Toolkit - Understanding Pacing in Four Simple Stages
Given how overwhelming pacing can be to tackle I have broken it down into four key elements:
WHAT it is
WHY it is so important
HOW we can do it
WHEN we should be doing it
Taking it step by step, this will hopefully demystify the process somewhat and make it easier for you to see which of the areas you need to tackle - it may be just one key element that’s missing or you may need a review of all of them, it’s all okay, you start where you need to.
Photo by Emily Morter on Unsplash
WHAT
Pacing is fundamentally a key strategy used to break what is known as the boom and bust cycle, or the over-activity/under-activity cycle.
It is not a cure for pain, but rather it aims to help you manage and cope with your pain and its effects.
It is about balancing periods of activity and rest in measured ways, usually by breaking activities down into smaller, more manageable parts that can be spread out, and finding ways of resting that aren’t all entirely passive.
It needs to be proactive, not reactive: that means taking breaks from activities before pain is triggered and rest is enforced, rather than keeping going until you cannot manage any more and need longer to recover.
WHY
Being able to perform the daily activities you want to do is central to having a sense of wellbeing and quality of life.
With every period of enforced rest the body starts to get a little more out of condition. The longer the rest lasts for, the more deconditioned the body can become. Joints become stiffer, muscles get weaker, brain functions become slower and less effective and even organs become deconditioned. Over time, it becomes harder for the body to do higher levels of activity and therefore the threshold level at which you have “overdone” things lessens. Rest periods can start to last longer and ultimately, activity levels drop even lower.
The boom and bust cycle can cause the nervous system to become more sensitive, making the malfunctioning chronic pain loop even stronger. More pain memories are created and strengthened, which feeds into an increase in pain.
By pacing your activity and stopping when it still feels manageable, not only does this place control back with you, it means your body maintains, and improves its levels of condition, new pain memories are not created and old ones can be rewritten.
HOW
There can be years of bad habits to unlearn when it comes to pacing as we may each have found ways we think work for us, so don’t expect to be perfect or even great at pacing initially! It takes time, effort and patience but if you crack it, it really will help in the long-term.
Some helpful techniques to consider:
Use activity and symptom diaries: logging your daily activities and symptoms can help a bigger picture begin to emerge, e.g. do you have a pain flare two days after doing a food shop?
Time yourself during activities and stop before experiencing an increase in pain or difficulty. Reduce this time further by 80% to reach your “baseline”; e.g. if you can stand and prep/cook food for 20 minutes before a pain spike your baseline would actually be 16 minutes.
Even if you feel you can keep going – STOP! The aim is to let your body acclimatise to being comfortable and safe while active.
Very gradually build up from your new baseline tolerances – increase initially by a minute per week.
Resting between activities does not have to mean laying down in a dark, quiet room. Switching between physical, mental and restorative types of activity can be just as effective: rest from doing the dishes might be sitting and reading for half an hour.
Break tasks into smaller, manageable chunks; e.g. instead of trying to prep an entire meal, which might take you twenty minutes, do five minutes here and there throughout the day. You achieve the same goal but without triggering a pain spike.
WHEN
EVERY SINGLE DAY
I cannot emphasise this point enough: pacing does require consistent work for it to really make a difference.
Being proactive in managing your time, activities and symptoms, in combination with other strategies for your pain management, whether that’s medication, acupuncture, graded exercise etc, will help you find the right level of pacing for your needs. With patience and practice these new pacing habits will become an ingrained behaviour, allowing you to more accurately assess your capabilities on any given day and know where your natural stopping point should be.
Of course there will be times when it’s harder than usual, or unexpected curveballs come your way. However, you will be far better equipped with a strong pacing strategy in your armor to manage recovery from times like these. You can also use your new pacing skills to help plan and prepare for big or more intense events, e.g. having to travel and attend a wedding. You will learn how to scale up to, and down from, situations like these so that although the day itself might throw pacing out the window a bit, the fact you can prepare for it returns control of the situation to your hands.
Learning to pace properly has been one of the most empowering skillsets I’ve learned in managing my own health, and I have been able to apply it to my fatigue and general health as well as using it to more effectively manage my pain. It hasn’t just given me the ability to do more, it has lead to an increase in independence and self-belief, and I sincerely hope it can do the same for you too.