Fatigue and Pacing in Hypermobility Spectrum Disorder and Hypermobile Ehlers-Danlos Syndrome
Fatigue can shape every part of rehabilitation. This guide explains pacing, repeatable activity and why more exercise is not always the answer.
Fatigue belongs in the rehabilitation plan
A movement can be technically possible and still cost too much energy to repeat consistently. A useful programme therefore considers what happens later that day and on the following day, not only whether the exercise could be completed once.
Pacing is not simply doing less
Pacing means distributing activity according to capacity and avoiding repeated cycles of doing far more on a good day followed by prolonged recovery. The aim is to make valued activity more sustainable rather than to remove activity indefinitely.
Look at function as well as pain
Useful measures include recovery time, walking or standing tolerance, work tolerance, confidence in a specific task and whether the same exercise dose remains repeatable. Pain alone does not always move in the same direction as function.
Post-exertional malaise changes the approach
If activity causes a delayed and disproportionate worsening consistent with post-exertional malaise, a fixed incremental exercise programme may not be appropriate. In that situation, energy management and appropriate clinical review take priority over simply increasing exercise each week.
A more detailed physiotherapy resource
For a more complete step-by-step resource, see the Complete Hypermobility Spectrum Disorder & Hypermobile Ehlers-Danlos Syndrome Physiotherapy, Rehabilitation & Self-Management Guide. The 227-page digital guide brings the wider education, self-management and exercise approach together, with 39 adaptable exercises across four pathways and linked video demonstrations.
Related reading
This article provides general physiotherapy education and does not replace individual assessment, diagnosis or treatment. New, severe or rapidly changing symptoms should be assessed by an appropriate healthcare professional.
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