Peaks and Troughs of Activity

As a physiotherapist I always prided myself on my ability to empathise with the patient. To be able to talk on a level about chronic pain and pacing, the do’s and don’ts, the reasoning behind it, and the need to avoid peaks of activity followed by troughs of inactivity and pain and the downward cycle of deconditioning.

I felt able to use myself as an example of it working, and of pacing’s benefits. But perhaps I never appreciated how much of a pivotal role my pain management played in my being able to achieve appropriate pacing.

Of course, I knew how important pain medication and pain management was with pacing. I regularly encouraged patients to go back to their doctors and consultants to discuss better pain management. But I think I lost sight of how much my medication was helping me! Until I had to stop taking it!

Over the last year, since stopping the methotrexate and just being on the Etanercept (Enbrel) my pacing has been POOR! My lifestyle and my pain levels don’t match well at present, and it has taken me a whole year to be able to look back and appreciate this… I am a rubbish patient, I have always been a rubbish patient, I have never taken my advice well, but now I wonder, if it’s about time I started to listen to myself.

In the past year my activity levels have plummeted due to the pain and exhaustion of a full day at work. I have managed little more than two dog walks a day, and that has now dropped to one more often than not. I have deconditioned. I am now feeling the effects of the deconditioning – Right Achilles tendinopathy, Right anterior knee pain, the list could go on – hills and steps have become my nemesis…. I’m 29!!!

For the last two months I have been giving myself exercises to combat these secondary problems… but like a bad patient I have done them infrequently, and therefore they are useless.

I feel that at the moment, work is my peak of activity, I have exhausted all I have by 4.30pm, and my trough of inactivity is the evening. My feet throb from being stood up all day – I want to sit down, then I seize up and struggle from the chair, my hands scream from holding, supporting and facilitating people all day – I don’t want to hold or touch anything in the evening. And the rest of me aches and feels heavy and difficult to move.

I know however, I have to start doing something to break up the inactivity of the evenings, I have loads of options easily to hand… cycling, swimming, rowing – all low impact, with the benefit of strength and cardiovascular fitness. Of course I know this! I’ve suggested those and many other activities to hundreds of patients… I’ve just got to listen to my own advice!!

So… the plan is… well, the plan is still forming! But I’m going to, I have to, get more active in the evenings… Ideally I’d get to rest a little in the day, but that’s not going to be possible, so instead I have to manage my time in the evenings better, relaxation can’t be on the settee… as I can’t get up again, and going up stairs to bed becomes a 10 minute ordeal. Perhaps going swimming, or pregnant yoga, or out on the bike… my problem is, I’ll miss my pooches, I have to cook dinner at some point… and will I burn myself out? People keep telling me that as a pregnant woman I should be getting some rest… it’s going to be a work in progress!

In the meantime, I’m waiting for an appointment with a colleague, so I have someone else telling me this stuff!! It’s a lot harder to ignore someone else, it’s very easy to talk myself out of doing things! Although that’s a trait I am working on.

And finally, what better motivation to stay in shape and find ways of pacing myself now… because in six months’ time, I’m going to be looking after someone else too, time management is going to become imperative!! And I know myself, if my muscles weaken, and my joints don’t get their support, on top of additional weight (both baby and the odd cake!) it’s only going to make my life harder!!

 

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