The Over/Under Activity Cycle
This article is about the balance of overdoing and avoiding.
Pain and Activity
People with pain find that their lives are badly affected by their pain.
Pain may have effects on their thoughts and feelings, but what most people complain of is the effect pain has on their activities.
Overdoing and Avoiding
Pain sufferers vary in the way they react to activities but there are two major groups, two extremes in the way people behave.
- The commonest reaction is to go on as normal as far as possible. People like this may say “I’ve got to get things done.” and “It’s not going to beat me.” They push themselves to complete the activity and suffer the consequences of increased pain afterwards. They may be competitive people and like to get things done and cleared away.
- The second group fears what is going on in the painful area, interprets it as ongoing damage or injury and back off. They then avoid any activity which increases pain, spending more and more time resting and doing little.
It is much more common to find people who push and overdo, and pain sufferers are not lazy people, often being desperate to get on with the things they think they should. Severe avoiding, where the person does very little, is much less common. Many people combine aspects of both behaviours in their lives, with a tendency to one or the other.
Pacing is one of the most useful skills to learn if you have pain. Many people with pain tell us this. It’s not easy but it works! Try it, the ebook below explains all about how to do it in detail.
Typical Over/Under Activity Scenarios
- Helen has chronic low back pain. She wakes up one morning and notices that her back pain, usually bad in the mornings, is much better than usual. “Great”, she thinks, “now I can get all the things done that have been building up, and I can cook the family a good dinner as I have not done that for so long.”She spends the morning cleaning the house, getting the shopping and starting to prepare the dinner. As the afternoon goes on she notices her back pain becoming worse but continues so she can get done all the things she has planned.By the evening her back pain is so bad she is forced to stop all activities and lie down. The pain is much more severe for the next few days and Helen is unable to do anything useful
- Michael has chronic low back pain. Since his injury at work he has found that almost all activities and postures give him pain. He is only comfortable lying down in bed at night and on the sofa in the day.Overall he does very little and admits he is very unfit and has gained weight. When he does do something he is so unused to it that it’s very easy for him to overdo it and be much worse after. This puts him off trying to be more active or doing any exercise
Both these imaginary people are doing completely normal things and trying their best to cope with chronic low back pain. Helen particularly tends to overdo things while Michael tends to avoid activities and rest. Both these strategies are unhelpful and in the long term counterproductive, leading to increased disability with time.
The Effect Of These Pain Behaviours
Several problems occur with these types of very common behaviour. Scientific work shows that rest is not a treatment for back pain and may be a factor in ensuring a worse outcome in the long term.
People who avoid activities may have a series of problems:
- Loss of confidence in their ability to do these activities
- Decreased strength and fitness from underuse of their body
- Loss of role at work or at home as they do not do the activities expected of them
- Depression/sleeping problems
- Overdoing when they do try an activity, as they are unfit.
People who overdo activities face other kinds of problems:
- Pain is much worse after, forcing them to rest for a time
- The extra pain puts them off trying the activity again, leading to avoidance
- The amount they can do gets less with time, and the enforced rest periods become longer before the pain settles to a level where they can be active again
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