Pacing & Activity Management

We’ll start this section with a question - does the above picture look familiar?

  • Do you find yourself having good days with your pain and then doing more housework, gardening or walking?
  • Do you find that after your good days, you get bad days where your pain is worse, so you have to rest and do less to make it settle?
  • Once it’s settled, do you find yourself doing more again?

If the answer is yes, you might find yourself in the ‘BOOM or BUST’ cycle, just like the picture above.

What does ‘BOOM or BUST’ mean?

In the most simple terms, it is when you find yourself using your pain as a measure of how much activity you can do i.e. good day = more activity and bad day = less activity. This is quite a normal place to find yourself when you are in pain, as it makes sense to use the good days for doing more and the bad days for doing less. However, being in the ‘BOOM or BUST’ cycle isn’t normally the best place to be, as it means you are not in control, your pain is in control and sometimes it might feel like you’re stuck going nowhere.

I can definitely see myself in this ‘BOOM or BUST’ cycle, but what can I do about it?

It’s important for you to know that you are not stuck where you are and that you can change things. Recognising that how things are at the moment aren’t really helping you move forwards is a big part in addressing the issue. The other part of the equation is understanding that if you want something to be different, you will have to do things differently. In other words, if you keep doing things the ways you’ve always done them, you’ll always get the same result.

One of the things that can be really effective at helping people regain some control over their painful complaint is pacing.

 

What is pacing? 

Firstly, pacing is not stopping things. It is not giving up, giving in or just admitting to the fact that ‘this is how things will be forever’. Pacing is simply ‘doing things differently’ and as we have said, if you want something like your ability to walk the dog, play with the children, work or walk do be different, you will have to look at doing things differently to get there.

Pacing in its simplest form is about adjusting, modifying or breaking things up into smaller or different chunks.

Think of this funny example...

Most people can’t (or shouldn’t) eat a whole cake in one go, but if you ate it in small slices, you’d get there in the end. As we’ve said, pacing is all about breaking things up and doing things differently to get a different, and hopefully better, result.

But I’m already doing this!

You are very likely to have tried various adjustments to things that are sore or difficult, but it’s worth remembering there is often more than one way to approach a problem.

Do you recognise yourself in one of these poor pacing habits?

 

Overactive Pacing


Underactive Pacing

 

‘Boom & Bust’ Pacing

 


This means doing too much activity or too many tasks over a short space of time. Typically, this happens if you are having a good day, with less pain, or your mood is better: you try to do too much and end up with more pain and tiredness. This means you miss out on enjoyable things because you have to take time out to recover.

 

Underactive pacing means that you are doing too little activity to help keep up your strength, stamina and flexibility in your muscles, ligaments, joints and bones. More of your time is spent resting, sitting or lying down, which is understandable. However, this can actually add to your pain as the lack of fitness makes muscles and other tissues tight, weak and painful.

 

Often people use pain and energy levels as a guide to their activities and pacing them. This means they risk doing too much activity on good days (overactive), which makes their pain worse. They are then forced to rest while the pain settles down (underactive). This is a mixed style of pacing, which is unhelpful.

 

Over time, people become less able to cope with activity and smaller amounts of activity produces an increase in pain.

 

Ok, so I might be better if I do things differently, but can pacing really help me?

Pacing, done right and done consistently, can help. People who have learnt to use pacing skills often report:

  • Improved sleep at night
  • More control and confidence over their pain and activity levels
  • Using less medication and experiencing fewer side effects
  • More choice over what they can do rather than what they can’t
  • Brighter moods with less frustration
  • More energy
  • Reduced frequency, severity and duration of flare-ups Source: Pacing - Live Well with Pain

Let’s use another example to help you understand how pacing works and how it can work for you.


Have you ever had sunburn?

Most people have at some point and most people know that it happens when you spend too long in the sun. Sunburn isn’t pleasant and once you’re burnt, jumping in the shade or putting sun cream on doesn’t really help. Sunburn makes your skin sensitive; it hurts when you move or put clothes on; it makes the shower feel hotter than it actually is; it normally means you will struggle to sleep well that night and most importantly, it normally means you can’t spend as long out in the sun the following day. Most people would agree that sunburn is not a good result on a sunny day and waiting until you’re burnt before jumping in the shade doesn’t work.

A paced approach to being out in the sun would be like spending some time in the sun but breaking the day up with some time in the shade. It might need some planning before you start your day i.e. to make sure you’ve got your sun cream on, a hat or a t-shirt to hand and a bit of a plan when you’re going to jump in the shade. Spending some time in the sun and the shade over the course of a day might not guarantee that you won’t get burnt, but it will reduce the chances quite a bit. With a paced approach to being in the sun, you are less likely to get burnt, less likely to have painful skin, more likely to sleep better that night and most importantly, more likely to be able to go out in the sun again the following day without any issues.

