"Rehabilitation Through Learning: Energy Conservation and Joint Protection."
U.S. Department of Health and Human Services by Gloria Furst, OTR, MPH, with Lynn H. Gerber, M.D. and Cynthia Smith, OTR.
Body Position
Energy conservation is
a process of saving energy and better distributing the energy you have over the
time you need to use it. If the energy you have is used up at the beginning of
the day, you have none left for other things you may need or want to do. People
with CFS/FM often sleep poorly which results in additional fatigue during the
day.
Unnecessary muscle tension in certain body positions drains energy. Good
posture is the head and back held straight and arms relaxed at the shoulders.
Poor posture uses unnecessary energy against gravity for hunched shoulders,
curved back, and the neck and head slightly bent forward. Good posture, sitting
or standing, balances the weight of your head and limbs on the bony framework so
that the force of gravity helps keep joint position. The further you move from
this position, the more energy is required of your muscles to pull against
gravity to maintain your position.
Avoid energy-draining positions. It takes approximately 25% more energy
to perform an activity standing than sitting down. Shoulders should not be in
"shrugged" or hunched position when working with hands on table or
countertop. When reading or working at a desk, if head is held forward instead
of straight up, unnecessary muscle power is used to keep that position.
When back is curved or bent from the waist, back muscles remain tense to prevent
you from falling forward.
Incorrect work heights, sitting or standing, can cause poor body
position and unnecessary energy loss. Correct work height should allow you to
keep your back and neck as straight as possible sitting or standing. Correct
work height, whether sitting or standing, should be approximately two inches
below your elbow when your shoulders are relaxed.
What can be done to change an incorrect work height? Since lowering
counters, tables, and desks is not practical, use a high stool with back
support, or raise the height of your chair, using wood blocks (make sure you
keep feet supported with a stool or box so they do not dangle.) Raise the height
of beds and low tables using wood blocks as necessary. Be sure raised furniture
is stable!
Practice Suggestions:
To be aware of your body position
during activities at home, work, or school, write down on a piece of paper the
energy draining positions you were in, what might be causing them, and how you
might correct the problem.
Rest:
Plan a daily rest period, whether you
feel tired or not. Just as you would fill the gas tank in your car at 1/2 or 1/4
empty rather than waiting until you run out of gas, rest gives your body time to
refuel. Rest one hour or longer, lying down if possible, every afternoon. Rest,
even if it may be difficult to "get going" afterwards. (Resting is
better than possibly having to stop for the remainder of the day from fatigue!)
Rest is like medication or therapy--it helps you perform better longer.
You can learn to balance rest and activity to save energy. Frequent, short (5-10
minutes) rest breaks taken during prolonged activity can increase the time
during which you will continue to have enough energy to perform that activity
and others. The United States Army has discovered by repeated tests that men can
march better and hold up longer if they throw down their packs and rest at
regular intervals during the length of the march.
If you persist in completing an activity that takes a half hour or longer
without a short rest, you will find that it takes you much longer to recover
your energy than if you rested briefly during and after the activity. Plan rest
breaks approximately every 20 minutes during long periods of activity.
Proper use of rest breaks: Vacuum living room and dining room for 20 minutes.
Rest for 10 minutes. Vacuum bedrooms for 20 minutes. Rest for 10 minutes. You
will have time and energy left for other activities.
Plan your rest breaks well. Before you start an activity, decide how long you
will work and when you will take rest breaks. If resting is difficult for you,
choose something restful to do during your break from the activity:
1.read a book or magazine (use book rack or other aid to maintain relaxed body
position), 2.do crossword puzzles or jigsaw puzzles, 3.watch TV or listen to
radio, 4.do relaxation techniques, breathing exercises, medication, or other
restful activities.
How can you tell if an activity is too much for you to do? If the activity
causes extreme fatigue, it is obviously too much to do at one time or you are
doing it incorrectly. Any activity that takes more than 20 minutes could be too
much to do at one time and should be changed.
Practice Suggestions:
Keep a daily record of how much time
you spend at one time doing one or several activities. Check the time you begin
and the time you stop. Include the amount of pain and/or fatigue you felt after
you stopped.
