Gradual Exposure and Pacing

Last blog I talked about returning to activities which currently result in a flare up and how finding a baseline is good starting point

But what’s next?

Today is all about the next phase and the pathway back to movement. Every heard of the saying fail to prepare, prepare to fail. This saying can be applied to so many aspects in life but today I want to use it to explore return to movement.

Pacing is making a plan, to gradually increase one variable of an activity at a time. This variable might be time, repetitions, load, range of movement or any aspect of the activity as long as the change is moving forwards. That means, a plan is in place in order to achieve an end goal and the practice and implementation of the plan is not dependent on how your body is feeling on the day. I know I found this the most difficult part when I had a plan to complete body weight squats without increasing my back pain.

I thought I was doing this pacing thing right. I had made a plan to complete squats in my gym program as all the reading I was doing said movement and lower limb strength will only help back pain. However the where I went wrong was I always carried the mentality of ‘I’ll see how I’m feeling at the time’. When the time came for body weight squats my back would miraculously always feel more restricted with increased pain and thus these squats didn’t happen- this is known as fear avoidance. This continued on for months before I realised 5 months had past and I still hadn’t done any squats. The minute I change my mindset of I am doing 5 squats today not matter how my back is feeling is the moment I starting moving forwards. Yes I felt extremely anxious when doing my 5 body weight squats and yes I was worried I would re injury my back, however this never happened. If an effective baseline is chosen for a particular activity, then applying a gradual pacing strategy despite how your body is feeling is the way to move forwards.

I have created a few key points to remember when using pacing strategies to return to an activity which currently result in a flare up.

  • Physically rite down a pacing plan.
  • Find your baseline- (see my last blog!)
  • Only alter one variable at a time.
  • Alter this variable by 10% per week.
  • Stick to the plan despite having a good or bad day.

This are the rules I stuck to when returning to squatting and now I can do a squat while carrying 50 kgs. I’ve said it before but I’ll say it again. Slow and steady wins the race.

In my next blog I talk about manual therapies and where services like massage play a role in ongoing back pain.

As always, I love hearing form you. Email me at


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