Warning signs, tips, and treatments

Fibromyalgia is a long-term condition that causes pain and tenderness throughout the body. Symptoms of fibromyalgia flares vary but often involve widespread pain, joint stiffness, and extreme sensitivity to stimuli.

Scientists estimate that around 4 million adults in the United States have fibromyalgia. Women are twice as likely to have fibromyalgia as men. Children can have fibromyalgia, but it is more common in older adults.

When fibromyalgia pains flare up, every activity can seem more difficult. All people experience flares differently, and there can be different triggers depending on the person.

This article discusses the symptoms of fibromyalgia flares, their causes, and how to manage them.

Some people with fibromyalgia may experience certain symptoms regularly. However, the pain associated with fibromyalgia tends to fluctuate and worsen.

When symptoms temporarily increase in number or intensity, it is called a flare or flare-up. A flare-up can last anywhere from a few days to weeks.

The main symptom of fibromyalgia is widespread pain. People may also experience stiffness and tenderness of the muscles, tendons, and joints. The individual symptoms differ from one person to another. Symptoms can vary in intensity and come and go.

Symptoms of fibromyalgia may include:

• pain throughout the body, particularly in the back or neck
• extreme sensitivity to touch, light, smoke, and certain foods
• stiffness when staying in the same position for long periods
• muscles spasms
• extreme tiredness
• poor quality sleep
• fatigue
• trouble with memory and concentration referred to as “fibro fog”
• slow or confused speech
• frequent headaches or migraines
• irritable bowel syndrome

Someone with fibromyalgia may sometimes experience clumsiness, dizzy spells, feeling too hot or cold, painful periods, restless legs syndrome, and numbness or tingling in hands and feet.

Daily pain and sleep deprivation can cause problems at home and work. The stress of coping with a condition can also lead to anxiety and depression.

Flare-ups can happen without warning but often have noticeable triggers.

The exact cause of fibromyalgia is unknown. However, changes in brain chemical levels and central nervous system function may play a role.

Periods of physical or emotional stress are common triggers for fibromyalgia. This may include:

• giving birth
• injury or infection
• large operations
• large life changes
• dealing with grief

Other factors may trigger a fibromyalgia flare-up, including:

• lack of sleep
• exhaustion
• temperature or weather changes
• diet changes
• hormonal imbalances

People are at more risk of fibromyalgia if they have a rheumatic disease. Rheumatic diseases affect the bones, muscles, and joints. They include:

• osteoarthritis
• rheumatoid arthritis
• lupus
• ankylosing spondylitis

Visit our dedicated arthritis hub here.

Although some triggers for fibromyalgia are beyond a person’s control, managing modifiable risk factors can help to prevent flare ups.

Reducing the risk of flare ups and practicing self care can improve symptoms and overall quality of life.

Below are several lifestyle changes and tips that may help relieve symptoms and make fibromyalgia easier to live with daily.

Keeping a log of triggers

Triggers for fibromyalgia vary from person to person. Maintaining a log of activities, meals, sleep times and duration, and symptoms of fibromyalgia may help to identify particular triggers.

Recording these activities might highlight patterns of what triggers a flare. This might help a person with fibromyalgia find out how to better manage or avoid those triggers.

Reducing stress and relaxing

Stress makes symptoms of fibromyalgia worse. Many people with fibromyalgia experience stress and feelings of depression, anxiety, and frustration. People may benefit from trying to avoid or limit exposure to stressful situations and making time to relax.

While techniques such as meditation or deep breathing may help manage stress, it is important that people with fibromyalgia do not avoid physical activity altogether. People with fibromyalgia who quit work or stop exercising do not do as well as those that stay active.

Options to assist with stress management are available and include cognitive behavioral therapy (CBT), group therapy, and feedback from qualified health professionals.

Exercising regularly

Regular physical activity can often improve symptoms of fibromyalgia. Although exercise may increase pain at first, it may help prevent pain over time.

Activities that may help people with fibromyalgia include walking, biking, swimming, and water aerobics. Maintaining good posture habits, stretching, and relaxation exercises may also help.

People with fibromyalgia begin with gentle exercises, such as walking and build up endurance and intensity slowly.

Resistance and strengthening exercises may improve muscle strength, physical disability, depression, and quality of life. They can also improve tiredness and boost mood in people with fibromyalgia.

