Ask Linda

by Linda Wobeskya, M.S., P.T., GBPPA Member

This column originally appeared in the Spring, 2001 issue of TRIUMPH.

Dear Readers,
This month, I’ll continue to discuss the issues raised by the letter from Getting Tired in Tewksbury printed in last issue’s column.

Dear Linda,
I can’t seem to do as much as I used to be able to do. I used to walk about a mile every day and now I get very tired after only about half a mile. I usually push myself to finish my walk anyway because I know exercise is important. What exercises can I do to get stronger?
Getting Tired in Tewksbury

Dear Getting Tired,
Thank you for your patience with this 2-part answer. The first part explained the causes of muscle fatigue. You may recall we discussed one way in which you recovered your strength after polio. The undamaged nerve cells in your spinal cord (motor neurons) grew extra branches in an effort to keep the communication lines open between your brain and your muscle cells. The result was one motor neuron controlling as many as five times more muscle cells than it was originally designed for. Now, many years later, these motor neurons have become less and less able to support all those extra branches. The extra branches begin to die off and your muscle cells again lose their communication line with the brain. When the brain sends a message down to your muscles, fewer muscle cells are able to respond, because fewer muscle cells actually receive the message. What you experience is new muscle weakness. More importantly, what you experience is a decreasing ability to perform the activities you enjoy.

As promised, this column will present some strategies for coping with muscle fatigue. First, in my experience the key to the success of any coping strategy is commitment to change. Doing more, doing less: both require a change in one’s lifestyle and neither happens consistently without a commitment to this change. Commitment requires a belief in the potential positive outcome resulting from change. What are your beliefs about healing yourself and helping yourself to feel stronger?

Let’s look at the question in your letter: “What exercises can I do to get stronger?” This tells me that, in your mind, perhaps the cure for weakness is more activity, more exercise. This belief makes a lot of sense, based on your initial experience with polio. When you first had polio, exercise was the cure. You experienced increased strength and function after lots of exercise and hard work. Unfortunately, exercise is not the cure for your current problem because the cause is different. As discussed in the last issue, your original weakness was caused by the polio infection. Now, the cause of your weakness is too much activity: more activity than your overworked motor neurons can handle. More exercise is unlikely to help you and is very likely to make you worse. This fact may be in direct opposition to your beliefs. It is extremely important to recognize that if you believe exercise is the best cure, it will be very difficult for you to try anything else.

So the first strategy for coping with muscle fatigue is to become aware of your beliefs about healing yourself. Are your beliefs consistent with the facts? The clients I have known who were most successful in achieving healthier and happier lives slowly came to accept the facts about post-polio syndrome and changed their lives accordingly. It took a lot of hard work and it was a great achievement. And they were unable to start making successful changes until they changed their beliefs about what they needed to do to become healthier. This does not mean their old belief system was bad. It simply no longer served their needs.

The second strategy for coping with muscle fatigue is to notice when you are falling prey to what I call the “All or None” thinking process. When you hear the words “pacing” or “energy conservation”, do you immediately think, “No way. I’ll have to stop doing everything I like”? Does not doing everything mean not doing anything to you? This belief will also keep you from making helpful changes in your life. Pacing and conserving energy means accepting the fact that you have a finite amount of energy and making healthy choices about how you want to use that energy. The truth is, making several small changes can often add up to feeling a lot better. For example, you know you get very tired after walking for a half mile. Don’t ignore your symptoms and walk the full mile. That’s doing it all. Don’t skip your walk entirely. That’s doing nothing. Try walking a distance that does not tire you, such as 1/4 mile. Think of it as choosing to compromise. You could push yourself through the pain and fatigue, walk the full mile and risk the future health of your muscles. You are choosing not to. It’s also important to acknowledge that it’s a difficult choice. That’s where the hard work comes in. Accepting undesired changes in your body is hard! But, as a polio survivor, you are no stranger to hard work. This is just a different kind of work.

The third strategy is to consider all options available to help you save energy. It’s like clipping coupons for the grocery store. Thirty cents here and forty-five cents there can add up to significant savings. Where can you save energy? Try reversing your thinking. Do you choose to use the stairs as often as possible? Do you park in the furthest parking space, just to get that extra exercise? Each time you think of some way to get some extra exercise, do the opposite. Each time you use an elevator instead of stairs, you have saved that energy to use elsewhere. Another energy saving strategy is the use of a cane or a brace. Most people I have worked with smile and shake their heads “no” as soon as I say the word “cane.” And yet I persist. A cane is one of the best energy saving devices I know. There has been a lot of research that shows that when one’s walking pattern involves extra motion in either the trunk or legs, it takes more energy to walk. A device like a cane or brace, which decreases this extra motion, saves energy. Does your body sway from side to side when you walk? Do you have to lift one leg extra high to keep from catching your toes and tripping? Once again, thinking about an energy-saving device involves a choice and a compromise. No one wants to use a cane. Yet using a cane may mean being able to walk farther with less fatigue. A doctor or a physical therapist can tell you if one of these devices could help you to conserve your energy. Then the choice is up to you.

I hope you have found this column helpful. Change of any kind can be very challenging and usually happens slowly, with many stops and starts along the way. I encourage you to acknowledge your courage in taking any small step toward changing your life for the better.