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"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.


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 or questions?  Send e-mail to LKDFMS@aol.com


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