The National Academy of Sports Medicine (NASM Link) defines flexibility as "the normal extensibility of all soft tissues that allow the full range of motion (ROM) of a joint." Simply put, flexibility is "the capacity of a joint to move fluidly through its full range of motion." Stretching muscles is recognized as the easiest and safest way to achieve and/or increase flexibility. Flexibility is important for maintaining optimal functionality, and therefore quality of life. For people with FM, flexibility can be achieved best by beginning a stretching program. This can be added to the two other important components of a full exercise program, strength and cardiovascular training.

Stretching can help remedy the general loss of flexibility inherent with FM. Moving a joint through the full range of motion will assist in supplying nutrients to the cartilage of the synovial joints as well as maintaining the length and strength of the joint's soft tissue (such as the capsule and ligaments). If you do not stretch often, there is the potential of diminishing your range of motion. For example, almost immediately after hospitalization and/or surgery, the muscles that move the joint begin to atrophy and the connective tissues around the joint begin to change. These structures begin to shorten and the subsequent bodily effects lead to a depletion of the joint's nutrition and a perpetuation of the joint's range of motion.

While many sources advocate that stretching should precede the warm-up, stretching is actually safer following a short amount of the warm-up and warm-down (cool-down) from the aerobic exercise itself. Warming up facilitates muscle and tendon stretching. Many sources claim that stretching helps reduce the chance of muscle injury, and if you don't warm-up before exercise, you might experience cramping, burning, and increased pain. However, other sources claim that overstretching (unless for dancing, gymnastics, or sprinting) may also lead to greater vulnerability to injury. You will have to decide with your own physician, physical therapist, or trainer what your approach will be.

Initially, you may not be able to sustain a stretch for more than a few seconds. Every success is valuable and your patience will result in greater and faster progress. Know from the outset that this is a slow process but that your determination to exercise and stick with it will pay great dividends and will teach you important aspects about your body's capability to perform various types of exercises.

For those who are unable to choose an aerobic (cardiovascular) regimen, there are some safe flexibility exercises that you should be able to perform. Some of these require a second person to assist you, and often require some preparation with medications before stretching can commence. Even those who are just beginning an exercise program should probably begin with several days of stretching. There are two reasons to begin this way:

1. Flexibility exercises must be learned, as they are part of the warm-up and cool-down routines of most exercise programs; and
2. Much of FM pain occurs in the muscles and tendons (tendons link the muscle to its bone). In most people these structures shorten with age and may become painful or discomforting when they are tight or when they are stretched--as they are in most exercise routines.

Two types of stretching are self-stretch and assisted stretch. There are several self-stretch routines to choose from, and it is wise to talk with a licensed health care provider to decide which routine is appropriate. In almost all self-stretch exercises, one must learn to mentally relax and regulate breathing so that the breath is exhaled slowly and evenly during the stretch. Assisted stretching is done with another person, and it may be done at home or in a practitioner's office. Tips for healthful stretching are listed in Table 2.

Table 2. Tips for Healthful Stretching

Stretching should always be performed slowly. In ballistic stretching, dynamic, rhythmic bouncing movements are done at the edge of the range of a muscle's motion. Ballistic stretching is not advised; this high-impact and quick movement could lead to muscle injury.

Doing stretching exercises throughout the day helps to prevent muscle tightness and stiffness. Incorporate exercises into daily routines (such as washing dishes or making a bed) and after periods of stationary activity (such as reading or typing).

If you have limited time for aerobic exercise some days, don't skip your warm-up. If you must, shorten the aerobic part of the routine on those days.