VITRUVIAN EXERCISE PHYSIOLOGY
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GUIDE TO MANAGING FLARE UPS
The hardest part about a flare up in symptoms is knowing how to respond. Understanding the nature of flare ups helps us organise our thoughts and make good decisions.
What goes up must come down
Flare ups are temporary and will settle down with time. Sometimes it takes just a matter of days, sometimes it might take a little longer. Regression to the mean is important to understand, because it helps mediate the initial panic that can follow a flare up.
Although it is natural to assume that the increase in symptoms is due to an increase in damage or a worsening in your condition, this is rarely the case. Your increase in symptoms is due to a temporary increase in sensitisation – to your system and to some specific structures.
This is a very important point to understand, as a belief that you have ‘damaged’ yourself can lead to coping strategies and behaviours that are not conducive to recovery.
The flare up is an outlier on the graph, not the norm. It will calm down.
Start with 'Why?'
It helps to be aware of the factors that can contribute to a flare up. Notice we said factors. It is almost never just one thing. Flare ups occur due to a variety of factors that combine to cause a spike in symptoms
So, what are these factors?
⦿ Reflect on your activity levels over the previous days and weeks:
Are you moving less than normal? Have you been moving more than normal? Are you participating in exercise or activity that is unusual for you? Have you noticed a particular movement or activity that provokes pain? These things can seem innocent at the time but can be enough to contribute to a flare up.
⦿ Reflect on your exercise routine:
Is the area of your flare up an area that you have been straining, overtraining, or not allowing time to recover? Alternatively, is it an area you have been over protecting and under training?
⦿ Reflect on your life circumstances recently:
Are there new stressors in your life? Are you managing your regular life stressors as well as usual? These can come from work, relationships, time pressures etc.
⦿ Reflect on recent health behaviours:
How is your sleep? Are you eating well? Have you been connecting with friends and family?
A nice way to visualise it is to consider the cup analogy:
Image by V. Tsaneva, 2023, Cup Analogy - adapted from Greg Lehman
Flare ups can occur when all of the sensitising factors in our life “fill” the cup and the cup overflows.
What can be done to help?
We can now attempt to do one or both of the following:
⦿ Reduce the number and/or intensity of these sensitising factors;
⦿ Build a bigger cup by increasing our capacity and tolerance to these sensitising factors – exercise helps with thisFlare ups are rarely the result of further damage.
The Vitruvian Team.
Flare up guide – adapted from Aaron Kabul
Cup analogy – adapted from Greg Lehman