Chronic Fatigue Syndrome (CFS) also referred to as Myalgic Encephalomyelitis (ME) is a debilitating disorder that is the manifested as profound fatigue causing reduction in occupational, personal, social, or educational activities. The fatigue is not relieved through rest. It can be difficult to diagnose. Persons suffering from CFS/ME often find their quality of life drastically impaired while struggling to obtain a reasonable diagnosis and explanation of what is happening to them. Even after diagnosis it can be difficult to find knowledgeable health care providers able to help with the management. Physical therapy provides one management option that may help sufferers begin to deal with this disorder.
 What is Chronic Fatigue Syndrome?
CFS/ME is an often misunderstood disorder, characterized by variable but often severe flu-like fatigue, exertion intolerance, headaches, dizziness, cognitive dysfunction, and mild to moderate symptoms of infection or allergy such as sore or scratchy throat, tender lymph nodes, low grade fever, joint and muscle aches. Symptoms are worsened by physical or emotional "stress" and certain types of activity, especially aerobic exercise. CFS typically has a distinct period of onset often during periods of additional stress. The Center for Disease Control’s case definition criteria for CFS includes persistent or relapsing fatigue for greater than 6 months. The fatigue may either be gradual or sudden onsets, and it may be progressive or relapsing.
Those who become ill are often rendered completely disabled from school or work, in the prime of active life, and may remain sick for years. A large and growing body of published scientific evidence exists supporting a dysfunction in the immune system, the central nervous system, aspects of the hypothalamic-pituitary-adrenal axis and the autonomic nervous system, and a genetic risk of tendency to develop the disorder.
The prevalence of Chronic Fatigue Syndrome in this country is probably between 1-10 cases per 1000 in the population. For example, researchers at DePaul University estimate that Chronic Fatigue Syndrome affects four out of every 1000 people in the United States, with 90% of these cases largely undiagnosed and untreated. Most research suggests that CFS is three times more common in women than men (5.2 women out of 1,000), a rate that is similar to autoimmune diseases such as lupus and multiple sclerosis. Chronic Fatigue Syndrome is four times as common as HIV infection and poses a higher lifetime risk of lung cancer in women. There may be more than a million cases in the United States. Based on a population of 1,514,417 adults (over the age of 18) in the state of Utah, this amounts to 6,000 cases of Chronic Fatigue Syndrome, 90% of which may be undiagnosed and not properly treated (offerutah.org, 2010).
How Can a Physical Therapist Help?
Physical Therapy strives to increase mobility and movement in individuals and to reduce pain. These health care professionals should be uniquely suited to provide appropriate management services to sufferers. Unfortunately, CFS/ME is still misunderstood and the optimal clinical management of it remains controversial (Davenport, et.al. 2010). Still physical therapists with the right background and understanding can provide significant management guidance.
Exercise for people with CFS/ME must be graded and address the unique physical and emotional needs of the individual. Research indicates that combination of compensation and rehabilitation approaches to physical training are required (Davenport, et.al., 2010). Any exercise regimen for a CFS/ME sufferer should be accompanied by an appropriate education program as well. It is important that CFS/ME sufferers not overexert initially but gradually step up exertion as they become capable. Overexertion leads to physical stress that then causes the sufferer to avoid activity and exertion. This cycle of activity followed by exhaustion and inactivity is debilitating for the sufferer. Self management strategies become important and a skilled physical therapist can help you understand how to manage and gradually move to increased levels of exertion and exercise appropriate to individual needs and abilities.
References
Davenport, T. E., Stevens, S. R., VanNess, M.J., Snell, C.R., & Little, T., (2010). Conceptual model for physical therapist management of chronic fatigue syndrome/myalgic encephalomyelitis. Physical Therapy Journal, 90(4), 1-13.
Offerutah.org (March 19, 2010). OFFER is a nonprofit organization providing education and research about Fibromyalgia and Chronic Fatigue (http://offerutah.org).
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