My name is Ann Alton, and I’m a physical therapist.
Pacing is about how to progress our activity levels and exercise in a safe way when we have chronic pain. So most of the time, people who have who don’t have chronic pain, they’re used to kind of this “no pain, no gain” kind of idea.
That’s really great – if you don’t have chronic pain. When we do have chronic pain, our nervous systems have been sensitized to a point where, even though we’re not doing any damage, we can still make ourselves pretty miserable for a number of days, if we overdo it. This is a way that we can progressively increase our levels of activity and our strength and still not experience those days of increased pain. So I’m going to go through just the basics.
For strengthening exercises: “Tease it, Touch it, Nudge it”
You should monitor your pain level – first by checking how you feel before the exercise (to serve as a comparison), then during, and after. If your pain level should increase during the exercise, you should stop. This should be a simple “Yes” or “No” response – is my pain increasing or is it the same?
Pain is our body’s way of protecting us from injury- we call this our “protect by pain line”. We do NOT want to cross this line during exercise. Sometimes your form might be compromised or your posture becomes abnormal, so continuing to push through could cause further injury which is NOT our goal!
Sometimes an exercise just does not feel right in your body and you need to LISTEN to that! We will likely have another idea for how to strengthen that area of your body. Let me know, and we can discuss it at your next appointment.
If your pain increases after the exercise, note how long after the exercise the pain increased and by how much, and then bring this to our attention next visit. You might also want to reduce the number of reps you are doing the next time to see if your symptoms improve afterward.
You should also monitor your fatigue level – check how you feel before (to serve as a comparison), then during, and after the exercise.
There are 3 levels of fatigue:
- Low = “That was easy”
- Medium = “I am tired”
- High = “I almost couldn’t finish the set”
If you experience Medium or High fatigue during the exercise, this is a sign that you should stop. Often as we become more tired, our exercise form can become compromised. If you push through higher levels of fatigue, the muscles might respond as they would to a strain or overuse injury, meaning that you are more likely to be sore for several days rather than just 1 or 2 days.
If you feel exhausted the rest of the day after doing the exercise, this also might be an indication that you are doing too much. The best way to keep track of all this is to write it down on your exercise log and bring it into your next therapy appointment.
Strengthening exercises should be performed 1 time every other day (3-4 days per week). Repeat each exercise 15 times as long as NO pain or anything greater than LOW fatigue is felt. Repeat for the second set of 15 reps IF no pain, only low fatigue.
Progress toward 3 sets of 15 reps using these guidelines. Once you are able to perform 3 sets of 15 reps easily, add resistance and start the progression over. Keep following this plan until you are up to the goal resistance for each exercise! Once you reach goal resistance then continue doing the program 1-2 times per week for maintenance.
Stretches should be performed at least 5 times per week, with the ideal frequency being daily. Stretches should NEVER be painful. The reason for this is that pain is your body’s way of warning you that an injury is about to occur. When we stretch too hard or incorrectly, we are actually straining the muscle which then makes us even tighter, and likely more sore, the next time we try to stretch. Mild DISCOMFORT is acceptable, as long as you stop and hold as soon as the stretch or “pulling” sensation is felt.
Most stretches should be held for at least 20-30 seconds unless you have been otherwise instructed by your therapist. Sometimes we start you off with holding just 5-10 seconds to help you get used to doing the stretch correctly before progressing to longer holds. Do them as often as you want to if they help you feel better.
