Muscle fatigue is a symptom that can affect people with Muscular Dystrophy, but there are many ways to manage and minimise its effects to ensure a good quality of life. This fatigue management guide will explain what muscle fatigue is and ways to manage muscle fatigue with Muscular Dystrophy.
What is Fatigue?
Fatigue is a feeling of extreme tiredness, exhaustion and a lack of energy. It is not the same as feeling sleepy. Fatigue is a very common symptom for people with a neuromuscular condition, like Muscular Dystrophy, and is usually caused by muscle fatigue.
What is Muscle Fatigue?
Muscle fatigue and general fatigue are very different. Many non-disabled people will experience general fatigue that makes them feel really tired after a busy day of hard work or stress.
This type of general fatigue they experience will improve overnight after a good sleep or after a few days rest.
However, for people with Muscular Dystrophy, this isn’t the case and there are three main types of fatigue in some neuromuscular conditions:
Progressive fatigue means it can continue to get worse over time. For example, some people may start the day off fine but as the day goes on they become more tired and then as the week progresses they feel exhausted meaning they lack energy by the weekend.
Variable fatigue changes from day to day or even hourly.
Persistent fatigue is on-going.
What Causes Muscle Fatigue?
When our muscles are working hard (over-used), micro-damage is produced at cellular level. This sends signals to the brain that the muscles need to be bigger and stronger to be able to carry out these daily activities.
The process of building muscle is achieved by stressing and damaging it through gradually repeating the same activity over and over (walking, running, cycling, resistance such as weights or bands).
Once the micro-damage is produced the muscles then need time to recover to enable them to regenerate, repair and grow.
Although, with neuromuscular conditions like Muscular Dystrophy damage to muscles is caused by much less stress to them and the recovery period is longer. It can also be very difficult to rebuild or make the muscle stronger.
Often overexerting yourself (overworking the muscles) can cause persistent fatigue and it can be very difficult to recover from. Being unable to get out of bed the day after over-exertion and needing a few days rest to recuperate and feel back to where you were is normal in some cases for people with Muscular Dystrophy.
Muscle recovery is a complex process and can vary depending on the level of activity and neuromuscular condition.
Being active is good for people with Muscular Dystrophy as activity helps keep muscles working effectively and efficiently to prevent de-conditioning. The type of exercise and how much depends on individual comfort, ability and muscle condition so it is important to speak to a specialist or neuromuscular physiotherapist for professional advice.
Non-disabled people will exercise by gradually increasing the length of time they do each exercise. For example, lifting weights for two minutes and increasing to four minutes and so on.
Although, this isn’t always the case for people with Muscular Dystrophy. Daily activities that are repetitive can be enough to cause muscle fatigue. For example, I experienced a lot of pain and discomfort working in an office due to stretching across the desk to answer the telephone. The repetitive movements caused muscle fatigue, but that was then solved when I started using a headset for using the phone.
So it’s important to be very careful when exercising and pay particular attention to when it’s time to take a break and rest. Most importantly seek professional advice before exercising to work out the most appropriate exercises for your neuromuscular condition.
As a child, I received physiotherapy until I reached the age of sixteen. My Mum was also shown suitable exercises/stretches when I was first diagnosed with Limb Girdle Muscular Dystrophy around the age of seven. This meant she was able to maintain my physio and still does along with my partner to this day.
Progressive Fatigue Symptoms?
Progressive fatigue is when the muscles are continually exerted throughout the day. Having energy in the morning, which gradually decreases as the day goes can be caused by different factors:
- For people like myself with Muscular Dystrophy (or neuromuscular conditions), our muscles are already weaker and won’t be able to manage daily tasks like non-disabled people.
- Weakness in the muscles puts a strain on the joints when moving which can cause us to be pulled into awkward postures. These movements are less efficient which uses more energy and increases tiredness.
- Joint and muscle pain affect energy levels. It’s not always possible to carry out activities when in pain and its easy to become more tired.
- Loss of muscle strength occurs when we age and from age 40 we also lose muscle bulk. For people with Muscular Dystrophy, muscle weakness due to their condition and loss of muscle from ageing combined has a greater effect on energy levels and the reason for feeling more tired.
Variable Fatigue Symptoms?
Variable fatigue is when there is no obvious reason to feeling more tired one day compared to another day. It’s important to take it easy on the days when you feel tired because overworking tired muscles increases the risk of falling and injury.
Variable fatigue can also occur throughout the day, especially during repetitive tasks. Picking up an object may become difficult or impossible after doing the same movement a couple of times. Doing the same thing over and over doesn’t make it easier.
A good way to understand this is by thinking of the power in our muscles as a partially charged battery. The more we use the muscles without re-charging (resting) the quicker they will run out of power/energy.
Fatigued muscles need time to recover/reset after periods of activity, but this will take much longer if energy levels have been completely exhausted. In particular, repetitive activities and high energy tasks in short bursts cause a lot of strain of the muscles.
Joints can be put under strain when the muscles are tired, which can cause ligament damage. Ligaments are the fibrous bands that connect bones to the joint.
