arteritis.”

Ruth Werner, BCTMB, is President of the Massage Therapy Foundation and the author of A Massage Therapist’s Guide to Pathology.

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