Pacing vs. Push and Crash
If you have ME/CFS or fibromyalgia, you are probably acquainted with the experience of push and crash. People who use this way of living with either condition find themselves caught in a frustrating loop, swinging between overactivity and forced rest, as illustrated in the diagram.
When their symptoms are low, they push to get as much done as they can, the overexertion triggers an increase in symptoms, which in turn leads to forced rest or a crash (Overexertion => Increased Symptoms => Rest).
Resting is usually successful in reducing symptoms, but then, feeling frustrated at all they didn’t accomplish while resting, they plunge into another round of overactivity to catch up (Reduced Symptoms => Frustration => Overexertion), leading to another crash.
Living in response to symptoms, they are caught in a vicious cycle in which high symptoms alternate with periods of extended rest. They feel out of control and find it difficult to plan.
Post-Exertional Malaise (PEM)
There is another important consequence of overexertion. Not only does overdoing produce an intensification of symptoms, called Post-Exertional Malaise or PEM, but the intensification is out of proportion to the overdoing.
So people with ME/CFS and FM are in a doubly difficult situation. First, they have much less energy than healthy people (on average, about one quarter as much). And, second, activity beyond their limits triggers a disproportionate increase in symptoms.
Here are four examples of Post-Exertional Malaise.
The first comes from a man named John. He is better off than many people with ME/CFS and fibro, functioning at about 45% of normal. He told me that he often spends an hour a day gardening with no consequences, but when he gardened for an extra hour one spring day, the extra time put him in bed for the rest of the day and triggered a relapse that lasted ten days.
Toni Bernhard, a person who is more seriously affected, writes in the preface to her book How to Be Sick that "some days I would get so involved in a chapter that I'd work too long. The result would be an exacerbation of my symptoms that would leave me unable to write at all for several days or even weeks."
Dean Anderson, a person with ME/CFS whose worst was about 65% of normal and who worked out while ill, writes about exercising with ME/CFS that "the penalty for over-exercise was a relapse which started about 24 hours after the infraction and lasted a week or more. Once, when I let someone talk me into going hiking, the penalty was a relapse of several months."
Finally, Rose, a person who was bedbound with ME/CFS for almost a decade, used to experience significant relapses each year, lasting up to six months, following one-week visits from her daughter and granddaughter. (That story has a happy ending, which you’ll read in the article on special events.)
Good News and Bad News
So how does it feel to consider the idea that the way you live your life has a big effect on your symptoms? I remember when that thought first occurred to me. Initially, I felt devastated by the realization that living a push and crash life meant I had been creating a lot of my own suffering.
I didn’t remember ever having a major effect on any illness in the past, but I had to admit that there was an obvious relationship between the number of hours a day I was active and my fatigue.
My next thought, however, was more hopeful. I told myself, “If the way I lead my life has such a direct effect on my symptoms, this effect should work in both directions. If living one way increases symptoms, living a different way should reduce them.” I set out to find that way and settled on an approach focused on pacing, which you will read about in this series.
Over time, as I saw the dramatically different effects of living a push and crash life or life focused on pacing, I came to believe that the effects on our symptoms of the way we live our lives was the key fact about ME/CFS and FM. I phrased the idea to myself as good news and bad news.
The bad news:
How you live your life has a big effect on your symptoms
Push and crash leads to lack of control, unpredictability, discouragement and post-exertional malaise.
And the good news:
How you live your life has a big effect on your symptoms
There is an alternative to push and crash, namely pacing.
In the remainder of this article, I’ll give you a quick overview of pacing. Then we’ll move on in the following articles to exploring how you can apply pacing in your life.
Pacing as an Alternative
The contrast of push and crash vs. pacing suggests that our symptoms are not random, but rather due in large part to variations in our activity level. If we do more than our bodies can tolerate, the result is an intensification of symptoms.
On the other hand, if we stay within our limits, which we call the Energy Envelope, we can gain some control over our symptoms.
Pacing offers the possibility of a more stable and predictable life. Using pacing, you can live your life according to a plan, rather than in response to symptoms, giving you a sense of managing your illness, rather than illness controlling you. The benefits of pacing include:
The Three Parts of Pacing
Pacing has three parts:
1 Finding Your Envelope
Fibromyalgia and ME/CFS impose limits. There are limits on physical activities and also limits in other areas, such as mental activity and socializing. The next two articles will show you how to define your limits or Energy Envelope.
2 Adapting to Your Envelope
The second part of pacing is adjusting your life so you live within your Envelope. This is a gradual process, usually involving the use of multiple strategies. Those strategies are discussed in third, fourth and fifth articles. After that, we will look at two other aspects of adapting, managing non-routine times like travel, and minimizing setbacks.
3 Expanding The Envelope
If you pace consistently, you may be able to expand your Envelope, doing more without intensifying your symptoms. As we’ll see in the last two articles, the keys to expanding the Envelope are to extend your limits a little bit at a time and to return to your previous level if the extension increases your symptoms.
Click on this link and we’ll jump into part 1 of pacing: finding your Energy Envelope