Post-Exertional Malaise (PEM) 

I deal with this as well, but when I’m doing an activity I feel my body so tense so I stand and tell myself I’m safe and healthy and make myself relax and keep going on and continue to make myself relax. I know this will pass eventually. I keep telling myself that I am safe but sometimes my NS gives me panic when it doesn’t believe me.

Been dealing with PEM for 5 years now. After all the blood tests and supplements, I kinda gave up. A few months back discovered brain training which educated me and helped some. Discovered Dan here recently, with his messages of safety, I've noticed more improvement right away. Thank You Dan!

I was just thinking, that I could see teaching my brain as if I am teaching my scared puppy about the world, and how most things are not scary, but it does take several steps and exposures for her to learn this.

You’re absolutely right Dan! I lived at several years like the doctor said don’t do too much that just made my world smaller! I have been taking it the other direction and when symptoms show up respond calmly know what it is and shift focus away it’s working thank you so much!

Had PEM probably a hundred times since getting diagnosed in CFS two and a half years ago. Discovered mind body work 7 weeks ago via the tms forum and then found your channel. PEM for me is almost always caused by emotions related to my core fear. It has nothing to do with how much I do which is what I used to think. If I'm able to release these emotions (usually via meditation) then the severity of PEM drops massively. I believe I was one of those that sarno explained as needing therapy, as my symptoms are reducing a lot by working through early childhood trauma (on my own right now). Just refocusing myself worked to an extent, but my body would still often go into a freeze response. Thanks for the video.

Post is unreal. Are you following me lol. Yesterday I actually attended my first group Writing course. My anxiety was so high. Beforehand I did a walk, nerve "pain" upped, didn't think I'd be able to go there. Anyhow I managed to stay sat for two hours despite wanting to get up and leave. Trying to sleep and my foot went into spasm, then my calf and thigh. Woke at 2am both legs hot and inflamed and I was burning up. This morning I feel flu like and very tearful and the overthinking high. I am having to keep reminding myself it's too coincidental, it's PDP. Struggled to get in my car and go for a drive to the shop but I did it. Yes "pain" keeps spiking but I'm calling it PDP. Am sounding like a used record lol On the other hand I thoroughly enjoyed the class. Can't believe this video came up 🙏👏👏👏 PS. Have to remind myself I had blood tests less than two weeks ago, all good.

I'm reading Gabor Mate's the Myth of Normal and it is so impressive that the mind and body are ONE. His theory actually verifies that TMS is very, very real.

I've had a lot of experience with this for many,many years and now, with my understanding of mind body conditions and perceived danger I can say.yes, this does make sense. And, Dan, you did an excellent video a while back related to this. It was called ,Seven steps to Resume Activity. That was very helpful to me and I'm sure would be for others. Thank you Dan!💜

Thank you! At first, when I got long covid, my PEM was insane! Any activity that I would do would mean being bedridden the next day, even sometimes more than one day. But, as I worked with the knowledge of John Sarno and Dan Buglio, PEM almost completely disappeared, which is amazing!

Initially I had this labelled response P.E.M...but thanks to all your correct information I gradually began to trust it's not real. Now I have to apply the same to emotions as sometimes I appear tired after releasing emotion & a brain that thinks it was too much...does anyone else experience this? Thank you Dan for another fantastic reminder. Nature keeping it real in the background!!❤

Hey Dan I couldn't believe my ears when you talk about the brain shutting us down when it perceives danger. I've long said my body shuts me down when I do any kind of exercise. I used to be an obsessive exerciser and I imagine when I even think about the gentlest exercise a big red light and a loud alarm go off in my brain saying "shut her down, we're not going through that again. I'm grateful to the person who recommended your channel 🙏😺

Very helpful. I tell myself I need a break or a cool down,then go back to doing something.

Thank you for this video, Dan! I do think you are on the mark. I have CFS - diagnosed in 2017 after a whole slew of tests. I've been pursuing a mind-body approach to healing for about a year and a half now and have made some progress over that time, although I have a ways to go still. PEM is my main symptom although there are many others, and I have come to understand that they are all caused by a sensitive brain perceiving danger. Today I am experiencing significant PEM because I spent two hours outside working in the garden yesterday. Even though I had a good night's sleep, I woke up feeling like I ran a marathon yesterday. I love gardening, but my brain seems to always interpret physical activity as dangerous. It's deeply frustrating, but I try to just accept the symptoms without freaking out and give my brain messages of safety. I believe I will have a life without PEM eventually, but it's taking a long time to train my brain to understand that I am really safe, which is understandable as I was in a state of high stress and anxiety for pretty much all of my 45 years.

