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Why Pacing is a Foundation of Chronic Illness Recovery

Thu, 16 Jul 2026 16:53:56 GMT

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.

The Biological Trap of the Push-Crash Cycle

Many people living with multisystemic conditions like Long COVID, POTS, Fibromyalgia and ME/CFS experience days where their symptoms feel momentarily manageable. During these windows of perceived energy, it makes sense that they would want to catch up on all the chores, social obligations, or physical tasks that were missed during a flare.

This common drive to do more on “good days” often leads to an inevitable crash the following day, resulting in a predictable and frustrating cycle of ups and downs, or a “boom-bust” pattern of symptoms. This is not just about tiredness or fatigue. Under the surface, mitochondrial dysfunction (difficulty with charging and re-charging your cells’ batteries), and increased inflammation in your system can make it even more difficult for your body to recover.

Breaking the Cycle with Strategic Pacing

Pacing is a clinical tool used to distribute your energy evenly across longer periods of time and protect you from pushing and crashing. Instead of spending all your energy as soon as you feel it, you become strategic and intentional about how to use it. In practice, this looks different for everyone. It might mean planning rest ahead of a social outing or doctor’s appointment. Taking rest breaks well before you feel tired, or spreading tasks throughout the day instead of powering through all at once. It often involves tracking your energy patterns to find your personal threshold — sometimes called your "energy envelope." The goal isn't limitation for its own sake. It's giving your nervous system and cells the conditions they need to actually begin healing.

This approach requires a shift in mindset from traditional fitness goals. In chronic illness recovery, success is not measured by how much you can push yourself, but by how well you can stabilize your energy levels to prevent the next crash.

Why Stability Must Come Before Progress

It is difficult to build physical strength or endurance on an unstable foundation. In the context of chronic illness, stability is defined as having a predictable and manageable baseline of symptoms. If your daily experience is a rollercoaster of higher energy followed by total exhaustion, your body is in a state of constant survival rather than recovery.

Once you become more confident with the art of pacing and your symptom crashes become less frequent and less severe, a stable baseline emerges. You can begin to very gradually and safely increase your activity levels. This ensures that every step forward is sustainable and does not lead to a long-term setback.

How to Get Started with Energy Management

Mastering these concepts requires a deep understanding of pain science, autonomic physiology, and your own unique biological limits. To learn more about how your nervous system influences your daily symptoms and how to build a personalized recovery plan that respects your energy envelope, read our full pillar post: Beyond the Diagnosis: A New Approach to Chronic Illness .

Ready to stop the cycle of crashing? Explore our Chronic Illness Support here or schedule your virtual consultation to start your journey toward sustainable movement.

Hoppers M, Yellman B, Bateman L, et al. Clinical Care Guide: Managing ME/CFS, Long COVID, and Infection-Associated Chronic Conditions (IACC’s). Bateman Horne Center, 2025: 13-17.

Beyond the Diagnosis: A New Approach to Chronic Illness

Thu, 16 Jul 2026 15:33:14 GMT

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.

Understanding Energy-Limiting Conditions

Conditions like Fibromyalgia, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and POTS are often misunderstood. If you are living with one of these conditions, your symptoms may have been dismissed or mislabeled as purely psychosomatic. But your symptoms are real, and they have multi-systemic, physiological causes that go way beyond the mind-body connection.

4 Pillars of Chronic Illness Recovery

Recovery from a long-term, complex illness is non-linear. At ReStory, we focus on four specific pillars to help you regain function without causing further harm.

1. Individualized, symptom-guided movement

We use gentle movement and education to teach your body that you can move safely without an unwanted response. By gradually introducing activity in a non-threatening way, with respect to body signals such as your heart rate and effort levels, we can carefully, intentionally build your capacity through movement.

2. Mastering the Art of Pacing

For those with ME/CFS or Long COVID, pushing through pain and exertion is a recipe for a crash. We teach you how to deeply understand your energy envelope, and move within it to avoid the cycle of overexertion and symptom flares.