Our movement patterns are altered when the ligaments are sprained and painful as this puts more stress on the joints. It’s important to keep the risk of joint damage to a minimal.
Ways to Manage Your Fatigue
Managing fatigue can be challenging and vary depending on your lifestyle, work or family commitments. The following are several ways I manage my fatigue that may be of help to you:
It’s good to pace yourself every day and consider the time of day when you have more energy. This helps you plan especially if you know what you are going to be doing that day or week.
Plan the tasks that require more energy for the time of day when you feel more energetic. Showering, personal care and dressing all require a lot of energy and rest afterwards so work out if showering in the morning or evening is best for you.
Work and social life are also important factors to consider when planning. If you are going out e.g to a concert then try and plan that the following morning has a slower pace.
Break down tasks into small sections so you are only doing them for a short period of time and switch to another task. It also helps to plan your daily and rest breaks into three segments; morning, afternoon and evening.
Pacing is all about slowing down and staggering activities/tasks throughout the day or week. Pacing activities will help prevent muscles from becoming too painful and tired.
It can feel like a burning sensation, cramping, shakiness, weakness or pain. These are signs that you may need to rest or change what you are doing.
It’s good to tune in to how your muscles are working and feeling as this will help you have a better understanding of when is a good time to stop before the muscle fatigue kicks in.
I often experience muscle fatigue after long periods of computer use (writing articles and blog posts etc). I make sure I pace myself and add rest breaks into my work schedule.
It may take a while to settle into your new way of working and it may feel frustrating or bitty, but it will be for the best and minimise fatigue.
Plan the day by prioritising things to do. It isn’t always possible to prioritise things that give us pleasure over the things we have to do, but being happy improves energy levels.
Stress and anxiety can be caused by doing things we don’t like which in turn make our mood drop so having something to look forward to each day/week ensures a good quality of life and helps energy levels.
Temperature can affect our energy levels so it’s important to take that into consideration when planning activities. The supply of nutrients and oxygen aren’t as efficient when our muscles are cold compared to when they are warm.
Fatigue caused by cold temperatures is brought on quicker for people with a neuromuscular condition like Muscular Dystrophy. Being cold makes our muscles tense up and this causes us to move in poor postures which increases muscle fatigue.
Having a plan to prevent becoming too cold when going outside in colder conditions is important. Non-bulky thermal clothes and a fleecy blanket may be worthwhile.
Personally, I prefer warmer temperatures as it eases any discomfort or pain. Keep in mind that extremely high temperatures can also be difficult causing the body to work harder to cool down.
Causes of Secondary Fatigue
Neuromuscular conditions and muscle weakness causes primary fatigue, but there can also be secondary factors that contribute to fatigue. The following are just some of the factors that can cause secondary fatigue:
Prescription medication can cause fatigue. It may be a good idea to speak with your GP or specialist if the tiredness is worsening due to a change in your medication. I’ve suffered from fatigue whenever I’ve taken antibiotics.
2. Intercurrent illness
Cold/flu, viral infections, fever etc are factors that can increase fatigue symptoms. This is because more energy is used to fight the infection and lower temperature which means more rest is needed. I tend to experience a period of fatigue after recovering from an illness, like the time I was admitted to the hospital with a UTI and suspected sepsis. It can last from weeks to months.
Energy levels can also be affected by pain, especially ongoing pain. If so, it’s best to speak to your GP, specialist or physiotherapist.
4. Low mood
Mental health including anxiety, stress, low mood and depression are all factors that affect energy levels.
A balanced and varied diet is best. A poor diet lacking nutrients and vitamins as well as calorie intake (too low/too much) can all contribute to low energy levels.
Poor sleep patterns or waking up throughout the night can have an effect on energy levels. A night of disturbed sleep can have a negative effect on anyone but more so for people with muscle weakness because our bodies need the vital rest during sleep in order for our muscles to recover and repair.
Exercise is another important factor that can cause fatigue. Being too active or not enough? It’s important to find the right balance that works for you. Doing too much tires the muscles but not being active enough can cause the muscles to become deconditioned. Again, after periods of illness, I will feel weaker because I’ve not been as active as I usually am. A neuromuscular physiotherapist is the best person to advise on the most appropriate exercises and stretches for your condition.
Speak to an occupational therapist if you are struggling with activities as they may be able to provide aids to help make things easier in your home or work. Continuing to overwork the already weakened muscle groups will cause further damage and fatigue which can then lead to falls or injuries.
Making things easier for you is by no means making you lazy or weaker. It is only going to preserve your energy for more important things in your life and keep you safe, prevent muscle and joint damage and falling. Tune into your body, what feels good, what feels bad? Knowing what works for you will help you with fatigue management.
To find out a little more about how LGMD affects me, check out the articles below.
What is Limb Girdle Muscular Dystrophy (and how does it affect me)?
5 Things I Do Differently Living With Muscular Dystrophy
How I transfer to and from my wheelchair using a Molift Quick Raiser Mobile Hoist
Parenting A Child With Muscular Dystrophy | Q&A With My Parents
How do you manage muscle fatigue?