Go Slow, Relax, and Don't Overdo It

When I was doing my internship at San Diego VA, I led several groups related to coping with chronic pain, and since then I have done a fair bit of work related to helping clients manage medical conditions. One of the key concepts that is always a core part of this type of work is pacing – balancing activity and rest. Often, when I see a client coping with chronic pain or some other chronic medical condition, the problem is about too much rest and not enough activity, becoming deconditioned, and then finding that activity exacerbates the condition leading to more rest and further deconditioning. It is a very frustrating and demoralizing loop to be caught in, and one I have been very careful to avoid. However, because of this I sometimes find myself at the other extreme – too much activity and not enough rest, leading to exhaustion and setbacks.

In my last post I talked about how I was walking around the house most of the time without any walking aids. Well, it turns out that I might have been overdoing it a bit. When my PT said to try this out apparently she didn't mean to start doing it all the time. Apparently it tired me out so much that I ended up totally crashing last Monday and Tuesday. Not quite as badly as I crashed a few weeks ago, also from overdoing it, by taking a trip out shoe shopping by myself. It was pretty horrible – I had multiple incidents of making mistakes at the entrance and exit to the parking garage with the little pushbutton ticket-spitter-outers, dealing with an overcrowded parking garage and no disabled parking spots, ending up having to go to two different malls because the store in the first mall didn't have my size and they assured me that the store in the other mall did have my size but they didn't so I had to get different shoes. I came home in tears thinking that I hated my new shoes (but I actually like them just fine). Jeff assures me that this isn't so different from my experience of shopping in my previous able-bodied state. But the difference is that now, after that incident, I was physically exhausted for about a week, and felt like I was moving backwards in terms of my rehab progress.

Pacing is extremely difficult during recovery, because it is important to push your limits in rehab in order to make progress, and if all is going well those limits keep changing, so it's hard to know exactly where the limit is. In my eagerness to continue making progress, I have recently apparently been pushing my limits a bit too far, and everyone involved in my rehab is suggesting that this strategy may not be in my best interest. We have been working a lot recently on trying to get my brain and my body to run some of those automatic programs for things like walking that I never used to have to think about. For the last 10 months this type of  movement has been effortful, requiring me to think about every part of every step I take – shift weight left right foot forward, shift weight right left foot forward, and a million other little things that are involved in walking just two steps. Shifting from thinking about every aspect of a movement to trying to allow the movement to unfold automatically requires a completely different approach. The goal now is to make room for the automatic process, and this means letting go of some of the effort. The feedback I hear over and over again during my PT sessions is to relax and go slow. It sounds like a good plan, but I'm finding it very difficult!