Pacing - Musculoskeletal Health Australia (MHA)

It’s an easy trap to fall into when you live with persistent pain. The days when you feel great you do as much as possible – you push on and on and overdo it. Other days you avoid doing things because it hurts. Both of these things – overdoing and avoidance – aren’t helpful for managing persistent pain and they can actually make your pain worse.

Pacing can be an effective strategy to help you do the things you want to do by finding the right balance between rest and activity (both physical and mental). This will help reduce your risk of pain flares and fatigue.

It requires that you listen to your body and understand what you can do on a good day (when you’re pain is under control) and on a bad day (when your pain is more intense).

Pacing is ‘time contingent’. That means it relates to the amount of time you can do things before your pain or fatigue worsens. For example, if you know that you can walk the dog for 20 minutes before your pain becomes worse, then that’s your current limit. Then you need to take a rest break. A rest break means switching from the active thing you’re doing (e.g. walking the dog) to doing something more passive (e.g. reading a book, paying your bills online, creating a meal plan for the coming week).

Working out your current limits can take some trial and error. Recording your activities and pain levels in a pain journal or pain diary will help you keep track. It will also help you see clearly the activities, or the time spent on activities, that may be causing you problems.

If you find that from day-to-day your limit changes quite a bit, try this – but hold on to your hat we’re about to do some maths! Over a week or two record the amount of time you can do an activity (e.g. walk the dog) before your pain becomes worse. Add these up and then divide by the number of measurements you’ve taken, this will give you an average limit. For example, if you’ve recorded the times of five walks, add all the times up and then divide by five. Now work out 80% of this limit – e.g. if the average was 20 minutes, 80% will be 16 minutes. This will be your new current limit for walking the dog.

By understanding your limits, and what you can do at this point in time, you can plan and take control of your day and the things you do. You can plan activities and rest breaks so that by the end of the day you’ve done all the things you wanted or needed to do, and you haven’t made your pain or fatigue worse.

Pacing will also help you gradually increase the amount of time you spend being active and performing certain activities. For example, if your current limit for walking the dog is 20 minutes, do this regularly for a week. In the second week, try increasing the amount of time by 10% – so instead of 20 minutes, walk for 22 minutes. Record how you’re going in your pain journal. If you’re able to tolerate this increase, try adding another 10% in week 3. And so on. Keep recording your progress. Set milestones (e.g. able to walk for 30 minutes) and reward yourself when reach them. Don’t be hard on yourself if this takes time.

Tips for pacing

Plan your day.
Prioritise the things you want/need to do – what really needs to be done?
Can you do some things tomorrow?
Break jobs into smaller tasks. Break jobs like cleaning into smaller tasks, and rest in between. The job will still get done, and you should have more energy for other things. For example, if you know your current limit for cleaning your house is 30 minutes, then do 30 minutes. Then take a rest break – even if you feel ok.
Alternate physical jobs with less active ones. For example, vacuum the lounge, then sit and sort through your mail or your pile of old magazines. You’re still cleaning, but you’re not overdoing it.
Don’t overdo things on your good days.
Ask for help when you need it.