You’re Not Imagining It: The Brain’s Role in Fibromyalgia Muscle Tension

If you live with fibromyalgia, you may be all too familiar with the constant sense of muscle tightness—like your body is locked in a state of tension that won’t release. Yet, surprisingly, when scientists measure muscle activity in people with fibromyalgia, the results often show something quite different. This disconnect raises an important question: Is muscle tension in fibromyalgia real?

The answer is yes—but not in the way we might assume.

Fibromyalgia is a complex condition that affects how the nervous system processes pain and sensory input. While many individuals report chronic muscle tension and pain, objective studies tell us this sensation doesn’t always correlate with actual muscle activity. Let’s explore what research reveals about this puzzling phenomenon.

Elevated Muscle Pressure Does Exist

Research has shown that people with fibromyalgia tend to have higher intramuscular pressure, especially in muscles like the trapezius (the shoulder and upper back area). One study found that the resting muscle pressure in fibromyalgia patients was almost three times higher than in healthy individuals or those with other rheumatic conditions. This increased pressure may contribute to the physical sensation of tightness and discomfort.

However, pressure doesn’t always equate to active muscle contraction or tension. It’s one piece of the puzzle—but not the whole story.

The Role of Central Sensitization in Fibromyalgia

Fibromyalgia is known for central sensitization—a state in which the nervous system becomes overly reactive to stimuli. Even minor pressure, movement, or stress can be interpreted as painful. This means that what feels like extreme muscle tension may be the brain amplifying normal signals.

In other words, the perception of muscle tension is real and distressing, even if the muscles are not more contracted or overactive than those without fibromyalgia.

The Brain’s Influence on Sensation

Advanced imaging studies show that people with fibromyalgia have altered activity in brain regions responsible for processing sensory input and emotional responses to pain. These include the insula, anterior cingulate cortex, and prefrontal cortex, which play a role in interpreting pain and bodily sensations.

So, when someone with fibromyalgia feels like their muscles are knotted or burning, the sensation may stem more from brain-based amplification than from the muscles themselves.

Measuring Muscle Activity: What Science Says

One of the most revealing findings comes from electromyography (EMG), which measures electrical activity in muscles. EMG studies in fibromyalgia patients often show normal or even reduced muscle activity, even when the person reports severe tightness or pain.

This reinforces a critical insight: perceived muscle tension is not always tied to measurable muscle activity. It’s not imagined—it’s a product of the brain’s interpretation of sensory signals.

Stress Amplifies the Cycle

Stress, both physical and emotional, plays a significant role in fibromyalgia. It can heighten sensitivity, increase perceived pain, and trigger episodes of muscle discomfort. People with fibromyalgia are often in a state of heightened alert; some call it a "danger mode" in the nervous system. In this state, even minor stressors can make muscles feel tight or painful, even if nothing has physically changed in the muscle tissue.

The Psychological Overlay

Anxiety, depression, and trauma are common in people with fibromyalgia and can influence how the brain perceives bodily sensations. Studies suggest that people with higher anxiety levels tend to report more severe muscle tension—even in the absence of objective changes.

This doesn’t mean the tension isn’t real. It means that psychological and emotional states are deeply intertwined with how the body experiences pain and discomfort.

What Does This Mean for Healing?

Understanding the disconnect between perceived and actual muscle tension opens new possibilities for healing. It reminds us that:

• Muscle tension in fibromyalgia is not just a mechanical problem—it’s a nervous system issue.

• Treatments that target brain-body regulation—like somatic tracking, mindfulness, gentle movement, and emotional processing—can be incredibly effective.

• Stress reduction and emotional healing are not side topics in fibromyalgia care; they’re central to symptom relief.

Fibromyalgia pain is real, and the tension you feel is valid. However, the source of that sensation may not always be in your muscles; it may be in how your brain interprets and amplifies signals.

By shifting our understanding of muscle tension from a purely muscular problem to a neurosensory experience, we empower people with fibromyalgia to explore new, more compassionate paths to relief.

If you're ready to understand your pain through a new lens—and finally feel heard and supported—let’s talk. Book a discovery call, and let’s explore a science-backed, compassionate path to healing.

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