On another day, plan and take one or more rest breaks (at least one break for
every 20 minutes of work) and again record pain and/ or fatigue. Compare the
differences. Hopefully, you will have more energy on days that you rested.
Increase your activity level gradually.
Flare Management For
Chronic Pain
Over 60 million Americans suffer from chronic pain - pain that persists
for six months or longer. The cause and course of chronic pain
varies from one person to another and is characterized by remissions &
flare-ups of symptoms.
A remission is defined as a period of time when one's symptoms are greatly
diminished or even absent. A flare is defined as a period of time in which
symptoms reappear or become worse. Remissions/flares can last for hours,
days, weeks, months and even years and often differ from one time to another.
A flare-up of symptoms can often be associated with specific reasons or
modulating factors such as: - lack of or too much physical activity - weather
changes- depression- major stressful events (good or bad)- PMS- Postural strain-
anxiety- repetitive and mechanical stress- interrupted sleep- illnesss
Sometimes a flare-up (increase in pain level) can't be attributed to anything
that we're able to identify and can contribute to a feeling of frustration and
lack of control over our health. Spontaneous or idiopathic flare-ups (with
no aggravation) are common. If we make our best effort to control
the things we can control and accept that there are uncontrollable elements, it
will help us better overcome a spontaneous flare.
Teddy Roosevelt said "Do what you can, with what you have, where you
are". Sounds like good advice anytime, but especially during a flare.
Remember, while we can't always control the physical aspects of
chronic pain, we can choose our thoughts and actions. Building a sense of
control by adjusting your thoughts and actions is an important part of pain
management. Thinking differently may not get rid of your pain entirely, but
having a more positive attitude can help. It may sound silly but
"mind amused; body relaxed" is a seven second method that can begin to
reduce the physical affects of tension. Distract your mind from your
discomfort/pain whenever you can - listen to your favorite music, read a
favorite book again, watch a funny movie, play some games of visit with a
friend. Laughter actually releases your body's natural pain killers into
your system.
Some pain flare
management guidelines:
- Remove or change a modulating factor if possible, such as - eliminate or
reduce repetitive stress, treat other illness, correct your posture.
- "Pain may be inevitable, but misery is optional" Talk with
your doctor before a flare to discuss medication/modality options.
- evaluate sleep & discuss medication options w/doctor:
- increase medication
- add muscle relaxants
- add a sleeping pill
- add anti-inflammatory
- try a topical cream
- discuss all possible options with your physician before a flare occurs.
- use relaxation/biofeedback techniques
Rest and be gentle to yourself; frequent breaks from activity, cancel
unnecessary appointments, give yourself permission to take care of your health,
try to make activities of daily living as easy as possible, take a nap and/or
try to get more sleep at night.
Reduce stress level; identify major stressors and eliminate or modify where you
can (both physical and emotional)
Heat/cold/alternate; warm baths, whirlpools, hot/cold gel packs, moist heating
pad - if heat or cold doesn't seem to help try alternating them - use a form of
moist heat for 15-20 min, let area of body heat was applied to come back
to room temperature then apply cold for 15-20 min. Repeat this cycle 2 - 4
times, it can be very effective when either cold or heat won't work.
Massage: by a professional, a significant other, gentle touching is very
relaxing and releases muscle tension. Use of a deep pressure massage tool
such as a hand held massager, wooden balls with a handle rolled over the painful
area, a Thera Cane or Intracell. Use pressure on trigger points (use an
ice cube to freeze area, then stretch it gently) Or use spray & stretch (fluori-methane
spray).
Gentle stretching; a warm bath or shower 15-20 minutes before will make the
stretching easier & more effective. Decrease duration & intensity of
exercise. Positive self talk messages; it's easy to feel discouraged, but try
repeating these self-affirming messages: "I am doing everything
possible/necessary to feel better." "This flare will be over
soon."
I would like to share a thought from Kathleen Lewis, "Successful Living
with a Chronic Illness": Celebrating the Joys of Life, 1994
"There can be victory in defeat, gain in loss, living in dying, wholeness
in brokenness, giving in receiving, success in failure, strength in weakness,
peace in turmoil, joy in sorrow, growth in pain, and mental health in the midst
of physical illness!"
Never, never give up. Hope remains an anchor sure.
Used by permission. Copyright 1997, Linda Davis
Comments
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