Polio survivors need to learn to conserve energy if they are to control their symptoms of pain, weakness and fatigue.[1] It takes effort and a change in attitude to learn to use energy conservation to our greatest advantage. Using our energy well can allow us to do more and do it better.[2] This article suggests four principles of energy conservation and three techniques for making the necessary changes in our lives. Many of us don’t have the strength and energy that we used to have so it’s time we started taking better care of ourselves.
In a study by Peach and Olejnik,[1] recommendations for change included “decreasing overall daily activities, a change in job, work environment modifications, a decrease in work hours, a decrease in social and recreational activities or taking rest breaks. New or additional orthotics were also recommended to effect safer, less painful and more functional gait patterns. In some patients, a component of disuse weakness was noted. In these cases, appropriate aerobic exercises were recommended, carefully avoiding over-exercising paretic extremities. A number of these patients had become overweight so a weight loss program was recommended.”[1] Those who made recommended changes showed either improvement or resolution of symptoms of weakness, fatigue and muscle and joint pain. Those who didn’t make changes found symptoms were either unchanged or increased.
Those with post-polio syndrome who were able to make changes and successfully control the factors responsible for overuse did not lose muscle strength. Polio survivors who didn’t make changes knew what they needed to do. Many simply refused to make changes in the behaviors that lead to overuse.
Agre and Rodriquez[2] noted that the amount of isometric “work” performed during interval exercise was significantly greater (237% on average) than during constant exercise. (Interval exercise was simply the constant exercise divided into quartiles by 2 minute rest breaks or into 20 second intervals with 2 minute rest breaks.) They also found that those with symptomatic post-polio were able to monitor local muscle fatigue and avoid exhaustion. Symptomatic post-polio subjects also recovered strength significantly less readily than a control group. If we allow ourselves to become overtired it takes us longer to get our strength back. By changing our activities to include rest breaks we may find we can do more with less effort.
Change is not always easy. In fact many polio survivors find change very frightening. Change requires examining the attitudes and beliefs that keep us from feeling well. We can change the quality of our lives by changing the way we look at our circumstances. Creative people are most successful at doing this over the long term. They see opportunity, where others see insurmountable problems. There is no reason we cannot see ourselves as creative and start making our lives better. Creative people are simply those who see themselves as creative.[3]
The way we see ourselves may interfere with our ability to change. One approach to the whole issue of activity is to be kind, positive and gentle with ourselves. The person behind the pain and fatigue, the real you, is a capable, worthy, individual and a beautiful human being. It’s time to start treating ourselves like the wonderful beings we are. It’s time to start taking care of ourselves as if we were precious possessions.
Only you can decide to be sore and tired or relaxed and comfortable. You must decide if you want your weakness and fatigue to progress. You are responsible for what you do. You have no control over anyone other than yourself, and only when you are clear about who is responsible for your activity will you have the power to master it. You have the capacity to recognize fatigue and overuse.[2] You must decide how much you will or will not do.
Your mate, your friends, your boss, your doctor, your physiotherapist and your occupational therapist can only advise you. When you go on Dr. X’s Program, you may lose the power to choose when, what and how much you’re going to do. It may carry with it the terrifying feeling that you are back in the polio ward again and someone else is in charge of what you do. It also gives you someone else to blame for your weakness and fatigue: Dr. X’s Program didn’t work. You have given your power away to Dr. X. Dr. X may have some useful suggestions, but only you can decide what works for you.
The main principles of conserving energy include (1) doing what you most want to do, (2) planning activities for times when you have most energy, (3) learning what your maximum work is and respecting the signs of fatigue you experience and (4) stopping before you become exhausted. Before you begin any activity you should think about whether you really want to do it at all. Don’t ask yourself what you should do; ask yourself what you want to do. It is important to be flexible. Let others in the house or office help you with the jobs you find tough. Delegate tasks whenever possible.
Plan your activities for when you have the most energy. Most people don’t think about doing things if they are tired. Don’t waste energy by trying to do more than your body can comfortably do. If you are tired by noon, plan activities for the morning. We take a long time to recover if we allow ourselves to become exhausted.
Learn what you can do without pushing yourself and respect the signs of fatigue (including muscle soreness, tiredness, muscle weakness, change in quality of movement, grimacing, etc.). Work simplification is an important tool to use in reaching our daily and long term goals in life. Work at a comfortable easy pace and avoid tension. A moderate work pace uses the least amount of energy and you will make fewer mistakes. Alternate heavy with light work each day and throughout the week. Break up heavy jobs over several days. Sit for as many jobs as possible. Allow time for interruptions and emergencies. If you find walking difficult, take along a wheelchair or get a scooter and save your energy for more important things. Pay attention to your body’s signals. Care enough about yourself to listen to the messages of pain and fatigue.
Plan rest periods during the day and STOP before becoming exhausted. When taking a rest, relax completely with your feet up. Try resting 10-15 minutes between each hour or two of activity. It will probably take some trial and error to determine what is best for you. If you get tired in the middle of the day, have a one hour sleep early in the afternoon.
Don’t expect the impossible, because even with a good plan, there will be setbacks. There are things we can’t change and accepting these will help make our lives work better. Sometimes we have to be willing to do a job less thoroughly than usual so we will have the energy to spend on our family or friends. Other times we may choose not to do the job at all!
Kohl[4] suggests three techniques that we could use to help ourselves make changes. These are push to avoid pain, blank pad and plain talk. The push to avoid pain system acknowledges the amount of energy that we must generate in order to reduce our activity level. It is a statement of action, not of failure or backing down. It means that we are dedicated to taking care of ourselves. Other people, obligations and commitments will be prioritized according to pain thresholds and those actions that reduce pain. To delegate is action; to use respiratory equipment is an action with enormous consequences; to retain authority in a seated position requires great assertiveness. Taking care of ourselves is not giving in but rather a restatement of control. The pain will not control us, we will control the pain.
The blank pad method of documenting accomplishments during the day reinforces a sense of purpose. Instead of making list after list of things to be done and then crossing off what has been completed, use a blank pad to record all you have done. It is a great training exercise for developing awareness of all the energy expenditure that does occur. It also saves us from devaluing ourselves for that which was not done. The goal is to avoid negative feedback at the end of the day and replace it with positive feedback.
Plain talk was developed in response to people asking how to keep themselves and others from feeling manipulated. If someone does not respect a simple “No” in response to a request, we may have to ask “Why do you want me to be in pain, more tired, overextended, not able to enjoy our time together, etc.?” We need to practice simply worded responses that will increase the other person’s awareness of the impact of their requests without creating defensiveness.
You have changed physically. Your old coping strategies don’t work anymore. You must decide if you want your weakness and fatigue to progress. You are responsible for what you do. When you are clear about who is responsible for your activity you have the power to master it. You can live better if you adapt to the changes in your body. Energy conservation can help you feel better and do more with less. Only you can make the decision to take control and take care of yourself.
References
Reprinted with permission of the author.
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