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Evidence of physical deconditioning in adolescents with juvenile fibromyalgia: deficiencies in strength and balance

      Juvenile Fibromyalgia (JFM) is a chronic widespread musculoskeletal pain condition associated with significant physical impairment and extended periods of inactivity, which can lead to physical deconditioning and loss of confidence in initiating exercise. Adolescents with chronic musculoskeletal pain are susceptible to altered strength and functional stability that may exacerbate their chronic pain. Specifically, functional deficits can alter joint mechanics that increase risk for injury and pain flare-ups with physical activity and further contribute to exercise intolerance in patients with JFM. The primary aim of this study was to objectively assess strength and functional stability in adolescents with JFM. Nine females with JFM (Mage = 16.5, SD = 2.02) were compared to healthy, active females matched by age, height, and weight (Mage = 15.17, SD = 1.5) on measures of lower extremity strength (peak isokinetic knee extension, knee flexion, hip abduction) and functional stability (Star Excursion Balance Test). Patients with JFM demonstrated deficits in their peak knee extension strength (M = 0.45 ft-lbs/kg, SD = 0.09) compared to norms (M = 1.21, SD = 0.19); however, knee flexion strength was comparable to matched controls. Adolescents with JFM demonstrated nearly 60% reduction in hip abduction strength (M = 0.37 ft-lbs/kg, SD = 1.20) relative to norms (M = 0.99, SD = 0.33). Functional stability also was reduced bilaterally among patients with JFM (Mright = 80.2%, SD = 10.1; Mleft = 82.0%, SD = 7.0) compared to controls (Mright = 95.7%, SD = 5.2; Mleft = 97.4%, SD = 7.2). Adolescents with JFM demonstrate deficits in strength and balance, which may increase their risk for physical activity related injury and pain. Integrative neuromuscular training focused on correcting these deficits may support interventions for JFM to further improve pain and function. Funded by NIAMS Grant #K24AR056698-09 and the Division of Sports Medicine.