title: Preliminary evidence of altered biomechanics in adolescents with juvenile fibromyalgia.
abstract: OBJECTIVE
  Juvenile fibromyalgia (FM) is characterized by chronic musculoskeletal pain and marked reduction in physical activity. Despite recommendations for exercise to manage juvenile FM pain, exercise adherence is poor. Because of pain and activity avoidance, adolescents with juvenile FM are at risk for altered joint mechanics that may make them susceptible to increased pain and reduced tolerance for exercise. The primary aim of this study was to assess functional deficits in patients with juvenile FM compared to healthy controls using objective biomechanical assessment.
  
  
  METHODS
  Female adolescent patients with juvenile FM (n = 17) and healthy controls (n = 14) completed biomechanical assessments, including gait analysis and tests of lower extremity strength (isokinetic knee extension/flexion and hip abduction) and functional performance (drop vertical jump test) along with self-reported measures of disability (Functional Disability Inventory), pain intensity, depressive symptoms (Children's Depression Inventory), and fear of movement (Tampa Scale of Kinesiophobia).
  
  
  RESULTS
  Patients with juvenile FM demonstrated mild deficiencies in walking gait and functional performance (P < 0.05 for both) and significantly lower left knee extension and flexion strength (18-22% deficit) and bilateral hip abduction strength (34-38%) compared with healthy controls (P < 0.008 for all). Patients with juvenile FM reported significantly higher functional disability, pain intensity, depressive symptoms, and fear of movement relative to controls (P < 0.01 for all).
  
  
  CONCLUSIONS
  This study showed that adolescents with juvenile FM exhibited objective alterations in biomechanics and self-reported fear of movement that may have reinforced their activity avoidance. Interventions for juvenile FM should include a focus on correcting functional deficits and instilling greater confidence in adolescents with juvenile FM to engage in exercise to improve functional outcomes.
authors.affiliation: Emory University School of Medicine, Children's Healthcare of Atlanta, and Aflac Cancer and Blood Disorders Center, Atlanta, Georgia.
authors.forename: Soumitri
authors.initials: S
authors.lastname: Sil
authors.forename: Staci
authors.initials: S
authors.lastname: Thomas
authors.forename: Christopher
authors.initials: C
authors.lastname: DiCesare
authors.forename: Daniel
authors.initials: D
authors.lastname: Strotman
authors.forename: Tracy V
authors.initials: TV
authors.lastname: Ting
authors.forename: Gregory
authors.initials: G
authors.lastname: Myer
authors.forename: Susmita
authors.initials: S
authors.lastname: Kashikar-Zuck
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena / Q000502:physiology; D002648:Child; D004185:Disability Evaluation; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D053580:Muscle Strength / Q000502:physiology*; D010147:Pain Measurement / Q000379:methods / Q000592:standards*; D057566:Self Report / Q000592:standards