Take control of your pain with activity pacing
Updated: May 7
Pain is, by definition, an unpleasant experience. Pain is especially unpleasant if it limits you from doing the activities that are most important to you. When pain persists for long periods of time, which is the case for nearly one in three people, it quite often becomes emotionally taxing. Long term pain can become irritable, flaring up when attempting important and necessary activities. When the relationship between pain and activity becomes unpredictable and difficult to control, an important concept to consider and follow is “activity pacing.” If you find yourself in this rocky relationship between your symptoms and your activities, whether by name or not, you likely have some understanding of “boom or bust.” Boom or bust is a mindset in which you ramp up your activity level beyond what your body is able or prepared for, only to find yourself unable to do much of anything the next day. From day to day, your activity level may be all over the board and your symptoms prowling in the background, ready to pounce when you try to return to your activities. Besides being frustrating, boom or bust over time will actually result in less activity tolerance prior to flaring up once again. Unfortunately from some people, they have been in this predicament and begin to avoid activity altogether to avoid flaring up. As is the case with “boom or bust,” activity avoiding will also result in a decline in your activity tolerance. So what is the solution to this problem? Activity Pacing.
First off, activity pacing is not easy and as a clinician it is important to lay the difficulties out on the table. Why? You likely already know that activity pacing is difficult. If it wasn’t, you wouldn’t be in this predicament in the first place. Rather, I lay the difficulty out on the table as a means of putting myself in your shoes. When I’m working with patients on activity pacing, I am not the teacher nor am I naive to the difficulties and frustrations that go along with practicing activity pacing. I am a coach, or rather your teammate, on this journey. But what I have learned is this: when regulating your activity level seems impossible without flaring up, activity pacing is one of the most important concepts to master.
Let’s return to the two extremes in activity participation that you may find yourself in, “boom or bust” and “activity avoidance.” I’m going to throw out a popular term right now in the health and wellness world: “mindfulness.” Be mindful of and truly understand the relationship between your activities and your flare-ups. It is okay to have a little pain when you are going about your business. But what I always tell my patients, don’t hit your point of no return. Don’t clean your whole house when you know by doing so you will render yourself useless tomorrow. The same goes for athletes. Don’t run 10 miles when 5 miles will keep you from participating in your running program for a week. If you consistently hit this “point of no return,” the 2 rooms that you tolerated cleaning will turn to 1 room and that 5 miles will turn to 3.
If on the flip side of this equation you avoid the “point of no return” by avoiding activity all together, if you have not done so already, be “mindful” that you likely are avoiding activities because of past experiences and the dream of returning to an active lifestyle may be fading away. Because the flip side of our advice to “avoid the flare” is to “not be afraid of the flare.”
For both groups, we want to understand the relationship between our activities and our pain levels. As I already mentioned, be okay with pushing into a little pain. Understand, and even write down, when your activity level is nearing a level that you would expect a flare-up. That line is often a bit blurry because life and our nervous system are both complex and we are trying to understand the relationship between the two, which is not easy. This complexity is one of the reasons why this can be difficult, but persevere because it’s important. The goal after all is to get you back to enjoying the things in life that are important to you. Once you have a relatively good understanding of this “line” of activity tolerance, use rest breaks to break up your activity level throughout the day. Over time, our hope and goal is to increase your activity level both in time and workload as well as to decrease the frequency and duration of the rest breaks. If you find yourself in a flare-up, adjust your activity level accordingly but try your best not to avoid activity.
Again, activity pacing is not easy, but it is important. When working on pacing your activity back to what’s important, know there will be hills and valleys. But also know that maybe for the first time in quite awhile, you will have control of your pain rather than your pain have control over you. Take back control!
Dr. Kelly Ashbeck, DPT, OCS