A Guide to Exercising with AMPS (Amplified Musculoskeletal Pain Syndrome)
Have you ever heard of Amplified Musculoskeletal Pain Syndrome (AMPS)? Many people haven’t, but for young individuals with AMPS and their parents, AMPS is a term they are all too familiar with. You may be familiar with some of its other names, such as juvenile fibromyalgia syndrome, chronic musculoskeletal pain (CMP), chronic widespread pain (CWP), reflex sympathetic dystrophy (RSD), reflex neurovascular dystrophy (RND) or myofascial pain.
As you can likely deduce from the names listed above, individuals with AMPS experience chronic pain along with other symptoms which negatively affect quality of life. AMPS can be difficult and frustrating to treat given the nature of pain science (we’ll get into this later), but the good news is that one of the most promising treatments for AMPS is *drumroll please* …exercise! Exercise proves to be a successful treatment for AMPS, but it can be difficult to navigate given the fact that the individual will experience a level of pain while exercising. Because of this, it’s important for those working with individuals with AMPS to have a thorough understanding of the nature of AMPS as well as how to guide exercise training in a way that pushes the individual but isn’t discouraging.
This guide will give you an overview of AMPS, briefly touch on pain science so as to better understand the nature of AMPS, and discuss exercise as a treatment for AMPS. Those interested in treating AMPS with exercise should consider working with a personal trainer or physical therapist who is well-versed in AMPS and understands how to navigate symptoms.
What is AMPS?
Amplified Musculoskeletal Pain Syndrome (AMPS) is an umbrella term for a number of conditions defined by inducing non-inflammatory musculoskeletal pain primarily affecting pre- to adolescent females, with a mean age of onset around age 12. The cause of AMPS is not well understood, but it is likely the result of malfunction or disordered response of pain signals from the nervous system, with the etiology being casually related to injury, illness, or psychological distress In other words, the nervous system elicits an increased pain response to normally painful stimuli (hyperalgesia) or may even interpret normal non-painful stimuli such as lightly touching the skin as being painful (allodynia). Individuals with AMPS may have continuous pain in a limb (more commonly the lower extremity), or have multiple intermittently painful sites involved.
Signs and symptoms of AMPS may include:
fatigue
sleep difficulties
headaches
abdominal pain
dizziness
arthralgia (joint pain)
tachycardia (fast heart rate)
other neurologic symptoms
Background on Chronic Pain
Before we get into the treatment of AMPS, it’s important to understand a bit of pain science. When most people think of pain, they think of it as the direct result of some sort of damaging or destructive occurrence. In reality, how we experience pain is much more complicated than this. Whether or not we experience pain and the extent to which we experience it is largely dependent on how our brain and the rest of our nervous system interprets the sensation. Confusing right? Let me explain:
Let’s say an individual is deadlifting and begins to feel an uncomfortable sensation in their back. If an individual has never had any back injuries and has been told that deadlifting is safe for their back, their nervous system might interpret that sensation as muscle fatigue or low-level soreness. Now let’s say that same individual has a history of back injuries and a pre-conceived belief that deadlifts are bad for your back: their nervous system might interpret that same sensation as being painful. Pain-related fear may actually amplify the experience of pain and there is evidence of a positive correlation between increased amount of attention paid to a painful stimulus and the amount of pain experienced.
With that being said, it should be noted that how we think about the concept of pain itself plays a pretty big role in how our nervous system interprets it and consequently how we experience it. This will be important to remember as we go on to discuss the treatment options for AMPS.
Treatment Options for AMPS
Current treatment of AMPS aims to improve quality of life by helping the child return to normal daily function while minimizing pain. Pain management is done without medication and may involve cognitive behavioral therapy, physical/occupational therapy, stress reduction, and exercise (we’ll talk more about this later).
There does seem to be a correlation between AMPS and psychological distress, although it is unclear what the exact relationship is between the two. Due to the nature of AMPS, many individuals experiencing it are or become hypervigilant to regular pain sensations, leading to anxiety stemming from a fear that the pain is indicative of serious disease. These individuals are also more likely to experience depression and fatigue.
Exercise is actually one of the most recommended treatments for AMPS, which we’ll get into in the section below.
Exercise as Treatment
As discussed earlier, the moment a child is diagnosed with AMPS, all pharmaceutical and invasive treatments should be immediately discontinued. Among the most successful and promising treatments for AMPS is intensive aerobic exercise. It is recommended that all mobility aids, such as crutches, be discontinued immediately unless the child is too weak to ambulate safely. Given the relationship between AMPS and hypervigilance/anxiety relating to pain, it is important that the individual understand that just because a sensation or movement is painful doesn’t mean it is doing damage or causing injury. It may be helpful for these individuals to work with a personal trainer or physical therapist who can help reassure the individual that the exercises they are performing are safe even if they are painful.
Why exactly does exercise work so well as a treatment for AMPS? Performing painful exercises can help reconceptualise pain-related fear such that the individual begins to think differently about pain and tissue damage, reducing the likelihood that they perceive these exercises and movements as a threat. Remember, individuals with AMPS are not doing any structural damage despite experiencing pain. Incorporating safety cues will be important here, for example “you’re experiencing elbow pain because your elbow became deconditioned to movements like this, so we need to exercise to strengthen and condition those muscles”.
Self-efficacy is also crucial when it comes to re-integrating individuals with AMPS into exercise, so much so that it has been recognized as a key prognostic factor for successful interventions for musculoskeletal pain. With that being said, it’s crucial that individuals with AMPS are instilled with a belief that they can challenge themselves to complete various exercises and movement patterns, even if they experience pain while doing so.
The goal of exercise should be functionality, such as going up the stairs. Like anyone beginning a new exercise program, the individual should expect sore muscles after the first few days of exercise. It is uncommon for the pain to change location as exercise treatment progresses. With exercise therapy, about 80% of children regain full function and are pain-free within the first month; 15% are functional but have mild or intermittent pain; and about 5% are no better.
TL;DR
Exercise proves to be one of the most effective treatment options for AMPS, if not the most effective. Unfortunately, many individuals with AMPS won’t feel inclined to begin an exercise program as 1) it will likely be painful at first and 2) they may believe they are doing damage to their joints. It is crucial to encourage individuals with AMPS to engage in exercise while also ensuring they understand that it is safe for them to exercise. Working with a personal trainer or physical therapist who is well-versed in AMPS may be helpful in these scenarios as they can guide the individual through various exercises while also managing pain.
