Everyone gets tired and worn down from time to time. But when that feeling goes from merely being tired to being extremely fatigued and no amount of rest seems to help, chronic fatigue syndrome may be to blame.
While the cause of chronic fatigue syndrome is typically complex, and likely multifactorial, physical therapy can help. Despite how someone might feel, those with this condition do not lack strength, but instead have extremely poor endurance. Additionally, symptoms are not consistent day to day. The level of fatigue waxes and wanes, often due to overexertion. Learning, through physical therapy, how to conserve energy while slowly improving strength and endurance, is key to managing chronic fatigue syndrome.
I find that people struggling with chronic fatigue syndrome tend to be overachievers who have a tough time asking for help. In this mindset, when an individual has a good day, following a few bad days, they tend to want to work really hard to get all the things done that they put off previously. As a result, they burn up every bit of their energy in one day and then crash and burn, unable to do anything for the following three or four days. It becomes a cycle.
One way we, as physical therapists, teach our patients how to avoid this scenario, is by presenting the cone theory.
How energy conservation can combat the symptoms of chronic fatigue syndrome
Avoiding extreme lows and highs is a balancing act for people working to overcome chronic fatigue syndrome. This condition essentially limits the amount of energy a person has, which can be illustrated by representing the available energy with cones. If I give a patient six cones to represent their energy for the day, without the option to borrow cones from another day, any activity they participate in uses up their cones to a proportionate degree.
For example, if a patient tells me they made a gourmet meal that took four hours, I grab away all their cones and that is their entire energy supply for that day. Then I will show them that alternatively they could have gotten up and made a simple breakfast, then I would have only taken one cone away. Then they would have had enough energy left to clean the kitchen, go to the grocery store, and do their physical therapy exercises, all while still having a bit of energy in reserve. I always encourage individuals to aim to leave a cone – do not use up every bit you have every day.
When a patient first begins to address chronic fatigue syndrome, they bounce between what they perceive as really terrible and really good days. Our goal is to level that out and ultimately reach a point where the bad days feel even better than the good days used to, as that energy level slowly increases.
On average, for every day of bed rest, it takes three days to recover. So, the ideal is to avoid doing something one day that will mean taking the next day off, which in turn sabotages three more days. For many, however, overcoming the mental anguish caused by slowing down and allowing themselves to do less on their good days can be extremely difficult. For this reason, and others, talking with a mental health counselor in conjunction with working with a physical therapist is an ideal approach to holistic healing.
How a physical therapist can help manage chronic fatigue syndrome
Physical therapists are highly educated experts in the function and movement of the human body who specialize in mobility, flexibility, strength, endurance, breathing and more. When facing the challenges associated with chronic fatigue syndrome, patients may experience trouble with one or more of these areas. A physical therapist can help.
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Exercise – graded exposure
When beginning an exercise routine, it is critical for patients dealing with chronic fatigue syndrome to start slow and increase activity levels very gradually. We work with each individual to customize a plan of care that meets their needs. It may begin with walking for two minutes and then resting, with more rest than work during a session. Eventually we will build up to walking for 10 minutes, taking a two-minute rest, and walking another 10. The focus is on building endurance, both while in clinic and through maintaining the program at home, which ensures continued progress. It is hard sometimes, to bypass chores to be sure there is enough energy in the tank to do the prescribed exercise, but that is one of the most important steps to finding balance. -
Strengthening
Strength training is important to ensure weakness patterns are corrected and injury therefore avoided. Most people maintain their strength, even when their endurance is extremely low, but a regular strength training routine helps reinforce muscle maintenance, which in turn supports the ability to do everyday activities and improves quality of life. Since managing chronic fatigue syndrome depends on learning to conserve energy, strengthening exercises are typically prescribed on an every-other-day basis in the beginning, based on each unique situation. -
Breathworks
Our breath is our life source and can impact our mobility and affect our quality of life. Many people do not breathe in an ideal way, which makes it harder to do any type of exercise. By practicing nose breathing, in and out through the nose, and slowing our exhale down, we promote health and wellbeing and can avoid draining our energy.
Breathing can be affected by joint stiffness, muscle tightness, poor posture or faulty mechanics. Treatment strategies for disordered breathing are designed based on symptoms, which often worsen during any mental or physical exertion and particularly after exercise. -
Assistive device fitting and instruction
For those who are extremely low on energy and find even basic movement challenging at times, using an assistive device can be helpful. A cane or walking sticks can help with balance, and a rollator walker with four wheels that lock, and a built-in seat, provides means to rest during an outing and reduces the fear of not being able to make it back from a longer excursion.
It is important to ensure a proper fit. If the handle(s) are too high or too low, users will find themselves slouching or raising their shoulders, which can lead to muscle pain and fatigue and even injury. Physical therapists are an excellent resource, but patients can monitor their fit independently by simply checking that with the arms hanging loosely to their sides, the bony part of the wrist lines up with the handle(s). Additionally, a PT can guide patients who may be unsure about the proper way to use their assistive device so that it aids in their progress and does not hinder them.
How to know when it is chronic fatigue syndrome
In many parts of the world, including the Pacific Northwest, the winter can bring extended periods of dreary, wet weather combined with shorter days and longer nights – equal to less light and more darkness. For some, seasonal affective disorder (SAD) can present similar symptoms to chronic fatigue syndrome. The difference is that with SAD, individuals are still able to do everything (they have the energy), they just do not want to (they lack the motivation). Additionally, SAD is completely dictated by the time of year, usually setting in around December and lasting until spring brings brighter, longer days.
When a patient presents with symptoms that indicate chronic fatigue syndrome, as physical therapists we will then refer them to their primary care physician. While we have a doctorate level education, our expertise is on the musculoskeletal system – anything that refers to bones, muscles, tendons, ligaments, bursae, etc. – and we are trained to recognize symptoms that suggest you might have an underlying medical condition outside the scope of our practice. Your doctor may determine that additional blood work or other screenings are in order prior to making a diagnosis.
In addition to persistent, unexplained fatigue, chronic fatigue syndrome can often cause musculoskeletal pain, sleep disturbance, headaches, impaired concentration and loss of short-term memory. It is important to pursue help, and to determine if your condition is chronic fatigue syndrome, as soon as your symptoms begin to impact your daily life.
Once you have a diagnosis, physical therapy is an excellent way to begin working toward overcoming it. For some, the course of care may only be a few sessions in which to learn what they should be doing, after which they can continue on their own; for others, more consistent treatment offers the guidance and accountability that will help them reach their goals and get better faster.
Because the causes behind chronic fatigue syndrome can vary, recovery times are completely individual. The key is to simply get started. The longer a person is sedentary, the longer it could take to get back to an active, healthy lifestyle.
We look forward to being a part of your healthcare team.
Chronic fatigue syndrome can be debilitating and impact your quality of life. A physical therapist will work closely with you, listening to your unique situation and collaborating with you to set individualized goals and to create a plan of care to reach those goals. Talk to your PT today and start your journey toward a healthier, happier tomorrow.
