Pacing For Beginners

Pacing in the context of managing our pain relates to our rate of activity or our performance progress. In this article I am using walking (that’s why the feet!) as an illustration, but the same logic can be applied to sitting, standing, resistance (weight) training or whatever activity it is that we are having trouble doing to the level we want to.

As I have shared previously, when I was first started on this journey, I walked five minutes at a time, four times a day. Five minutes was how long I could manage before I experienced pain. Slowly, by pacing, we can build up.

Please be aware pacing is only one component of condition management, it is not THE solution. This is a general introduction only, each person requires specific planning tailored to their circumstances.

Warning: Maths Ahead

Let’s assume for the maths part of the exercise that like me, you can also walk five minutes before you experience pain.

  1. Take that five minutes as your Test 1 measurement.
  2. After a suitable rest, do a second Test. The Test 2 result might be four minutes.
  3. Add 5 + 4 = 9. To find the average of your two trials: 9/2 = 4.5 minutes.
  4. Now you need your baseline, your official starting point. This is 80% of your average. 4.5 * 0.8 = 3.6 minutes, or 3 minutes 36 seconds.
  5. Increase at a rate of 10% from your baseline. 3.6 * 1.1 = 3.96 minutes. Let’s just call it 4 minutes!

Each day you increase by 10%. JUST 10%.

Putting Pacing into Practice

How does this work in practice? I did some timings on a stroll the other day. It took me 217 steps and 1 minute 48 seconds to walk from one tram stop to the next.

What is a tram, you ask? I’m glad you asked! This is a Melbourne tram. Terrific mode of city transport.

If you don’t have trams in your area, do you have an alternative?

Why was I doing the timings? Because we can use local infrastructure to our advantage. After a while you will get very bored with your backyard or walking around the same block. Tram lines are fantastic because we can walk, hop on a tram for a rest, get off further down the line preferably within one or two metres of a nice cafe, finish our rest over a nice coffee and then repeat the exercise back.

As we build up, we can use the distance between trams stops as stepping stones. Looking at my 1 minute 48 second walk between stops cited above, that is way more than a 10% increase from a 4 minute baseline. That would be closer to 50%, WAY too much. But later on it will be possible. You are not stuck on 4 minutes for long! As you build up you can walk just past a tram stop then back and still catch a tram to reward yourself with coffee. Over time you will be reaching the next tram stop.

A little reconnaissance may be necessary. This is the tram stop I was passing. In the middle of a busy main road, there are lots of steps up from the pavement, an over-bridge and then more steps down. This may not be ideal for those pacing up slowly! This is one of the tram stops you might want to zoom straight past – as a passenger!

Of course there are many alternatives: drive to a favourite park or beach, then walk. I don’t suggest the shopping centre, as it could take 20 minutes to walk from the car park to your store of choice!

The Rules

Rule #1: stick to the times. DO NOT be tempted to do more than you should, despite how great you might feel right that minute. You risk undoing all your hard work to date if you do that.

Rule #2: do it every day. Even if you don’t feel the best today, do your allotted time. Every day.

Rule #3: Wear appropriate footwear. If it is sitting you are working on, ensure you have an appropriate chair.

Other Thoughts

I also apply pacing strategies to manage the fatigue, along the lines of how much I do on any given day. I’ve mentioned before I don’t do grocery shopping on days I do a strength workout. I don’t do strength workouts the days I work eight hours in the office. We work out rules for our individual circumstances.

Christine Miserandino (lupus and fibromyalgia) has written The Spoon Theory which is a great way to visualise the energy/fatigue situation. I found it very early on in my journey and it certainly helped me adjust to my new life. I do have many more spoons these days than I used to, but that didn’t happen overnight.

Our Pain, Our Brain and Our Nervous System

Most of us felt cynical, and disliked the physio and doctors enormously. We’d talk among ourselves, ‘Oh it’s all right for them to tell us so and so, they’re not in pain.’ “Like most in the group, I’d been protecting my painful body, using the old reasoning, if it hurts, rest it. I’d bundle my arms around me and pick things up with my toes. My life had become massively restricted.” Source: Barbara’s Story The University of Sydney

That is Barbara Walker speaking about her initial introduction to a new approach to managing her chronic pain (see definition below). While Barbara was skeptical, the approach worked so well she and her family were instrumental in establishing the centre in Melbourne.

The following short video covers a lot in five minutes, please do take the time to watch it.

I was very surprised to learn 1 in 5 people worldwide suffer chronic pain. This is not a small percentage of the population. Think of all the people in your family, your workplace and your circle of friends. 100 people? I like round numbers. So it is statistically probable 20 are suffering or will suffer chronic pain.

I am writing this as a patient, just like you or someone you know. My objective today is to highlight there are evidence based approaches to living with chronic pain which you may like to consider. Referral information and other details about the Barbara Walker Centre for Pain Management are found on this St Vincent’s web page for those in Melbourne.

Because I am not qualified to speak on the topics of neuroplasticity or the finer points of nerve receptors and neurotransmitters, I’m not going to. This is actually sad, because I’d LOVE to, it is interesting and exciting stuff! It is also very specialised and the multi-disciplinary team have many years of clinical experience. Providing patients with an in-depth understanding of how pain works is a vital component of this approach to improving our quality of life. The relationship between our nervous system and our brain is very much a part of the solution. No, the pain isn’t “all in our heads” – but our brain is involved.

Ask yourself what are all the things you have tried to date? Has your quality of life improved as a result, or has there been only brief periods of respite? How often have you felt you had to choose between taking pain meds OR going to work, because invariably doing both is not an option? Is it worth trying something different, as Barbara did in 1995? As I have done and continue to do.

I feel as if I’m writing an advertorial for others, when if I should be writing one for anyone, it should be for my services! The truth is, while exercise and movement are part of the equation, there are other variables, some of the practical ones I have addressed in previous introductory articles. I would be remiss if I didn’t draw attention to the work being done and the support available in this sphere. After all, I didn’t know of pain centres until I was referred by a general practitioner.

Chronic pain is defined as pain that continues after the initial cause of the pain (injury, surgery, inflammation etc) has healed. Those of us with chronic conditions/illnesses/diseases may have ongoing causes of pain – so perhaps a mix of chronic and acute pain but the approach should still help us.

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