3. Trauma-Informed Clinical Support

Many people with chronic, energy limiting illnesses have experienced medical gaslighting, and have had their symptoms dismissed. Some have experienced care that did not respect their energy limits, resulting in prolonged recovery time and post-exertional symptom exacerbations. Trauma-informed care creates a physically and emotionally safe space where your limits are believed, and your story is honored as a vital part of your healing.

4. Collaborative Advocacy

Chronic illness requires a team. Dr. Thobaben works in collaboration with your medical team to ensure that your physical therapy plan aligns with your overall medical management and symptom fluctuations.

Why Virtual Care Works for Complex Illness

You might wonder if movement is effective if it feels easy. The answer is absolutely yes. When you choose movement that is inviting and easy enough for your body to appreciate, you are teaching your nervous system that movement is friendly.

Consistent, gentle movement builds a foundation of trust between you and your body. This trust allows you to slowly enrich and deepen your movement practice over time without triggering the push-crash cycle common in chronic illness and chronic pain.

Words Matter: Why We Say Movement, Not Exercise

The shift from using the word exercise to movement is intentional. For patients navigating Long COVID, ME/CFS, or size-bias in healthcare, exercise often represents a history of being dismissed or harmed by well-intentioned providers.

Movement, on the other hand, represents options and possibility. It is a way to discover what your body is asking for today, not what a plan or provider says you should do. Movement is adapted, personalized, and chosen by you as a way to care for yourself on purpose.

If you have experienced weight-bias or are navigating a complex illness, you deserve support that listens deeply. You deserve a movement practice built on trust, not shame.

Schedule a free consult today to gain personalized strategies and to create a customized plan unique for your needs.

Hoppers M, Yellman B, Bateman L, et al. Clinical Care Guide: Managing ME/CFS, Long COVID, and Infection-Associated Chronic Conditions (IACC’s). Bateman Horne Center, 2025: 13-17.

Why the Way You Relate to Movement Matters

Wed, 01 Jul 2026 15:08:34 GMT

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.

Moving Beyond Exercise as Punishment

For many people, the word “exercise” is loaded with history. It often stirs up feelings of inadequacy, shame, or even past medical trauma. If you have previously experienced movement as a means for punishment, self-harm, or a way to earn your worth and health, it is time to redefine its purpose.

The word “movement” can open up a sense of possibility and an invitation to a different approach. Movement is not a box to be checked or a tool for self-criticism and comparison. Movement doesn’t have to be a performance. While exercise often feels like an external imposition of shame, along with resistance or increased pain signals, movement can start small, allow curiosity, and create safety. To truly transform your health, your movement must feel safe, supported, and flexible.

The 50% Rule: Choosing Quality Over Quantity

A common question in rehabilitation is: How do I know if I am doing it right? The answer is simpler than you might think. If you are living with a chronic, energy-limiting illness, chronic pain, or just getting started, movement should feel easy and light, as if you could sustain it for a long time. However, the strategy is to choose to do it for only a short time, then rest.

After trying a new movement, evaluate your response over the next two to three days.

If you feel well: This means you may be able to repeat this movement without an adverse response.
If you feel extra fatigued or in pain: This is a signal to rest, and reduce your effort.

If you feel like you are paying for your activity, or you’re experiencing post-exertional malaise, you can try changing your position, and/or reducing what you did by at least 50%.

If a walk was too much, try a seated movement. If a seated movement was too much, start horizontally. Choose sustainability over striving and quality over quantity.

Is Easy Movement Actually Doing Anything?

Words Matter: Why We Say Movement, Not Exercise

If you have experienced weight-bias or are navigating a complex illness, you deserve support that listens deeply. You deserve a movement practice built on trust, not shame.

Schedule a free consult today to gain personalized strategies and to create a customized plan unique for your needs.

Hoppers M, Yellman B, Bateman L, et al. Clinical Care Guide: Managing ME/CFS, Long COVID, and Infection-Associated Chronic Conditions (IACC’s). Bateman Horne Center, 2025: 13-17.

How to manage physical and daily activities with fatigue and post-exertional malaise (PEM)

Thu, 24 Jul 2025 18:45:31 GMT

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.

What Is PEM, Really?

