Pacing
Jon Ford, Clinical and Managing Director, Associate Professor of Physiotherapy, Fellow of the Australian College of Physiotherapists
Your body is designed to move! However, injury can lead us into doing either too little or embarking on a boom bust cycle, prompting flare ups. So how do you find the perfect balance?
In the early stages of an injury, people are often told to rest from day to day activities such as work, recreation and home duties. This can be helpful initially to promote healing and resolution of pain. However, doing too little for a prolonged period of time (referred to as being under-active) can actually delay recovery! Because your body is designed to move, too much rest can be harmful and lead to deconditioning and other health related problems including:
Weak muscles and stiff joints
Reduced blood flow to the injury and slower healing
Brittle bones from loss of calcium
Reduced immune system function
Weight gain
Chemical changes in the brain that can lead to depression
Fear and anxiety about activity
Sensitisation of the nervous system
At some point after a period of under-activity, most people try to become more active. However, because of deconditioning, this often results in overdoing the activity, and the person experiences a “flare-up” that takes days or even weeks of rest to settle. This cycle is called “the boom/bust cycle”, and it’s almost impossible to treat an injury effectively when someone is in one!
Here’s how to break this cycle and “pace” your activity, the important first step in your rehabilitation program.
Identifying the postures or activities that cause flare-ups (e.g. watching TV, vacuuming)
Finding your limit for each posture or activity. This is the amount that you can do without experiencing a flare up (e.g. sitting for 20 minutes in an upright chair, vacuuming for 15 minutes)
Plan and prioritise your activities at the beginning of each day. Focus on the most important activities, and keep within your limit for any one activity
Break difficult activities into shorter manageable chunks. Completing a difficult activity in 3 chunks over the day is often tolerated better than completing it in one go
Monitor your overall total daily activity. When planning your day, appreciate that undertaking a range of activities over the day is good (breaking things up). However if this all adds up to an overall excessive amount (volume) of work this can also cause a flare-up.
There may be some activities that you cannot do for now. The intensity of some activities (eg returning to full work duties, heavy gardening) may be too much for you at the moment. It is okay – and important – to ask others for support!
Stick to your pacing limit! Stick to your limits with awareness and trust that pacing strategies work. When your limit has been reached, stop the activity, even if you are in the middle of something interesting, or if you feel the urge to complete the activity (which is very normal)
…and don’t freak out if you start to experience a flare-up. It can be difficult to completely avoid flare-ups. If you do experience one, it can be tempting to give up, and go back to looking for a “quick-fix” treatment. Be kind and forgiving to yourself, learn from the experience, and try to get back on track. Your practitioner can also help you with some techniques to settle the flare up.
With guidance from your practitioner, after the first 1-2 weeks of using pacing strategies you should establish your stable baseline. This is the level of activity that doesn’t lead to flare-ups. Once achieved you should feel confident that you have taken the first step in your rehabilitation program, which will ultimately lead to a long-term improvement in your quality of life.
Ready to take the first step? Contact your nearest Advance Healthcare clinic or book online at: https://www.advancehealthcare.com.au/contact-us
Jon Ford is the clinical and managing director at Advance Healthcare. An Associate Professor of Physiotherapy, Fellow of the Australian College of Physiotherapists, Musculoskeletal and Pain Physiotherapist, Jon is a leader in physiotherapy and multi-disciplinary pain management in Australia. Jon’s clinical and research interest is in the individualised treatment of musculoskeletal pain, in particular low back pain.
Associate Professor Jon Ford (PhD and titled Musculoskeletal and Pain Physiotherapist) is Group Leader of the Low Back Research Team at La Trobe University where he conducts clinical research on the effectiveness of individualised treatment for pain problems. He also the Clinical and Managing Director of Advance Healthcare where he leads a multi-disciplinary team working with chronic pain.