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ME/CFS and fibromyalgia impose limits. The limitations range from relatively small disruptions of life to severe restrictions that render people housebound or even bedbound.

 

As described in the previous article, fighting against or trying to ignore those limits produces an intensification of symptoms. Finding and honoring limits, in contrast, offers a way to regain control and provides a path for safely increasing one’s activity level.

 

So the way you live your life reduces symptoms if you honor your limits or intensifies them if you don't. In either case, your actions have consequences, making you the most important person treating your ME/CFS or FM.

In the words of well-known ME/CFS and FM authority Dr. Charles Lapp, Director Emeritus of the Hunter-Hopkins clinic, “The key to recovery in CFS/ME is acceptance of the illness and adaptation to it by means of lifestyle changes, for which medical treatment is no substitute.”

 

 

You can think of limits using a variety of ideas. Our favorite is the concept of the Energy Envelope,

 

To understand the term, imagine your life as composed of three elements. One is your available energy, the energy you have to accomplish things. This is your Energy Envelope. It is limited and is replenished by rest and food. On average, ME/CFS and FM reduces it by 60% to 85%.

 

The second element is your expended energy, the energy you lose through physical, mental and emotional exertion. This is the resource you have to accomplish things. The third is your symptoms: fatigue, pain, poor sleep, brain fog, and so on.

 

In this view, if you expend more energy than you have available, you will intensify your symptoms. This is called living outside the energy envelope. This approach commonly leads to the cycle of push and crash.

The alternative is called living inside the energy envelope. If you keep your expended energy within the limits of your available energy using pacing, you can reduce symptoms and have a chance to expand your envelope.

 

You can get a good understanding of your overall limits by using our Rating Scale, placing yourself on it by answering the question “What is the highest level of functioning I can sustain without intensifying my symptoms?”

 

 

Some people find it helpful to think of their overall limits using different images, metaphors and ideas. Here are four that people in our program often use.

A second way to think about limits is to imagine your energy as money stored in a bank account. Because of ME/CFS or FM, your account has a very low balance. While healthy people are able to store up energy for a day’s activity with seven to eight hours of rest at night, people with either condition may get only a few hours of energy from a night’s rest.

 

The small amount of energy available makes it easy to spend more energy than you have and overdraw your account. There is often a big service charge (intense symptoms) if you overdraw your account. Once you’re overdrawn, you have to deposit more to your account in the form of rest.

 

Alternatively, if you budget your time and control the amount of energy you spend, you can save some energy for healing. Vicki Lockwood explains how she uses this approach in the article My Energy Bank Account.

The bowl of marbles approach offers a similar idea with a different image. In this approach, you imagine your available energy as marbles in a bowl. Each marble represents a small amount of energy.

You estimate your energy level each morning and put an appropriate number of marbles in the bowl. (Some people in our program have taken this idea literally, using marbles, coins or poker chips.)

 

With every activity, you take one or more marbles out of the bowl: one for showering, one for dressing, etc. Some projects take more marbles than others. Also, the same task may require more marbles on bad days than on good days. Physical activity uses up your supply, but mental and emotional activity consume marbles as well.

 

For example, if you feel frustrated about how few marbles you have, your frustration will use up some of your marbles. Stress, tension and fear are all big marble-users. Whatever you can do to lessen them will preserve your supply of marbles for other uses. One person who uses this concept says that if she is overactive, she tells people “I’ve lost my marbles.”

 

Another way is to think about, and live within, limits is called the Fifty Percent Solution, described by William Collinge in his book Recovering from Chronic Fatigue Syndrome. He suggests you estimate how much you think you can accomplish each day, then divide that in half and aim to do the lesser amount.

 

Rather than challenging your limits, you keep your activity to a safe level. The unexpended energy is a gift of healing that you give your body. Collinge’s idea is a clever way of addressing our tendency to overestimate what we can accomplish. Another benefit is that it gives you permission to take care of yourself, something discussed in the chapter on mental adjustments.

A final way to think about limits is called The Spoon Theory, which is described in an article by that title written by Christine Miserandino, a woman with Lupus. People with ME/CFS or fibro sometimes use it to explain the idea of limits to family and friends.

 

The article describes how Christine once explained to a friend what it is like to have a serious illness using spoons to symbolize available energy. She gave the friend 12 spoons to symbolize her energy allotment for the day. With each task the friend imagined doing, Christine took away one or more spoons.

The friend used half her spoons just getting ready to go to work. Her friend “was forced to make choices and think about things differently.” Christine contrasts her life to the life of healthy people. “When other people can simply do things,…I have to make a plan…Once people understand the spoon theory, they seem to understand me better.”