"The Benefits of Pacing and Movements" by Katherine Lyttle PT, DPT was presented at the 12th annual Cheri Woo Scleroderma Education Seminar on March 9, 2013 hosted by Oregon Chapter of the Scleroderma Foundation.

1. The Benefits of Pacing and
Movement
Katie Lyttle PT, DPT
March 2013

2. Your body’s response to pain
Pain makes you want to move differently
and/or less
– This is normal
– Motor changes are a response/output to a
perceived threat
– Protective response
 Movement is protective and helpful in
the short term BUT problematic in the
long term

3. How do you start moving?
• Understand the benefits of moving
1. How inactivity affects the tissue
2. How the tissues will specifically benefit from
movement
• Finding your baseline for various activities
• Doing enough but not too much, or too little
• Log activity/movement
• Progressing activities
• Flare up plan
Continue to assess barriers throughout the whole

4. Activity IS important
• Our bodies rely on movement to maintain
overall health
• Without normal movement tissue
becomes unhealthy and body systems do
not function properly
•  movement = unhealthy tissue
– Does unhealthy tissue feel good OR bad?
– For many  pain means  activity = unhealthy
tissue

5. Activity IS important
Our bodies are DYNAMIC
– Body systems and tissue are continuously
changing according to the demands placed on it,
positive or negative
• Wolf’s Law: form follows function
• Use it OR lose it
– We do not have the option to do nothing and stay
the same
– Everyday what we choose to do or not do causes
a change that could be positive or negative

6. What happens to the body with
inactivity
Musculoskeletal system
• Muscle atrophy  muscle fatigue and decreased
endurance(1)
• Altered neurologic control of muscles
– The body “forgets” how to coordinate muscles(1)
• Decreased joint stability(1)
– Increased risk of injury
• Muscle length imbalance around joints(1)
– Short and tight vs. long and weak

7. What happens to the body with
inactivity
Nervous system
• Decreased Nerve mobility(6)
– Decreased oxygen delivery to nerves(3,5)
– Increased nerve sensitivity  decreased pain
threshold
• Altered sensory perception(3)
• Increased inability to cope with stressors(2)
• Increased susceptibility to depression(2,3)

8. Benefits of movement
• Increased blood flow(6,7)
– Healthier tissue: muscle, tendon, nerve, bone, etc.
• Increased muscle strength
– Improved endurance and activity tolerance
– Improved joint support
• Restoration of tissue balance
– Lengthen what is short; strengthen what is long and
weak
• Decreased stiffness; increased range of motion
– Motion is Lotion

9. Benefits of movement
• Decreased nerve sensitivity(6,7)
– Normalization of pain threshold
• Improved sleep
– Improved balance between sympathetic nervous
system and parasympathetic nervous system
• Parasympathetic = “rest and digest”
• Sympathetic = “fight or flight”
• Improved emotional and stress management
• Activation of the release of endorphins

10. Bottom Line
•If you don’t move, your pain can increase,
even in healthy tissue
•Maximizing motion/function is critical for all
joints and tissue
•Exercise interrupts the chronic pain cycle
•Avoiding motion causes more long term
problems

11. Why is pacing important?
• Prevent pain flares
• Prevent “boom/bust” activity  increased pain
– Extreme bouts of activity followed by an extended recovery
period
• Maximize function; increase function
• Minimize recurrent injury
• Respect rest/activity balance

12. How do you start moving?
• Understand the benefits of moving
• Find your baseline for various activities
1. Have to start somewhere to get anywhere
• Do enough but not too much, or too little
• Log activity/movement progress at a week at a
time
• Progress activities
• Flare up plan
Continue to assess barriers throughout the whole

13. What is your baseline?
What you CAN do currently without making
yourself worse?
Amount that you CAN do…
• without overall making yourself worse the rest
of the day
• In a day and and not feel worse the next day
• Each day without needing a full day or more

14. Find your baseline
1. Take BASELINE pain level
2. How much activity can you do before your
pain increases?
3. If your pain level increases, does it return to
your baseline when you stop the activity?
• YES; that is a good amount to start with and that is
your baseline
• NO; that is likely too much activity and you need to
start with less.
4. If you want to be conservative: STOP the
activity BEFORE your pain stops you = your
baseline

15. How do you start moving?
• Understand the benefits of moving
• Find your baseline for various activities
• Do enough but not too much, or too little
– Boom bust vs. just in case
• Log activity/movement
• Progress activities
• Flare up plan
Continue to assess barriers throughout the whole
process.