Put simply, you can apply the basic idea of pacing to prevent sunburn to anything that might make your pain worse, like walking, standing too long or cutting the grass.

 

Is pacing easy? 

The honest answer is no, with a 'but'. Any new skill takes time to get really good at and pacing is no different. Often the biggest challenges people report is that they struggle to change the way they’ve done things for years before, or they simply forget to do it. We’ve got some tips at the bottom of the page to help you with this.

Remember, pacing is something that can help, but it requires you to look at things you do or have done in the past with a different mind-set or approach. Done correctly, pacing can help most people.

So how do I start pacing?

A whole cake with a slice being removed.

The first step is to find yourself a goal. A good tip is to start with one thing that is easier for you to adapt and adjust with pacing. Taking on too many things at once or picking something that is really tough right from the start is unlikely to help you.

You can find some help on setting goals here: Goal Setting

The second step is to establish how much of that activity you can currently do. Keep track of how much you can do before your pain stops you over about 3 days. A simple bit of maths can help you work out your average. Add all of the scores (in minutes or hours or number of times) together before doing the next bit.

Total minutes/hours or number of times (until your pain stops you)  ÷ 3 = your answer.

Take the answer from step 2 and simply cut it in half.

E.g. Step 2 answer = 20 mins of activity caused your pain, then cut that answer in half and your new answer is 10 minutes.

Use the answer from step 3 as the new limit of how much you will do i.e. if your step 3 answer was 10 minutes, then stick to 10 minutes of activity before you take a break/do something different.

Over time, the amount of what you can do is likely to change, therefore revisiting these steps from time to time can help you see your progress and set new limits for your activity.

Try watching this video if you are in need of a different way of understanding pacing:

Watch Video

So, I just need to do less?

Not necessarily. Sometimes doing less works for some people but equally, sometimes doing things in a different order, spreading things out over a longer time or asking for help can be just as effective. Taking breaks or doing something different before your pain either comes on or gets too uncomfortable is the trick to making pacing work.

Using your pain as an indicator to stop or do something different is best seen as 'trying to close the barn door after the horse has bolted.'

Shouldn’t I just stop doing things? 

No. Some things in life can’t be stopped and therefore, simply stopping or avoiding things just aren’t realistic options for most people. Pacing is not about stopping things - it is about helping you continue to do things and eventually regain some control over them. Pacing is about increasing your options, not reducing them.

Dice with arrows and the words 'Step by step' written on them in the shape of stairs.

Can you give me an example of something I can do?

Sure! Let’s say your goal is to cook a meal for the family. Think about how you can break the cooking down into separate stages. Baselines can then be used in each stage -cooking a meal can be broken down into smaller steps:

  1. Collecting items and ingredients required (walking for x minutes)

  2. Preparation of ingredients (sitting for x minutes, or standing for x minutes before changing position)

  3. Cooking (standing for x minutes before walking or sitting)

  4. Laying the table (walking for x minutes)

  5. Eating! (sitting for x minutes, standing or walking a little before returning to sitting).

You may have noticed the 3 building blocks that are needed for success with pacing:

Take frequent short breaks before you are forced to

Break up tasks into smaller bits

Gradually increase the amount you do

What else can I do to help make pacing work for me?

  • Focus: It is important to focus on one task at a time. Ideally this will be something that is important to you and that allows for pacing.

 

  • Plan and record: It also helps to plan and record your activity so that you can monitor your progress. There is a record sheet you can print off at the bottom of this page or you may wish to develop your own. A starting point may be simply keeping a record of your activity so that you can identify where you may need to focus your pacing.

 

  • Plan for setbacks: Life is full of ups and downs and so will your pacing journey. We’ve developed an entire information page about managing the ups and downs here.

 

  • Stick to the plan: Try to stick to the limits that you have set yourself and do not be tempted to rush into the next step. Pacing takes time to be effective and rushing things will not get you better quicker.

 

  • Don’t try to do it all yourself: Remembering to pace is often the hardest thing. Using your smartphone, kitchen timer, friends or reminders you can see (post-it notes or something written on your calendar) can be really helpful.

 

  • Build your team: Discussing and sharing your pacing plans and limits with friends and family will help them understand that you might take longer or do things differently. It will help to reduce the feelings of guilt of not being able to do what people think you should, or what you used to be able to do.

Pacing Diary

Additional resources to support you with pacing

Pain Toolkit

Live Well With Pain