Pacing

Pacing – when is the Boom worth the Bust?

Symptom management is a really important part of living well with a chronic health condition. For symptoms like fatigue and pain, Pacing is an essential skill to learn 1 . There is no easy fix for life with long-term health conditions but there are a lot of little fixes that can help. To make the most of these little fixes we have to understand something called the ‘Boom and Bust Cycle’.

People with chronic pain tend to fall into activity patterns that exacerbate their symptoms 1 . Boom and bust is one example of this. It’s something that a LOT of people fall into regardless of whether they have any health problems at all. Simply put it’s a period of intense activity followed by a crash with low levels of activity to recover.

  • Monday: I feel good so I push my limits and do loads…
  • Tuesday: I feel rubbish so I stay in bed…
  • Wednesday: I’m still not feeling great but I’m a day behind so I have to do loads to catch up…
  • Thursday: I’m really feeling bad so its back to bed..
  • Friday: I’m trying really hard but I just can’t …keep pushing..keep pushing
  • Saturday: I’m totally exhausted and in pain, even being awake is a challenge
  • Sunday: After a proper rest I’m starting to feel a little bit better…

So by the end of the week I’ve pushed myself to the limit and had to struggle back to readiness by Monday…

Not everyone follows a week-long pattern but the fluctuations are the same, really high activity levels followed by really low activity levels. Some people follow a much less structured boom and bust. As opposed to this happening every week, a boom and bust can happen over the space of a few hours. Sometimes a boom can last as long as a month before an epic bust. This is not a healthy or efficient way to live. Pacing aims to stabilise the activity levels so that you can achieve a fairly consistent amount each day and don’t end up in ‘rest mode’ for days.

Pacing is a concept that’s loved by OT’s across the world but its one that often disliked by patients. Even in slinical settings it’s often misunderstood 2 . The way pacing is presented and explained has a big impact on how well a patient gets on with it.

In short pacing is the art of breaking your life into small manageable micro-tasks. An example might be writing this blog post.

I could sit still and write the post in one go, really push myself to get it done and to deal with the consequences later. It would probably take me about 45 minutes. I’d be tired afterwards, probably have a headache. My neck and shoulders would be stiff and achy, my hands and wrists would throb and ache, my spelling would be atrocious. I’d need a good long rest afterwards. 45 minutes typing + 1hr stretching and resting = 1hr 45mins

Or I could pace the blogging.

I might take an hour and half to write the post, with 60 second breaks every 5 minutes to stretch my neck, back and shoulders. I could rest my hands and do some exercises to keep my fingers supple, I could get a drink and spell check each paragraph before having a rest and carrying on. You might now be thinking something like ”I don’t have time for all of that” but here’s where the magic happens…Because I paced the activity I don’t really need a break after, I can take a few minutes before moving on to something else.  I took 1hr30 for the blogging + 15 minute break afterwards = 1hr 45mins

So the activity takes about the same time but at the end of the second scenario I’m feeling much better and my quality of work is much higher. Score 1 for pacing.

Now this is all well and good for an ideal world, but we don’t live in an ideal world. We must fit our lives into the modern world schedule, work deadlines, family commitments, big events and unforeseen circumstances.  Sometimes you cannot always pace perfectly.

Sometimes you really want to make the most of a big event or you just really need to do something crazy, to feel alive. How do you decide if that’s really a good idea? Well I go through a sort of decision-making process in my head. I’ve put it into a table to help explain things. If you’d like to use my tool for anything other than personal use please visit Therpy Share to get a legitimate copy.

Pacing Decision Tool

Down the left hand side is a list of things that are impacted by the given activity. Across the top a scale from -3 to +3. The scale goes from seriously negative outcomes to epically positive ones. The next step is to fill it in, check a box for the categories on the left, then add up your scores, if the overall score is positive then the overall outcome is also likely to be positive, if the overall score is negative then chances are this activity isn’t going to do you many favours!

I’ve filled one out for a demo to help you all make sense of the process.

This is my decision-making process for whether or not to go to Gymnastics.

decision-making-tool-gymnastics

So my decision-making score for gymnastics is +1 this means that overall the outcome is more positive than negative. I might have a big ‘bust’ or crash afterwards but I’ve justified it. The overall outcomes are actually doing me some good.

Pretty cool huh, I’ve taken a potentially risky but very enjoyable activity and looked at it from all aspects. I’ve decided whether I can risk it and whether I should risk it!

A final thing to consider when using this is what also you have planned in the following days. I do usually put the same answers in my mental checklist but if I know I’ve got plans for the following day I will take that into account with my score. If people are depending on me the next day or I have plans then gymnastics comes out as a negative number, I don’t go ..or I go and just hang out at the gym and gossip!

Using methods like pacing and by adapting my activities I’ve able to keep doing things that would otherwise have been impossible. Often, modifying and pacing challenging activities is better both physically and emotionally than simply avoiding them 3 . I have managed to stay active in the sporting world by pacing my activities like uni lectures, social activities and work roles. I have to pace my sport and exercise, I spend a lot more time resting than the other gymnasts that’s for sure. I’m willing to compromise with my body, it lets me do sport and I let it rest every few minutes. It might seem like making these changes is a hassle but in the long run its 100% worth the effort!

It it worth noting that sometimes, flare-ups happen. You can pace your entire life perfectly but there will always be times when your body just needs more rest. You know what? That’s ok. It’s not your ‘fault’ it’s just that life is made up of up’s and down’s. Some down’s last longer than others! If you do find yourself in a flare-up it’s perfectly sensible to adjust your activities accordingly. You might need more rest, longer breaks or more heavily adapted activities. You know your body best so just take each day as it comes.

I hope that helps some of you and if you’ve found it useful or have any feedback then please let me know.

If you’d like to learn more about Pacing the please check out my Pacing Masterclass! Everything you need to know to become a Pacing Pro!

As always, questions, comments and shares are welcome

JBOT

Reference List

1.
Birkholtz M, Aylwin L, Harman RM. Activity Pacing in Chronic Pain Management: One Aim, but Which Method? Part One: Introduction and Literature Review. The British Journal of Occupational Therapy. 2004;67(10):447-452. doi: 10.1177/030802260406701005
2.
Nielson WR, Jensen MP, Hill ML. An activity pacing scale for the chronic pain coping inventory: development in a sample of patients with fibromyalgia syndrome. Pain. 2001;89(2):111-115. doi: 10.1016/s0304-3959(00)00351-1 [Source]
3.
McCracken LM, Samuel VM. The role of avoidance, pacing, and other activity patterns in chronic pain. Pain. 2007;130(1):119-125. doi: 10.1016/j.pain.2006.11.016
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20 thoughts on “Pacing – when is the Boom worth the Bust?

  1. Jo, once again a very helpful example of real life use of pacing techniques. Like the pros and cons scale for decision making,. I have several people I want to share this with. Thanks.

  2. Thank you Jo. I enjoyed reading this and developing such a tool is a good way of facilitating individuals to assess the worth of their activities and to consider positive risk taking because of the possible benefits different activities can bring. I especially found it interesting as I am a gymnast myself 🙂

    Thanks again

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