16. Beginning and Progressing Activity

17. How do you start moving?
• Understand the benefits of moving
• Find your baseline for various activities
• Do enough but not too much, or too little
• Log activity/movement
– progress at a week at a time
• Progress activities
• Flare up plan
Continue to assess barriers throughout the whole
process.

18. Log, keep track of activity
Allows you to…
• Manage flares more accurately
– Identify cause of the flare
– Change activity accordingly if a flare occurred
• See your progress
– Motivation
• How
– Calendars
– Online exercise/activity journals
– Grids
– Apps?

19. How do you start moving?
• Understand the benefits of moving
• Find your baseline for various activities
• Do enough but not too much, or too little
• Log activity/movement
• Progress activities
– Progress by an amount you KNOW you can
successfully do.
• Flare up plan
Continue to assess barriers throughout the whole

20. How to progress your activity
• Increase a small amount every week or two
• Progressions should be easy and attainable
– Increase in baby steps
– *Small increases you know you can successfully do*
• If you flare up after you progress your activity, you
increased too much, too soon
• Keep progressing!
• You should always be progressing until you reach
your goal

21. How do you start moving?
• Understand the benefits of moving
• Find your baseline for various activities
• Do enough but not too much, or too little
• Log activity/movement
• Progress activities
• Flare up plan
Continue to assess barriers throughout the
whole process.

22. Flare-up Plan
Is it realistic to think that you will NEVER have a set-back?
1. Do not PANIC
– Use heat, ice, movement, reasonable rest periods, TENS,
relaxation to decrease the flare
2. Keep track of what triggered your set-back
– Use the information to prevent the same flare from happening
again
3. Maybe decrease your level of activity in order to prevent
further exacerbation
– Prioritize your responsibilities
– Say NO to unnecessary demands until you’re function is back
at your before flare baseline
– Ask for help
4. Don’t stop all activity, KEEP MOVING

23. How do you start moving?
• Understand the benefits of moving
• Find your baseline for various activities
• Do enough but not too much, or too little
• Log activity/movement
• Progress activities
• Flare up plan
Continue to assess barriers throughout
the whole process.

24. Barriers: what keeps you from
moving forward
• Ambivalence to change
– Interested in change, but not ready to commit
– Cost vs. benefit
– 30 days of rehearsed behavior change takes another
3 months of practice to stick.
• Priorities
– Daily, weekly, long term
• Boundaries
– Expectations from others and self
– If I change, others (family, children, friends) may have
to as well

25. Barriers: what keeps you from
moving forward
• Values
o What do you care about most?
o What are your basic assumptions about what makes
you a good person, life worth living?
o How do you define your self-worth?
o Most people discover some values/assumptions that
can sabotage their recovery efforts.
o If you feel stuck in your progress, it may be connected
to a deeply-held value that is interfering with
progress.

26. References
References:
1. Knight J, Jones A, Nigam Y. Effects of bedrest 3: musculoskeletal and
immune systems, skin and self-perception. Nursing Times. 2009; 105:
23,18-22.
2. Nicholas M, Molloy A, Tonkin L, Beeston L. Using Pacing to Overcome the
Effects of Chronic Pain on Activities. Practical and Positive Ways of
Adapting to Chronic Pain, Manage Your Pain. London: Souvenir Press Ltd;
2003: Chapter 7.
3. Knight J, Jones A, Nigam Y. Effects of bedrest 2: gastrointestinal,
endocrine, renal, reproductive and nervous systems. Nursing Times. 2009;
105: 22,24-27.
4. Knight J, Jones A, Nigam Y. Effects of bedrest 1: cardiovascular,
respiratory and haematological systems. Nursing Times. 2009; 105: 21,16-
20.
5. Butler D, Moseley L. Explain Pain. Australia: Noigroup; 2003.
6. Butler D, The NOI Team. Mobilization of the Nervous System Course.
Neuro Orthopaedic Institute (Australia). 20th Edition. January 2010 – USA 2
day.
7. Butler D, Moseley L. Explain Pain Course. Neuro Orthopaedic Institute
2009.
8. The McKenzie Institute USA. Mechanical Diagnosis & Therapy: The