Whilst recovering from an injury or living with a long-term injury, learning the skill of pacing activity levels is the key to success!
The best way to explain the principle is to look at the graph below for an example patient, Orla who has low back pain:
From our extensive experience we have seen lots of patients use a ‘boomerang’ approach to managing their symptoms. For example on a day Orla’s back is feeling better she may do all of the large ironing pile, swim as far as she can or hoover the whole house. However the next day her back would be inflamed and painful, meaning she has difficulty in doing even her essential daily tasks such as caring for her baby, working or doing her physiotherapy exercises.
This is shown on the graph by the purple line (indicating inflammation) which when it increases past a certain point (the threshold- shown as the black line) produces pain and symptoms. When Orla is not pacing her activities and is doing too much of one thing in one go, her back is aggravated to such an extent that it does not get the time to recover enough before it is aggravated again. Over time this means that symptoms get more regular and easier to trigger as the inflammation only settles to just below the threshold point, if reaching it at all.
Learning how to plan or ‘pace’ your daily tasks is not about stopping you doing things but about having a more balanced approach making both recovery quicker and living your everyday life easier!
We can think of pacing in three helpful ways:
1. Put tasks in to manageable chunks of time, ideally not more than 20 minutes in one go.
2. Vary the order of tasks to changes postures and positions, for example after sitting for a task then do one in standing.
3. Have small regular breaks, even three or four minutes to rest in a different position to a task was conducted in.
The second half of the graph shows how Orla’s inflammation and so symptom levels would be if she paced herself well using the above principles. Using these strategies would mean that Orla could be efficient but in a way that does not cause her to build up inflammation to the point symptoms become a more significant problem, and sometimes even prevent symptoms arising at all. For example, if she split her ironing into smaller piles that she did separately and then interspersed them with sitting down at the computer or walking to the shops or station, her back would be much less irritated and painful on going to bed or on exercising that evening. With exercise as part of injury recovery, pacing to help make consistent progress rather than doing too much and having to then reduce it would prove much more effective. For Orla this would be doing a 20-minute swim with no pain rather than 1 hour but being restricted and in pain afterwards. Furthermore, using these principles will be time effective as pacing ensures a more consistent ability each day, thus reducing the number of ‘bad’ or ‘boomerang’ days when high pain levels would mean being able to do much much less.
Doing certain tasks that are hard work for an injured back is always likely to cause some irritation and inflammation. Pacing has the benefit that occasionally when a task is that bit more challenging or stressful for the back but is unavoidable, it will cope better and the symptoms will be triggered less easily than they would have been. This is because inflammation levels are kept much lower so there is further to go before they reach and cross that threshold into pain.
Recovery from any injury that forces a change in lifestyle and hobbies can easily cause stress and worry. Stress can have significant negative effects on the body, especially with back and neck injuries. It very commonly causes the person to collect more tension in the muscles of the back and neck which in turn causes pain and increased symptoms, even to the extent of referred pains in to the legs or arms and reduced mobility. Learning to manage your daily tasks using pacing can at least in part help you feel a sense of achievement without the frustration that comes with painful reactions and avoidable set backs.
Following our advice would mean when you then see your Pulse therapist we can work you a bit harder, give you more challenging exercises and achieve your goals quicker, whether that be getting back into sport, exercise or pain free daily living.
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