Post-exertional malaise is a delayed and prolonged worsening of symptoms after physical or mental exertion. Unlike typical fatigue, PEM doesn’t improve with a nap or good night’s sleep—and the symptoms are often disproportionate to the activity that triggered them.

PEM can affect multiple body systems at once. You might notice:

Intense fatigue
Brain fog
Worsened pain
Flare-ups of neurological or flu-like symptoms
Poor temperature regulation
Dizziness or weakness

This response isn’t just “in your head.” It’s a dysregulation in how your body processes exertion, and it demands a new way of approaching activity.

Step One: Learn (and Respect) Your “Wall”

PEM happens when your body’s energy system is pushed beyond its current capacity—what we call “your wall.” Everyone’s wall is different, and it can shift over time. Your job is to learn where your wall is right now and to respect it.

Start by identifying what triggers your PEM:

Physical activity (even light housework or self-care)
Cognitive effort (reading, screen time, decision-making)
Social interaction (conversations, texting, meetings)
Emotional stress (positive or negative)
Sensory input (light, sound, motion)
Standing or upright posture (orthostatic stress)
Environmental factors (heat, cold, chemicals, fragrances)

Tracking these triggers gives you valuable insight for daily pacing—and crucial data to share with your healthcare providers.

Step Two: Use the 4 P’s

Once you understand your limits, the goal is to reduce unnecessary exertion while still living meaningfully. The “4 P’s” can help you do that:

Pace: Break up activities, schedule intentional rest, and avoid back-to-back tasks.
Prioritize: Decide what must be done today. Let go of what isn’t essential—or ask for help.
Position: Choose body positions that conserve energy. Sitting with back support, elevating your legs, or lying down can drastically reduce energy output.
Plan: If you know you’ll have an activity (like an appointment or social event), build in rest before and after to soften the impact and support recovery.

Step Three: Respond Early and Kindly

Even with the best planning, PEM can still happen. When it does, it’s important to respond quickly and gently.

Immediate recovery tips:

Stop all activity and rest in a quiet, dark space
Hydrate with water and electrolytes
Minimize sensory input (noise, light, movement)

Long-term prevention strategies:

Build extra rest into your schedule after any planned exertion (even physical therapy!)
Learn to recognize early signs of PEM, like rising fatigue or irritability, and adjust your day before symptoms escalate

This early response can mean the difference between a short flare and a long, debilitating crash.

You Don’t Have to Figure This Out Alone

At ReStory, we specialize in helping people navigate PEM with compassion and evidence-based strategies. Whether you’re managing Long COVID, chronic fatigue, or another complex health condition, we’re here to help you move forward—without overdoing it.

Schedule a free consult today to gain personalized strategies for managing PEM and making daily life more manageable.

Hoppers M, Yellman B, Bateman L, et al. Clinical Care Guide: Managing ME/CFS, Long COVID, and Infection-Associated Chronic Conditions (IACC’s). Bateman Horne Center, 2025: 13-17.

How to Enjoy and Sustain Physical Activity After Bariatric Surgery

Thu, 24 Jul 2025 18:29:11 GMT

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.

E is for Enjoyable

The best kind of physical activity is the kind you want to return to. But for many people, especially those recovering from surgery, the idea of “enjoyable” movement can feel far away or unrealistic. That’s okay. The first step is to get curious about what feels good —and explore movement on your terms.

Consider:

Do you prefer being outdoors, indoors, or a bit of both?
Would you enjoy moving with a friend or family member—or do you prefer solo time?
Does a structured class feel supportive, or would you rather set your own pace?
Are there types of movement you’ve enjoyed in the past—walking, dancing, swimming, lifting?

The goal is not perfection. It’s reconnecting with what brings you energy and joy.

A is for Accountable

Accountability isn’t about pressure—it’s about having support systems that help you stay connected to your goals, especially on hard days. Even when motivation dips (which it will), a bit of structure can keep you grounded.

Ways to build accountability:

Set simple, realistic goals and track your progress
Check in regularly with a trusted friend, therapist, or coach
Keep your “why” visible—whether it’s mobility, confidence, or long-term health
Celebrate small wins. A short walk counts. So does stretching or dancing in your kitchen.

Remember: all movement counts. Give yourself credit.