Learn more about the best exercises for fibromyalgia here.

Getting enough sleep

Fatigue is one of the main symptoms of fibromyalgia. It is essential that people with fibromyalgia get enough sleep.

Sleep hygiene practices that may help include going to bed and getting up at the same time every day and limiting napping during the day. Other helpful practices include:

• limiting screen time before bed
• limiting caffeine intake
• ensuring the sleep environment is dark and quiet
• avoiding eating large meals late in the evening

Learn more about the importance of sleep in our dedicated hub.

Not doing too much

While regular physical activity is recommended to help manage fibromyalgia symptoms, it is crucial to limit overexertion and not to do too much.

Moderation is the key. If a person with fibromyalgia does too much on days where their symptoms are good, they may end up having more bad days. However, on bad days, individuals should still try to be as active as they can. Keeping activity levels as even as possible provides the best outcome.

Diet

Although there is no specific diet recommended for people with fibromyalgia, there are certain foods that appear to make fibromyalgia symptoms worse.

Try an elimination diet, in which you exclude certain food groups each week to see if symptoms improve. If symptoms get better after ruling out a certain type of food, they may well be connected to fibromyalgia symptoms.

Studies show that Mediterranean, vegetarian, low gluten, and low FODMAP diets may all help manage fibromyalgia symptoms.

Maintaining proper nutrition will help boost energy levels and help avoid other health problems.

Learn more about which foods to limit or prioritize to manage fibromyalgia here.

Fibromyalgia and Social Security

Many people with fibromyalgia find themselves unable to work or resume a normal standard of living.

For such people, Social Security rulings in the United States dictate that so long as a medical or osteopathic doctor can determine that the disease causes medically determinable impairment (MDI), the condition will qualify as a disability for Social Security payments.

This means that a doctor should be able to confirm:

• a history of widespread pain
• a minimum of 11 tender points following examination
• repeated instances of at least six fibromyalgia symptoms
• no other conditions are causing the pain

The Social Security Administration (SSA) requires medical documentation dating back 12 months related to the disease and may conduct interviews with relatives, friends, neighbors, and past employers to confirm the diagnosis.

In some cases, the SSA may fund a consultation to confirm the debilitating nature of the disease.

Treating fibromyalgia flares can be tricky. Preventing a flare from developing in the first place is less complicated than treating a flare.

Fibromyalgia has several symptoms, which means that no one treatment will fix them all. Also, a treatment that works for one person may not work for another.

Treatment plans will often combine medication and lifestyle changes.

Medications that may help reduce fibromyalgia pain and improve sleep include:

• antidepressants
• anti-seizure drugs
• naltrexone, which is an anti-opioid medication, may be helpful

Talking therapies such as CBT aim to alter the way a person thinks about things and may help tackle fibromyalgia in a more positive way. Psychotherapy can also help someone with fibromyalgia help understand and deal with their thoughts and feelings.

Alternative treatments such as acupuncture, massage, and aromatherapy may also help with relaxation and stress.

There is no cure for fibromyalgia. However, medication and lifestyle changes can help treat fibromyalgia and reduce the likelihood of flares. Fibromyalgia is a condition that can be managed, and people with the disorder can live a full life.

Participating in regular exercise is one of the most effective ways to avoid fibromyalgia flares and manage pain.

Fibromyalgia can cause widespread pain, fatigue, and stiffness. Symptoms tend to occur in periods of flares.

Physical and emotional stress are the most common triggers of fibromyalgia flares. Other triggers include lack of sleep, weather changes, and hormone imbalances.

3. Symptoms of CFS and Fibromyalgia

Fibromyalgia. What is Fibromyalgia?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Fibromyalgia is a chronic pain syndrome resulting from a genetically determined phenomenon of central sensitization. It manifests itself as diffuse pain in the musculoskeletal structures, combined with fatigue, sleep disturbance, and depression. It is diagnosed according to clinical criteria with laboratory and instrumental exclusion of rheumatic pathology, organic causes of pain. Treatment is carried out using a combination of non-drug (exercise therapy, psychotherapy) and medication (antidepressants, GABA derivatives, local anesthetics) methods.