I went to the gym came home ate lunch and i got the malaise and fell asleep for 2 1/2 hours and i had a fever when i woke up - so i took a hot Epsom salt bath and the fever went away. I was then able to go out to the grocery but i still had the fatigue when walking

You can have the whole encyclopedia full of labels, to make doctors feel useful, to keep us fearful.. you are spot on Dan: every out of proportion symptom ( that is benign)just needs 1 label: TMS/ PDP! And the cure is calm and safety to the system. P. E.M.: Practice your Exercise Mindfully- there will be no problem then! Have a good day Dan and everyone ❤

What a word pff ......another doctor diagnose. But it is all PDP.. Still having a challenging day going on a trip this Saturday for 5 days to the forest in the Netherlands. A bit nervous because of sensations. I am changing my story like I am going to have a smashing amazing time full stop ❤😊 ty Dan sending you love and to all of you on RU-vid 😁😘❤️🌷

People suffering from ME/CFS symptoms are on a constant merry-go-round of blood tests and experimental IV treatments. PEM and other terms came about gradually. In the beginning, speaking historically here, it was difficult for CFS sufferers to be taken seriously. Hence, all the terminology and blood test panels and what-not. Most of the people suffering from it are women, which adds to the complexity and aggrieved feelings about taking the suffering seriously. Western medicine has a dodgy track record around conditions associated with women. I’ve known quite a few people with the condition. They struggled to get docs to believe them for years before getting a diagnosis. But all that effort to be taken seriously by the medical community is a catch-22. Now you are in their clutches. Now you have a stack of blood tests and a word salad to describe your human experience. Trips to MDs, NDs, therapists, etc. And once you have that and pursue that path it becomes harder to retrain the brain to think psychologically about the issues at hand. It requires an ontological shift. It’s very hard to argue with someone who is in the thick of it, especially when all this effort has been done historically to get the condition to be taken seriously. We have to be respectful of the history of this problem. It requires compassion and understanding.

Yes, we are so subject to believing labels. So, " I am well". " I am strong".

Hello. It makes sense. Wishing everyone well

I had never heard of this. But it is so recognizable. Had this the last 4 days since I had half a day working in the garden. I thought I will get the flu, but now it is over all of a sudden. Aching body and very low mental state. I am glad now to know what this is. Thank you Dan.

This makes a lot of sense - thank you so much for covering this topic! PEM is the ‘main’ thing left that I’m still experiencing with CFS. Most other things have faded away now. The challenge I’m finding is that it’s kinda a negative feedback loop: I’ve had SO many experiences of severe PEM now, that when I want to do an activity a part of me immediately fears doing it because of the potential for it to cause PEM. But that fear is the thing that actually causes the PEM. Without the fear, it happens a loooot less. It’s such a tricky cycle to break!! It’s not just physical activity that causes it though. Conversations with people do too - BUT only when they include bigger emotions, so I absolutely know that it’s not the talking itself, but my oversensitised brain seeing emotion as unsafe. Same with a whole host of other things. And this has shown me that it’s PDP.

Thanks so much, this is what I have ❤

This came at a perfect time for me. I used to get this all the time after activity, though it's been getting a lot better recently. I went swimming yesterday and I knew since I hadn't done that for a while that my brain would probably perceive some danger. I took it easy swimming and had such a nice time. This morning I've felt a little flare up of symptoms but I thought of your videos and I said to myself that's fine and I know why it's happening and I don't have to worry about it. I know if I keep going swimming and having fun soon my brain will get the message that it's not dangerous. This has already happened with yoga and pilates. The "don't do too much" messages I'd hear used to freak me out a lot and it was only with your videos that things "clicked" and I started to get better and not worrying so much about activity. Thanks Dan :)

My comment a few days ago was about this type of thing. Thanks for making a longer video about it. I've been reading the comments and so many people can relate to what you're saying. It truly is about gently nudging our brains to believe we are OK, isn't it? I've been reading Neville Goddard and studying the law of assumption for a while. A lot of what you're saying makes sense from that perspective as well. In that paradigm, people even heal from verified medical issues by adopting the belief that they are awareness/consciousness, that imagination is primary reality, and that they do have the power to choose something different. It just takes a lot of bravery and persistence, but I've seen many people heal. I've set a personal goal to do one "new" thing each day. It doesn't have to be anything crazy, just something I don't normally do or going someplace I haven't been in a long time. Yesterday, I got a manicure and pedicure for the first time in years! Today, I am going to the gym . I'm teaching my brain that we are safe and we're not waiting around ot live life anymore!

