Energy Strategies and Managing Fatigue

Fatigue after Injury

Fatigue is a common symptom for individuals recovering from a concussion or living with functional neurological disorder (FND)¹. There are different types of fatigue such as physical fatigue, psychological fatigue, and mental fatigue, all of which affect your ability to think, move, focus, and complete daily activities².

Every action you take – thinking, walking, reading, day-to-day activities – all use brain energy. To understand this further, imagine your brain works like a cellphone battery. Charging your phone overnight allows you to start the next day with a full battery of energy³. As we use our phones throughout the day, we slowly use up the battery power. Similarly, a good night’s sleep can help us to start the day with a full battery, and the various activities we do during the day slowly drain our energy reserve. However, after a concussion or when managing FND symptoms, your brain might not start the day at a “full charge”. You might begin with less energy than usual, which is why you may feel tired even after resting³.

Managing Fatigue

Managing your fatigue means balancing and planning your activities⁴. This process is called pacing, and it’s a powerful tool to avoid overloading your brain, staying active without burnout, and feeling more in control of your day⁴. Balancing activities helps you become more aware of your limits⁴. This awareness allows you to plan your day in ways that maintain your energy and support your recovery⁴. Think of this like plugging in your cellphone for a quick boost, so you can allow your phone battery to last you longer throughout the day³.

Occupational Therapists (OTs) play a key role in helping individuals manage their energy and improve their quality of life. OTs help individuals use energy conservation strategies to allow better utilization of their remaining “battery” power – this helps individuals to balance both activity and rest while maintaining independence. One effective method which OTs use is called the 4P Approach, which includes 4 components: prioritize, pace, plan, position^3,6,7,8.

1. Prioritize
   • This means focusing on completing your most important tasks when you have the most energy. Prioritizing can mean choosing activities that are essential for daily living and well-being, and letting go of less urgent activities or tasks. For example, if you have the most energy in the morning, you may choose to prioritize essentials like self-care, medical appointments, or meal preparation early in the day. Less critical tasks like organizing your desk can wait!

2. Plan
   • Plan to spread out your energy across the day or week. Planning involves organizing tasks and activities in a way that spreads out energy expenditure to avoid overexertion. Planning can include creating a daily/weekly schedule, or breaking tasks down into smaller, more manageable steps.
3. Pace
   • Pacing means completing activities or tasks at a steady and sustainable rate, rather than rushing through them. Consider how you are going to do an activity – can it be broken into steps? Can you do it over a period of hours or days? Pacing can involve taking regular breaks during activities, breaking the activity into smaller steps, setting a comfortable pace to work through, and using timers to remind yourself to rest. For example, pacing might look like taking a break every 15 minutes while vacuuming the house. It is also important to rest even before you start to feel tired and to always listen to your body.

4. Position
   • Positioning involves using body mechanics and postures that reduce strain on the body and conserve energy. It includes making changes to the environment to make tasks easier and more efficient. For example, organizing your space, so that commonly used items are closer and easier to access. Positioning can also mean using ergonomic tools, adjusting the height of work surfaces, and sitting down while performing tasks that are usually done standing.

The 4P Approach is widely used by Occupational Therapists and can be a powerful tool for managing energy and improving daily functioning for individuals with both persisting symptoms after concussion and functional neurological disorder. By incorporating these strategies into one’s daily routine, individuals can better manage their symptoms, reduce fatigue, and enhance their overall quality of life.

References:

1. Fatigue – functional neurological disorder (FND). Functional Neurological Disorder FND. (n.d.). https://neurosymptoms.org/en/symptoms/common-associated-symptoms/fatigue/
2. Concussion symptom spotlight – “fatigue”: Broadview Clinic. Broadview Spine & Health Centre. (2023, May 18). https://broadviewhealthcentre.com/concussion-fatigue/#:~:text=In%20most%20cases%2C%20fatigue%20gradually,or%20accompanied%20by%20other%20complications.
3. Diamond, J. (2025, April 1). Concussion Rehab 101. In CAOT Practice Evidence Webinars series. https://caot.ca/client/product2/products.html?categoryId=1251
4. Balance. FND Hope International. (2020a, September 9). https://fndhope.org/living-fnd/healthy-living/balance-2/
5. Energy conservation. St. Joseph’s Healthcare. (n.d.). https://www.stjoes.ca/patients-visitors/patient-education/a-e/PD%208278%20Energy%20Conservation.pdf
6. Resting and conserving energy after concussion. Resting And Conserving Energy After Concussion – Sunnybrook Hospital. (n.d.). https://sunnybrook.ca/content/?page=bsp-concussion-conserving-energy
7. The 4 P’s of energy conservation. 360 Concussion Care. (2022, July). https://www.360concussioncare.com/uploads/1/4/5/0/145000321/strategies_to_help_you_through_the_day_4ps.pdf
8. (n.d.-e). Managing persistent post-concussion symptoms. https://www.uhn.ca/Krembil/Canadian-Concussion-Centre/Education/Documents/Managing-Persistent-Concussion-Symptoms.pdf

Disclaimer: The content provided on this website is for informational and educational purposes only. It is not intended as a substitute for professional advice, diagnosis, or treatment. Always seek the advice of a qualified professional with any questions you have regarding your health.