ICD-10

M79.7 Fibromyalgia

• Causes of fibromyalgia
• Pathogenesis
• Symptoms of fibromyalgia
• Diagnostics
  • Differential diagnosis
• Fibromyalgia treatment
• Prognosis and prevention
• Prices for treatment

General

Fibromyalgia has long been known in medical practice, it is observed in 4% of the population, it is prevalent mainly in middle-aged women (35-55 years). Due to the lack of an organic substrate, the disease was for a long time attributed to mental disorders, diagnosed as hypochondria, hysteria, psychogenic rheumatism.

The term fibromyalgia was coined in the 1970s. In 1990, the American College of Rheumatology first published diagnostic criteria for the disease. At the beginning of the 21st century, evidence was obtained that fibromyalgia is not accompanied by inflammatory changes in peripheral tissues, therefore, it is not a rheumatic pathology. Identification of violations of the central mechanisms of pain perception in patients finally secured the curation of the disease for specialists in the field of clinical neurology.

fibromyalgia

Causes of fibromyalgia

Recent studies have proven the hereditary nature of the pathology. The localization of the genetic defect has not yet been established. It is known that the probability of developing the disease in people whose relatives are diagnosed with fibromyalgia is 8 times higher than the average for the population. Studies of twins show that 50% of the risk of pathology is genetically determined, and 50% is associated with exposure to external factors that act as provoking triggers. The most likely etiological factors under the influence of which genetically determined fibromyalgia occurs are:

• Peripheral pain syndromes. Associated with damage to the peripheral nerve trunks as a result of trauma (nerve damage), compression (carpal tunnel syndrome), inflammation (neuritis, sciatic nerve neuropathy), dysmetabolic processes (diabetic neuropathy).
• Infectious diseases: borreliosis, herpetic infection, infectious mononucleosis, Q fever.
• Distress is mental stress accompanied by negative emotions. The negative perception of life events is due to the presence of suspiciousness in the patient, a tendency to catastrophize events, excessive alertness, and fixation on one’s own feelings. Similar character traits are observed in almost all patients.
• Physical injury (bruise, fracture, burns). Acts as a stress factor, associated with severe pain.
• Hormonal imbalance. Fibromyalgia is most commonly seen in hypothyroidism.
• Pharmaceuticals and vaccine administration. They negatively affect the neurotransmitter processes involved in the formation of pain perception.

Pathogenesis

Chronic pain syndrome, which accompanies fibromyalgia, is caused by central sensitization – constant hyperexcitation of sensitive neurons of the posterior horns of the spinal cord. Increased excitation is formed both under the influence of pain impulses coming from the periphery (injuries, peripheral syndromes), and as a result of neurometabolic changes against the background of distress, infection, hormonal disorders.

The leading role in pathogenesis belongs to serotonin- and noradrenergic neurotransmitter systems. It has been established that in patients the concentration of serotonin, L-tryptophan, norepinephrine in the blood is reduced, the level of 5-hydroxyindole, the basic metabolite of serotonin, is reduced in the cerebrospinal fluid. Since serotonin is considered to be responsible for good mood, the drop in its level explains the propensity of patients with fibromyalgia to depressive and anxiety states.

Fibromyalgia symptoms

The leading symptom complex of the disease is persistent diffuse pain throughout the body. Patients characterize the pain syndrome as “a feeling that it hurts everywhere”, “a constant feeling that you have a cold”, “burning all over the body”. Pain is accompanied by sensory phenomena: tingling, numbness, “goosebumps”, especially pronounced in the limbs. Sometimes fibromyalgia occurs with periodic arthralgia.

Increased fatigue is characteristic, most pronounced in the morning, less pronounced during the day and somewhat increasing in the evening. Even a slight increase in physical activity, as well as a prolonged lack of activity, can increase pain and fatigue. Sleep disturbances are represented by difficulties falling asleep, frequent nocturnal awakenings, lack of vigor after a sufficient period of sleep. A typical symptom is a feeling of weakness, fatigue after sleep. The feeling of lack of sleep is present even after a period of sleep lasting 9-10 hours, accompanied by morning stiffness in the body.

In 30-60% of cases, fibromyalgia is combined with mental disorders. The most typical generalized anxiety, depression. Many patients experience mild cognitive impairment: memory impairment, reduced ability to concentrate, inattention. Patients often describe them as a “fog in the head” that makes it difficult to concentrate.

