Fibromyalgia has long been one of the most misunderstood chronic pain conditions. Not because it is rare, but because it does not show up neatly on a scan or blood test.

I recently interviewed Carla Mullins, one of Australia’s leading educators in complex conditions and clinical movement, to unpack how our understanding of fibromyalgia has evolved — and what that means for us as Pilates professionals.

For many years, fibromyalgia was treated as a diagnosis of exclusion. In simple terms, that meant everything else had been ruled out, so perhaps it was this. There was no single test. No definitive marker. Just a cluster of symptoms — widespread pain, persistent fatigue, sleep disruption, cognitive fog — that did not fit neatly anywhere else.

That diagnostic history matters.

By the time someone walks into your studio with a fibromyalgia diagnosis, they have often spent years navigating appointments, investigations, and uncertainty. They are not just presenting with pain. They are presenting with experience — sometimes frustration, sometimes dismissal, often exhaustion.

One of the most important areas we explored was fatigue.

This is not simply feeling tired. People with fibromyalgia frequently wake unrefreshed. Their energy capacity is limited, and exceeding it can result in days of setback. That changes how we program.

Sometimes 15–30 minutes of well-paced, intentional movement is more appropriate than pushing through a full hour. Progress must be gradual, staged, and monitored. Research supports exercise for fibromyalgia — but only when it is intelligently paced and progressed over time.

We also discussed nervous system sensitivity. Fibromyalgia is closely linked to centralised pain processing. The system is protective and often heightened. Large, loud environments or high-volume class formats may increase symptoms. Regulation needs to come before progression.

This is where Pilates, taught with integrity, excels.

Breath. Alignment. Controlled load. Clear boundaries.

Not exhaustion. Not competition. Not choreography for the sake of it.

The goal is not to “cure” fibromyalgia. The goal is to restore agency. Clients regain control over pacing, over load, and over how they respond to their body. They learn what safe movement feels like again.

If you want to explore this conversation in more depth — including clinical reasoning, diagnostic shifts, and practical teaching strategies ⤵

🎧 Listen to Episode 72 of The Pilates Lounge Podcast — Fibromyalgia: Teaching with Carla Mullins, available on all podcast platforms.