S is for Sustainable

Sustainable movement is safe, consistent, and kind to your body. It means you don’t pay for it the next day with pain, fatigue, or burnout.

Here’s how to keep it sustainable:

Start slow when trying something new—steady progress beats fast starts
Support your body with solid nutrition, hydration, and sleep
Ask for help when needed—from a physical therapist, trainer, or coach

Sustainability means you can keep saying “yes” to movement over time—because it works with your life, not against it.

Y is for Say Yes

This is where it all comes together. Saying “yes” to intentional movement—on good days and not-so-good ones— builds confidence and helps momentum grow over time. It doesn’t need to be big or impressive. It just needs to happen.

Each time you say yes, you reinforce that your body is capable of healing, progress, and strength.

Ready to Make Movement E.A.S.Y.?

You don’t have to do it alone. ReStory offers virtual support to help you build a plan that honors your experience and helps you move forward with confidence.

Schedule a free consult today to create your personalized E.A.S.Y. framework and begin your journey to sustainable movement.

How to Ask for (and Get) Person-Centered Care When You Have a Complex Chronic Condition

Thu, 10 Jul 2025 05:02:15 GMT

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.

You may have experienced appointments where your story was rushed, misunderstood, or reduced to lab values and symptom checklists. Maybe you've left feeling unheard or even blamed. You’re not alone.

At ReStory , we believe that the way care is delivered matters just as much as what care is delivered. That’s the essence of person-centered care —and yes, you deserve it. Here’s how to advocate for it in medical spaces, even when it's hard.

1. Know What Person-Centered Care Looks Like

Before asking for it, it helps to define it. Person-centered care means:

You are seen as a whole person, not just a diagnosis
Your lived experience is valued as essential clinical information
Your preferences, goals, and values help shape your care plan
Communication is collaborative, not one-way
You are allowed to ask questions, take time, and say "no"

This isn’t a special favor—it’s a basic standard of ethical care. But in complex or high-pressure settings, it often gets lost. Naming it helps.

2. Bring Your Story Into the Room

Complex conditions don’t always fit neatly into a 15-minute appointment box. If you have a nuanced history, summarize key patterns and priorities in writing ahead of time:

A 1-page health history timeline or symptom overview
A list of things that help vs. worsen your condition
Your top 1–2 goals for the visit (e.g., “rule out X,” “update treatment plan,” “ask about referrals”)

This can ease your cognitive load and give your provider a better chance to understand the full picture.

3. Use Grounding Language to Advocate Without Conflict

It’s possible to advocate for yourself without being adversarial . You can name what you need with calm, clear phrases like:

“It’s helpful when I feel included in decisions about my care.”
“What you’re describing makes sense. Can we also explore X based on what I’ve experienced?”
“My body tends to respond differently than expected. I’d love to walk through what’s worked and what hasn’t.”
“Would you be open to co-creating a care plan together?”

Most providers want to help. Giving them a pathway to meet you in partnership can shift the dynamic.

4. Ask These Specific Questions

Sometimes you just need the right question to reframe the conversation. Try asking:

“How do you usually approach care for patients with overlapping conditions like mine?”
“What would a person-centered version of this treatment look like for someone like me?”
“If this doesn’t work, what’s our next step together?”
“How can we measure progress in a way that matches my lived experience?”

These invite collaboration instead of compliance.

5. Know You Can Redirect—or Opt Out

If a provider seems dismissive, rushed, or rigid, you can reset the tone by saying:

“Actually, I’d like to focus on how this is affecting my daily life.”
“That approach hasn’t worked well for me in the past. I’m open to alternatives.”

And if a provider consistently disregards your input or autonomy, it’s okay to leave. Seeking care elsewhere isn’t quitting—it’s reclaiming your right to be treated with respect.

You Are Not Asking for Too Much

Your needs are not too complicated. Your story is not too long. Your voice is not too loud.
You are allowed to ask for care that sees you.

And if you’ve never had that experience before—we want you to know: person-centered care is possible. It may take persistence, but it is worth seeking, and you don’t have to do it alone.

Book a free consult today to speak with Dr. Thobaben and take the next step towards getting the care you deserve.