The characteristic symptoms of fibromyalgia in most cases are combined with other problems: migraine-type headaches, restless legs syndrome, gastrointestinal dyskinesia, urinary disorders. Chronic pain, disturbed sleep negatively affect the patient’s ability to work, complicate his daily life, reduce its quality.

Diagnostics

Fibromyalgia is diagnosed mainly on the basis of clinical data after the exclusion of the organic genesis of pain. The comprehensive examination includes:

• Patient interview. Allows you to determine the main complaints, their nature, duration of the disease, concomitant pathology. As a diagnostic screening, the FiRST questionnaire is used, the sensitivity of which is at the level of 90.5%, the specificity is 85.7%. The questionnaire contains 6 items, a positive answer to 5 questions indicates the presence of fibromyalgia.
• Assessment of neurological status. The status is correct. Asthenization of the patient is noted, in the study of cognitive functions – difficulty concentrating.
• Trigger point research. 9 pairs of points are known, the pain of which is accompanied by fibromyalgia. Diagnostic palpation should be carried out with a certain uniform pressure force, combined with comparative palpation of other areas.
• Laboratory tests. The absence of inflammatory changes in the general blood test, an increase in markers of autoimmune pathology (C-reactive protein, RF, antinuclear antibodies, ASL-O) makes it possible to exclude the rheumatic nature of the disease. There is a decrease in the concentration of L-tryptophan, serotonin in the blood serum.
• Tomography. Computed tomography, MRI of the brain do not reveal morphological changes, exclude intracranial hypertension, cerebral tumors, slow infections of the central nervous system, degenerative processes.

Differential

Differential diagnosis is carried out with myositis, dermatomyositis, hypercalcemia, neurasthenia, hysterical neurosis, somatoform disorders, oncological processes. When making a diagnosis of fibromyalgia, doctors can focus on the following diagnostic criteria:

• Pain in the four quadrants of the body, present in the chest and/or spine, lasting at least 3 months.
• On palpation, pain occurs in 11 out of 18 trigger points.
• The presence of increased fatigue.
• Characteristic sleep disorders.
• Difficulty focusing when necessary.
• Morning stiffness.
• Depressive, anxious mood background.
• The impact of the disease on the quality of life.

Fibromyalgia treatment

The therapy is carried out by a neurologist or an algologist, it requires an integrated approach, a combination of several techniques. Among the methods of treatment used, there are non-drug and drug treatments.

Non-drug methods:

• Cognitive-behavioral psychotherapy. Allows the patient to develop a positive outlook on life, reduce anxiety, raise the background of mood.
• Therapeutic exercise. It has been proven that moderate physical activity helps to reduce pain, regression of the symptoms of the disease for a period of up to a year or longer.
• Other methods: biofeedback therapy, acupuncture, hydrotherapy, hypnotherapy. Showed moderate effectiveness in pain relief. Can be used as an addition to basic therapy.

Pharmacotherapy:

• Antidepressants. Effective against fibromyalgia and associated depression, improve sleep. Amitriptyline, serotonin and norepinephrine reuptake inhibitors (venlafaxine, duloxetine) have proven efficacy.
• GABA anticonvulsants (pregabalin). Against the background of treatment, there is a significant decrease in pain symptoms, sleep is normalized, and the overall activity of the patient increases.
• Central analgesics (tramadol). Used to relieve acute pain. The analgesic effect of tramadol potentiates its use in conjunction with paracetamol. Side effects are pronounced (dizziness, weakness, nausea), a long course of treatment is addictive.
• Local anesthetics (lidocaine). Used as part of a course of treatment in the form of infusions. When locally injected into trigger points, they have a local and general analgesic effect.

Prognosis and prevention

Fibromyalgia is a chronic pathology. Regular complex treatment can reduce pain by 30-50%, normalize sleep, reduce anxiety and depression, improve the efficiency and quality of life of patients. The best prevention of the disease is a positive attitude towards life, a benevolent outlook on current events, caring for others, as opposed to an excessive focus on internal sensations. People who have developed such an attitude towards life are protected from the likelihood of disease, even if there is a genetic predisposition.

You can share your medical history, what helped you in the treatment of fibromyalgia.

