Pacing Means Moving Ahead and Not Falling Behind
By Rachel Feinberg, PT, DPT, and Steven Feinberg, MD
Note: Reprinted with permission from The ACPA Chronicle, the magazine of the American Chronic Pain Association.
Pacing is a vague word that is thrown around, often incorrectly, by both providers and people with pain. Pacing is not about decreasing the intensity of an exercise, doing less activity, or being unproductive. Pacing is actually the exact opposite.
Pacing is a tool that allows you to change the way you perform or complete an exercise or activity so that you can successfully increase strength, tolerance, and function. Some people with persistent pain markedly reduce their physical activity because it hurts. Others push too far into pain and overdo the activity.
This over-activity generally increases the pain level and the increased activity becomes hard to sustain. Still others overdo when their pain level is relatively low and then stop their activity too late, when the pain has already reached a higher stage. This sets up an unhelpful cycle of over-activity and under-activity. All of these patterns have the eventual overall effect of reducing activity because of:
- higher levels of overall pain
- fear of the activities that cause this increased pain
- frustration (because, despite pushing through each activity, people are unable to increase their physical ability level)
The purpose of pacing and goal setting is to regulate daily activities and to structure an increase in tolerance through gradually increased activity. Pacing requires that you break an activity up into active and rest periods. Rest periods are taken before significant increases in pain levels occur. In this way, pacing provides structure to the overall activity and guides you to build an optimum schedule that minimizes pain and maximizes productivity during the day. Pacing also imposes a structure on the day, giving you a sense of control.
Pacing Can Help Increase Activity
People often become frustrated when they are instructed to take breaks and to slow down (i.e., pace themselves) during a project. They believe that they will never get anything done and that the task will take two or three times as long. However, when the activity time is added to the time needed to cope with or calm down the increased level of pain, the sum is often longer than the time needed to build in breaks.
Consider an example of 15 minutes of vacuuming. Without pacing, this might involve 15 minutes of vacuuming followed by 30 minutes to manage a pain flare-up for a total of 45 minutes, with a flare. With pacing, in contrast, there might be three sets of 5 minutes of vacuuming followed by 10 minutes of rest for a total of 45 minutes, but without a flare.
Even if the activity does take longer with pacing, you are experiencing appropriate pain management because you are not causing continued flareups. As activity tolerance increases, rest breaks may be shorter and/or activity time may be longer.
Many people forget to pace themselves during certain ‘danger' times. Some examples include:
- Days when you feel good and you become over-confident in your physical abilities
- While performing a physical activity that you enjoy
- When trying to please other people
- When you are feeling rushed, pressured, or emotionally upset
These are times when you can become careless and forget to use good judgment while performing physical activities.
How to Begin Pacing
To begin pacing yourself, you first need to establish your baseline for each activity. The baseline is the amount of that activity you can do before you suffer from a significant flare-up. Although increased pain is expected, especially with a new activity, you want to stop the activity before the pain becomes difficult to control. The baseline may include a specific amount of time, speed, distance, or number of repetitions- or any other way to measure your tolerance.
One common mistake is to compare your starting level of an activity to the level that you performed at before your pain or injury. This typically creates a baseline that is too high and leads to an over-activity/under-activity cycle.
Don't forget to set baselines for activities that require sedentary prolonged positions including sitting, reading, and computer work. These sedentary activities are often forgotten when pacing your day, but can cause increased levels of pain due to their constant stress on the neck and back or repetitive nature of the upper extremity movements.
The next step is to set a rest or break time if you plan to perform the activity in chunks of time, as in the example of vacuuming above. The rest/break time could include time to stretch or to perform relaxation breathing. You may want to switch to an activity that rests the muscles you were using and shifts your position, i.e., going from sitting to standing.
Once you have set your baseline, gradually and systematically increase your tolerance by setting goals. Your goals should be very small increases from your baseline. Focus on increasing only one part of the activity at a time-for example, lifting slightly more weight or doing a few more repetitions. You want to be able to complete your goal so don't feel pressured to progress too fast.
Set Goals You Can Reach
Another part of goal setting is picking realistic goals and asking yourself why you are attempting to reach that goal. If you are picking goals that will place you back into an over-busy, stressful lifestyle, you may want to reconsider. Design a plan that provides a balanced lifestyle and allows you to manage your pain appropriately.
For exercise, pacing requires that you modify an exercise in a way that allows you to be successful. This could mean starting at a very low weight or only moving through part of the range of motion. The most important part is just finding a way to begin the activity. Your increased strength and tolerance will follow.
There will be many times that the activity that you are performing will not allow you to pace yourself: a 30-pound child must be lifted from the tub, you are participating in an important work meeting, or you are unable to pull over frequently while driving. For these times, other tools such as relaxation breathing, change of position, cognitive behavioral techniques, and distraction can assist you in managing your pain level while completing the task.
Remember, pacing is an art, not a science. Don't be afraid to be creative and to keep trying to use pacing in different ways. Be open to performing activities in new ways. Above all, remember that pacing is to help you get ahead, not fall behind.