Learn to manage energy-limiting conditions and post-exertional malaise (PEM) safely with a symptom-guided approach and the energy envelope concept
If you live with an energy-limiting condition, you've probably heard the advice to “pace yourself" — often without anyone explaining what that actually means or how to do it. Pacing is both a skill and an art. It's a proactive management tool that can help stabilize your baseline and, over time, safely expand what your body is able to do. Think of it less as holding yourself back, and more as spending your available energy on purpose. Here are five places to start.
If seeking care has come to feel risky, you're not imagining it — and you're not alone. For many people living in larger bodies, or with a complex chronic condition, past experiences in healthcare settings have caused real, lasting harm. Trauma-informed virtual care is one way to make seeking help feel safe again. Many people have experienced medical gaslighting or bias when seeking care — and that shapes how safe it feels to ask for help again. When you've been dismissed, doubted, or told your symptoms were "all in your head," or attributed to your weight, it's completely understandable to approach the next appointment with your guard up, or avoid following up altogether. Trauma-informed care starts by acknowledging that harm. It prioritizes your well-being and psychological safety. In a trauma-informed setting, your provider informs and guides — but you hold the decision-making power in your own care.
Managing POTS and heart rate with Long COVID: how heart rate monitoring, recumbent movement, and pacing help prevent post-exertional malaise (PEM).
For individuals living with chronic, energy-limiting illnesses, the most important clinical skill is not exercise, it’s pacing. Learning to manage your energy envelope is the physiological foundation that allows all other physical therapy interventions to be successful without triggering a systemic symptom crash.
Chronic, energy-limiting illnesses are not just about physical symptoms; they are complex experiences driven by a sensitized (and often exhausted) nervous system. Traditional physical therapy can be challenging for people living with chronic illnesses because it often focuses on reconditioning tissues–bones, muscles, joints, aerobic capacity, and strength. If you have a chronic illness or chronic pain, an effective recovery plan must look beyond tissues and your level of conditioning. It is not possible to “push through” to overcome your symptoms. And if you have an energy-limiting illness like Long COVID, Fibromyalgia or ME/CFS, your symptoms are not simply a result of deconditioning.
If you're navigating chronic illness or living in a larger body, the relationship you have with movement is as important as the movement itself. Shifting from a mindset of exercise as punishment to movement as a safe, chosen resource is the key to building a sustainable practice that supports healing rather than causing harm.
If you're living with fatigue and post-exertional malaise (PEM), managing daily life can feel like walking a tightrope. One moment you’re doing okay, and the next—after what seems like a minor activity—you’re hit with overwhelming exhaustion, brain fog, and symptoms that can linger for days or even weeks. You’re not lazy. You’re not failing. In fact, many people with PEM were once highly active—working full-time, parenting, exercising—before their condition changed their capacity to function. It’s not a matter of motivation or willpower. It’s about physiology. At ReStory, we understand how real and frustrating PEM is. That’s why we take a compassionate, science-backed approach to help you manage it. Here’s how to begin.
Using the E.A.S.Y. Framework to Build Confidence and Momentum When recovering from bariatric surgery, movement can become one of the most powerful tools in your wellness journey—but only if it feels achievable, supportive, and aligned with your life. That’s why Dr. Thobaben created the E.A.S.Y. framework: a simple, thoughtful way to reintroduce physical activity in a way that honors your body and your goals. E.A.S.Y. stands for Enjoyable, Accountable, Sustainable, and Say Yes—four interdependent pillars that help you build lasting, meaningful movement habits.
Living with a complex chronic health condition—whether it's ME/CFS, Long COVID, EDS, POTS, fibromyalgia, or another long-term diagnosis—often means navigating not just symptoms, but systems that weren’t designed with you in mind.