Sources

1. self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

   Drawing pain in the thigh, buttock and groin

   Drawing pain in the thigh, buttock or groin is a common symptom that makes people immediately seek treatment from doctors of various specialties. Most people at least once in their lives have experienced such complaints. Self-administration of medications, application of anesthetic ointments, warming up can aggravate the development and manifestation of pain without an accurate diagnosis.

   Let’s try to understand the causes, possible diseases associated with the manifestation of such symptoms, as well as methods of diagnosis and treatment.

   The main causes of pulling pain in the thigh, buttock or groin

   Finding the starting point of such a complaint often causes difficulties in differential diagnosis, since the causes of unpleasant sensations in these areas may be the result of a number of pathological conditions of the human musculoskeletal system. There are everyday causes (lifestyle, postures at work), acute diseases (traumas, exacerbations of chronic conditions), functional deviations in the work of the muscular corset.

   Among the provocateurs of this pain syndrome, it should be noted:

   – excessive physical activity associated with labor activity

   – “sedentary” work;

   – overweight problems;

   – the period of bearing a child.

   Conditions and diseases of the musculoskeletal system, the symptom of which may be drawing pain in the lower limb.

   1. Lesions of the lumbosacral spine.

   Degenerative-dystrophic processes in the spine often become the main cause of pain in the thigh and buttock. This is due to the pathological cascade of changes in the state of the intervertebral discs, intervertebral joints of the ligamentous-muscular corset. With the progression of intervertebral protrusion or hernia, compression and irritation of the nerves may occur, resulting in pain symptoms. Depending on the level of this influence, the localization of the problem will also change.

   2. Arthropathy of the hip joint

   Among the lesions of the hip joints, coxarthrosis should be highlighted in the first place. The prevalence of this pathology, according to scientific literature, reaches 18% in the group of diseases of the musculoskeletal system. Clinical manifestations of coxarthrosis, namely, limited mobility in the joint, sparing of the leg when walking, pain when probing soft tissues, muscle spasm can cause pain both in the back and in the hip area. Second defeat

   3. Femoral neuropathy

   Femoral neuropathy is a fairly common mononeuropathy of the lower extremities. There are several areas in which the anatomical and topographic features of the femoral nerve predispose it to an increased risk of compression or injury – in the region of the iliopsoas muscle, under the inguinal ligament, in the region of Gunther’s canal and when exiting it. Depending on the level of the lesion, the clinical manifestations of femoral neuropathy vary significantly.

   4. Physical injuries of the thigh area

   Any traumatic impact on the muscle structures of the lower limb gives a range of pain symptoms. Bruises, sprains and overstrain of the musculoskeletal system, the consequences of femoral fractures should be considered as a possible cause of pain. Even remote manifestations are often the result of trauma.

   5. Trochanterite

   This is inflammation of the upper point of the femur, called the trochanter, to which tendons and muscle fibers are attached. Given the inflammatory nature of tronchateritis, this disease is often mistaken for arthrosis. This condition is characterized by pain during verticalization, movement. The anterior-lateral surface of the thighs is most often affected. Unlike coxarthrosis, movement in the joint is not objectively limited.

   6. Myofascial pain syndromes

   Musculoskeletal disorders are also one of the factors of pain in the thigh and buttocks. Most clearly, such a pathology is reflected by myofascial pain syndromes, characterized by the development of muscle dysfunction and the formation of local painful seals in the muscle tissue. The most common of these syndromes are piriformis syndrome and iliac-tibial tract syndrome.

   Piriformis syndrome is a condition that is particularly associated with pain in the buttock and/or thigh. In some articles, this syndrome is defined as peripheral neuritis of the branches of the sciatic nerve caused by non-physiological overexertion of the piriformis muscle. Women with CGM are diagnosed more often than men (ratio is 6:1)

   (connective tissue that covers all the muscles in your body) connective tissue that runs from the top of the pelvis down the outer thigh, crosses the outside of the knee, and attaches to the very top of the tibia. This anatomical structure serves as a link between the main muscles of the pelvis and the knee. The main function of this tract during running is to stabilize the knee during the impact of the foot on the ground. The syndrome of the iliac-tibial tract most often develops against the background of its damage. The pain is localized in the area of ​​the outer part of the knee or just above it, although it can extend up to the top of the femur.

