Pacing is a key part of dealing with chronic illness. You pace your activities so that you don’t exhaust yourself and thus worsen your symptoms. It can be hard to pace properly because a major part of it, is being very aware of what you can and can’t do with your body. It’s also hard because it’s very common for people who are chronically ill to be on a rollercoaster of ups and downs with their symptoms, meaning their limits also go up and down alongside this. Adjusting based on your wellbeing is something that isn’t natural, we naturally want to adapt to a task and make it habitual.
On the other hand, pushing yourself is synonymous with improvement. We know instinctively that if we don’t push ourselves out of comfort zone, that we don’t tend to improve. Pushing yourself whilst you are chronically ill is something you learn early on as unwise. It just seems to do more damage than good.
But the real goal of pushing yourself is getting your body to take notice of something; like your cardiovascular system for example. The goal is for the body to understand that this task you’re doing is too hard to keep doing as you are, and that the system involved needs more resources. You keep pushing yourself and your body keeps giving you more resources to bring that system up to scratch.
But the problem is, that if you’re chronically ill, that when you push yourself, you simply don’t have the resources to spare. All you cause is damage, that then isn’t even repaired, so now you have both a damaged body and a body with no extra energy, which spirals you down into a worse state.
Maybe we need to change what pushing ourselves when chronically ill really is. When you have an acute illness, you obviously rest initially and then slowly work back to good health. With chronic illness, you rest, and rest and rest, and you’re never back to good health.
First I think it’s a good idea to intensify your pacing, and then define reaching your previous level of pacing as pushing yourself. This seems counterintuitive, because by pacing even more, you’re essentially saying to your body that this system needs less resources, so you’d think your fitness would decline to mirror it’s lower output of energy. The issue isn’t really what your body is adapting to, it’s how much energy you have to spare. If you’re pacing and still have no energy to spare, that isn’t enough pacing. Energy to spare is for pushing yourself and for emergencies that require you to be responsible. Trying to push yourself sometimes both in terms of exercise, learning new things and putting yourself in uncomfortable situations, is a requirement for many people’s lives that they might not realise they are missing, and can be a major source of positive mood. Failure in these situations can also be a source for a negative mood, so don’t overdo things, keep small goals.
Let’s use it in an example. A healthy person might be used to doing a 30 minute run. But then they become chronically ill, they try to do a 30 minute run, and they can’t handle it, it now exhausts them. They learn about pacing, and reduce their run to 15 minutes. It’s bearable but they feel disappointed that they can’t improve and they are a lesser version of their healthy self.
My point is, that this 15 minutes might still be considered pushing yourself habitually in this scenario. In this example if you really pushed yourself when you were healthy, you could do 1 hour of running and be exhausted . Usually healthy people use a step progress to improve. One week they’d do 30 minutes, the next 35, the next 40, and so on. This doesn’t work when you’re chronically ill because you just don’t have the extra resources, whether you take in more calories or not, it’s not about calories, it’s about your body’s capacity for stress. Step progress becomes ineffective, because your body is already in a state of pushing itself, to just maintain homeostasis.
So the only logical thing to do, is to keep taking a step back until you really get rest and spare energy. Keep moving but do less, and truly work out your limits for good and bad days. The worst part is how responsibilities and random events can conspire to rob you of energy at any moment. These things are hard to deal with, and it’s why you always need a reserve of energy on hand. You can’t attempt to live life properly by exhausting yourself all the time. Pushing yourself is a good idea, sometimes, just not every day.
The issue with stepping back, and back, is eventually life becomes really drab; you stay at home, doing nothing, sleeping or sitting about, you might have no energy to even entertain yourself, reading and watching become difficult because you can’t concentrate or relax. Depression sets in, and a pervading sense of hopelessness about your situation. Your life becomes hollow and you feel insignificant, like a burden to the world. What’s really happening here, is you are becoming more and more internal, you are interacting with the world less, because all interaction is a matter of energy.
One idea is that even in this state, you might be wasting massive amounts of energy on things you don’t realise. Such as worrying, anxiety and habits like phone use. We can also all eek out a little extra productivity and energy by being more efficient in life. This might mean something simple like using a stool to sit for a shower rather than standing or having your home adapted with handrails, etc.
An issue that some people don’t consider is that sometimes introducing something in your life to make you more comfortable actually uses up more of your energy. One example of this is using a cane to walk. Many people with chronic illness find they require a cane to steady themselves, or to support their weight. But cane use needs adaptation, and your walking gait changes when you use one, in this adaptation period you might use more energy than normal to walk, because your body is moving in a different way that it has normally.
Another issue is with situations like sitting down. Sitting down in the same position all day, will actually drain you of energy. Have you ever sat in a couch for hours, and gotten up all stiff and unable to move properly? You’ve done damage to your body by not moving it. Once stiffness sets into your body position, your muscles become tight, and you start to waste an enormous amount of energy in trying to maintain a position without really realising it. Also when you finally move, since some muscles have been overworked and some underworked, the body now has to make a major change to promote movement. It’s easier to keep a boulder rolling than move it from standstill.
Directly connected to this idea is how posture and body alignment overall can contribute to a major drain in energy. Being in constant fatigue and pain can put you into a protective posture, this protective posture is actually a collapsing posture. You collapse your posture in order to relax, but what you’re actually doing is causing overwork in one muscle group, and underwork in another, and then setting that in stone. It’s hard to correct your posture when you want to crumple into the ground, and basic movement becomes effort. But essentially you are making a bad situation worse if you don’t pay some attention to it.
Again it’s not something you need to push yourself to conquer every minute of the day. But it’s something you should check in frequently, probably at least once an hour, shift your posture and see how you feel, move about even just a little bit. It can actually reset some of the tension you’re holding, especially if you’re dealing with a lot of pain, or you’re collapsing your posture due to fatigue.
In conclusion, you can push yourself whilst pacing, you just need to probably pace yourself even more and understand your changing limits. Creating a baseline is key, as is becoming very prudent with your energy expenditure. An important aspect to all this, is your energy efficiency, your posture and how stiffness can set in. All of this can be hard to get a handle on, staying calm and steady is obviously the ideal way to react at first. But it’s not always possible. Adapting to chronic illness is really the best focus, and not putting too much pressure on yourself to get back to being healthy when it might still either be a long way off, or impossible.
It makes sense yeah