Load and load capacity: the key to functioning better with chronic pain

Load is everything your body and mind ask of you; load capacity is how much you can handle - and with chronic pain that balance is quickly disrupted. On good days you do as much as possible - finally catching up on what you missed. But afterwards you're flat out for two days. On bad days you hardly dare to do anything, out of fear that the pain will get worse. And so your life swings between too much and too little, without really getting better.

This pattern is one of the most recognizable experiences with chronic pain. It has everything to do with the balance between load and load capacity - and why that balance is so easily disrupted with chronic pain.

What are load and load capacity?

Load is everything you do in a day: moving, working, housekeeping, social contact, but also emotional effort and stress. Load capacity is what your body and mind can handle in a day.

When you make good use of your body's possibilities — without asking too much or too little — you feel your best. You are then in balance and your body functions optimally within the possibilities you have.

In short: Load = what you do. Load capacity = what you can handle. In balance = you function optimally.

With chronic pain, this balance is extra important - and extra vulnerable. Because chronic pain in itself already takes energy. Your load capacity is therefore lower than it would be if you weren't in pain, while the things you want to do haven't become any fewer.

Overload or underload often occurs, and both don't feel good.

In response to underload or overload, your body sends out all kinds of signals that make you feel unwell. The pain persists and you feel limited in doing the things you want to do.

Overload: the negative spiral

Overload occurs when you structurally do more than you can handle. With chronic pain, that's tempting — especially on days when you feel a little better. You finally get to do something again, and you want to seize that chance.

But when your body becomes exhausted, you notice that it becomes increasingly difficult. You can handle less and less. From this point, you may end up in a negative spiral:

• Because your body is exhausted, you take it easier to recover.

• As a result, your strength and fitness decrease.

• You can handle less and less, which causes frustration. The frustration can influence your pain.

• You experience more pain and you can do less.

• You take it even easier, and the cycle repeats itself.

Even though you're doing less and less, the foundation of the pattern remains overload: you want more than your body can handle.

Underload: the other pitfall

The other side of the scale is underload. There are many reasons why you may consciously or unconsciously start avoiding activities. For example, to avoid pain, because you're afraid of breaking something in your back, or because you no longer know what's important to you. Sometimes this means that you literally and figuratively stop moving.

The all-or-nothing principle

A well-known reason for avoiding movement is all-or-nothing thinking: if I can't do it at maximum anymore, then I won't do it at all.

In the short term, this seems to work:

• Avoiding a painful activity means that the pain (temporarily) stays away or lessens.

• You don't have to confront your limitations if you no longer practice your favorite sport.

• You don't experience anxious thoughts if you leave out the movements you're afraid of.
  

But in the longer term, you end up in a negative spiral similar to that of overload:

• By avoiding activities, your fitness and strength decline.

• Your body can handle less and less and pain occurs sooner.

• You miss the activities that bring you joy and give you energy; you become increasingly isolated.

• You experience more pain, you avoid more activities - and the cycle repeats itself.

Back in balance: pacing as a skill

Whatever reasons caused your balance to be disrupted, it's important to look for a good balance again. That's easier said than done - there is no simple recipe. It depends on personal factors: what do you find important in your life, where do you get energy from, what costs you energy, and what do you need to be able to do the things that matter to you?

A concrete skill that helps with this is pacing: consciously dosing your activities. Not doing too much on good days, but also not doing too little out of fear. Breaking activities down into smaller parts, gradually building up, and learning to recognize where your limits lie. Pacing is not a matter of doing less. It's a matter of dosing smarter - so that in the long term you can do more.

Is RealHealth something for you?

RealHealth can help you find the balance again and sustainably rebuild your load capacity.