   7. Joint dysfunction and flat feet.

   Tracing the direct muscular-fascial relationship of the distal and proximal parts of the lower limb, it is necessary to take into account pathological changes in the ankle joints and feet. Regular physical overload, as well as deformation of the anatomical structure of the feet, give ascending causes of the development of pain symptoms in the upper legs, in the hip joint, ligaments and muscles. The scientifically proven myofascial kinematic chain with a high frequency leads to the development of pain in the area of ​​the previously mentioned regions. However, such a clinical picture does not always have organic lesions in the joints, muscles or bone and ligamentous elements. Localization of pain sensations may vary depending on the violation in a particular biomechanical motor chain.

   Diseases and pathological conditions not associated with lesions of the musculoskeletal system and capable of causing similar pain

   – Diseases of an infectious or parasitic nature, accompanied by fever, severe intoxication, damage to the vascular membranes of the brain and spinal cord (bacterial or viral infections, tick-borne encephalitis, borreliosis, botulism, trichinosis)

   – Damage to the vascular and lymphatic bed of the pelvic region and lower extremities (varicose veins, atherosclerotic changes in the walls of blood vessels, lymphostasis)

   – Conditions characterized by deficiency of vitamins and microelements formations in muscle tissues and connective tissues (rhabdomyosarcomas, leiomyosarcomas,

   – Side effects of drugs (glucocorticosteroids, hypolipidemic drugs)

   – Endocrinological diseases (diabetes mellitus)

   – Physiological pain symptoms during pregnancy due to postural restructuring of the vertical axis of the body

   – Ecomb syndrome (restless legs syndrome)

   – Autoimmune diseases

   900 03 Diagnosis

   Correct diagnosis – the key to effective and high-quality treatment. Therefore, there is a certain examination algorithm, the volume of which can be determined by the doctor. The diagnostic path of a patient is built from the following steps:

   1. Consultative examination and history taking.

   2.Manual-muscle testing, assessment of motor stereotypes, detection of violations of the biomechanical chain of the musculoskeletal system.

   3.Performance by the patient of specific tests and samples

   4.Passage of additional laboratory and instrumental methods of research: general and biochemical blood tests, laboratory tests for specific markers, radiography, ultrasound, Electroneuromyography, MRI, MSCT.

   5. Consultation of doctors of related specialties for verification of differential diagnosis.

   This amount of diagnostics allows you to accurately determine the pathology and the cause that caused pain, since pain in the thigh, buttocks, groin can have different etiological factors. A well-designed diagnostic strategy allows the doctor to prescribe the necessary range of therapeutic measures in a short time.

   Treatment

   Any physical discomfort that changes the quality of life and movement will force a person to look for ways to solve and get rid of the disease. Often the lack of clinical thinking and trust in the media have a negative impact on the development and progression of the pain syndrome. Long-term refusal to visit a doctor, self-administration of medications and various procedures can lead to chronicity and difficulty in conservative treatment, turning to radical, surgical methods of treatment, followed by loss of functions and restrictions.

   At the “Freedom of Movement” medical center, an experienced team of qualified doctors will help you accurately diagnose and create an individual set of treatment procedures for achieving recovery. The staged reception of doctors allows the patient to ensure the smoothness and softness of the impact of therapeutic instruments.

   Stage 1 is the initial appointment and diagnostics.

   Stage 2 – treatment.

   After the final diagnosis is made, a treatment plan is formed, which may include the following procedures:

   – manual therapy

   – osteopathy

   – medical massage

   – acupuncture

   – physiotherapy

   – medical therapy (therapeutic intraarticular and paravertebral injections, P RP-therapy, ACF-therapy, droppers)

   Stage 3 – stabilization of the result

   After achieving a stable improvement in the previously impaired function, reducing the pain syndrome, the patient proceeds to the stabilization phase. The basis of such consolidation of the result is a complex of means of therapeutic physical culture (LFK). The goals of exercise therapy are to strengthen the muscular corset, improve balance and coordination of movements, increase the range of motion in the joints, develop the flexibility and elasticity of the muscular-ligamentous apparatus.

   Returning to possible provocateurs of the pain syndrome, in particular pain in the buttocks, thighs or groin, the patient is clearly and easily explained the need to form healthy habits and an optimal lifestyle:

   – organizing a comfortable workplace

   – position hygiene at night

   – healthy balanced nutrition

   – preventive check-ups

   – procedures that support the result of treatment

   – performing individual home exercises.