Dan, I appreciate you tackling this issue and also for welcoming new information and ideas. There is in fact testing and science behind PEM. A few good researchers to look up are David Systrom, Maureen Hanson, and Lucinda Bateman. The main way to test for this is through what’s called a 2-day CPET (cardiopulmonary exercise test). The key is, folks with fatiguing disorders can get through the test on day one, but all of their physiological markers start tanking on day two. That is specific to people with ME/CFS (and now many with long COVID); even people with congestive heart failure get through the second day of testing just fine, but not folks with ME. It’s what is meant by “post-exertional” because the physiological effects happen 24-48 hours after the physical (or cognitive) exertion. If fear were causing this, there’d be no delay in symptoms. But that’s not to suggest fear isn’t contributing to the severity of it, as you say in your video. I myself have had this test (only offered in a few places in the U.S., very expensive, not covered by insurance, and 99% of doctors don’t know anything about the test). It showed significant, measurable impairment and it helped me obtain disability benefits, because it specifically measures problems with everyday functions - blood and oxygen getting where they need to go, for one. And even though I’ve had this test, I’ve still been able to dial down my fear over time and my PEM is much less severe than it used to be. Pacing my activity and strategically pushing my body’s limits (easier to do when you dial down fear) have also helped me improve the PEM. It all goes hand in hand.

Thanks for this, Dan!

This couldn’t have been a timelier message! After finely getting healing from Rheumatoid Arthritis, neck pain and spine pain; I have now developed PEM. I had chronic fatigue for a year where I barely left the bed and I have been “afraid” that it is coming back. Thank you for the message Dan. I believe that my body has gotten so deconditioned at 64 after years of being sedentary and/or bed bound, that it’s going to take some time to adjust to my new daily exercise routine. I want to think I can just be in shape and active like I was at 61 when I got “ill”. I’m going to tell my brain it’s okay and be more patient with myself. Thank you for all you have done for me in my healing journey!!

I was thinking about this myself as I've just gone back to the gym after 3 months of inactivity plus socialising a bit more. Everything you said resonated with me..spot on information ❤

Thanks Dan!

thanks Dan...this is spot on and i will likely reference this video a lot in my journey moving forward : )

Great video and timing

I had never heard this term, but that was exactly my experience before I discovered TMS and began healing. I spent years doing the bare minimum activity because the pain and fatigue for the simplest things was so outrageous.

I’ve never heard of this!

Agree with your assessment (in the absence of a medical condition that may be causing it). I tell myself (brain), "I know you're tired and want to stop. We're not doing too much. Tired does not equal pain. Tired is just tired and you can handle it and will take a break at an appropriate time." We don't need to be energizer bunnies to prove the point. Especially if you're 68 😁

Great video! I totally agree! Follwimg this approach ive seen huge improvement! Im now going to the gym and doing tahitian dance and actually have energy afterwards

If you believe you’re sick, you’ll always stay sick. I learned so much from Jesus. He didn’t just heal people, he first asked them "Do you believe I can heal you?” Or "Do you want to get healed?” It all starts with the Belief that we are actually okay. The belief doesn’t have to be big. But we mustn’t doubt. If we doubt, we sink, like Peter did when he doubted Jesus. I think the Bible has so many valuable stories for our lives :)

Dr Myhill explains it in her book. People with M.E/CFS and experience PEM often have a mitochondrial problem as well as other things. Also it takes much longer to make the ATP to replenish the energy used in people with CFS, that is why it takes time to recover. So it is a physical body thing but it’s still a dysfunction of the nervous system which needs to be calmed down so your rules still apply I think and calming the nervous system should allow the body to function more normally again. To me it doesn’t matter if I do something I enjoy or not, results are the same. Working on your/Dr Sarno's theory because I believe in it

Morning Dan yes my understanding is that if you start exercising to get fit .. ie go to the gym, walk or run more etc. is using your muscle more to strengthen them. Within the next 24/48 hours you can get what my physio calls DOMS , Delayed Onset Muscle Soreness. It goes away and muscles will get used to doing more.. so nothing to be scared of. Brain saying your muscles need a rest..thats my take. Dan more or less the same that you are saying.. take it easy but don’t stop moving and living life. I have some muscle soreness today after weekend trekking a bit further than usual. My friend Orla walked 30k in Saturday, much longer than she is used to (10k) and has sore muscles in legs and glutes.. which she knows is normal.. take Dan’s advice and don’t be scared 😱 ❤❤❤❤

❤❤❤❤ and they tell you the "spoon theory" or "battery theory " which just escalates the overthinking, worry and fear 😅🙉🙉 currently still working thru all this, trying to undo those terribly unhelpful teacings, reteach my brain 🙏❤️

I like the point he makes about doing an activity you enjoy and the absence of PEM vs. something you dread doing and can cause PEM. I struggle with compulsive exercise, a lingering effect from an eating disorder which began at age 14. When I engage in this type of exercise, I am always anxious, frustrated with my body, and it feels like a punishment. My chronic pain started after a major surgery that was extremely physically/psychologically traumatic for me because it took all control I had over my body away. Now if I engage in compulsive exercise, I have a major pain flare. I'm just now realizing that I have to let go of control, let go of exercise as punishment in order to heal.

Thanks for this video. This is something that has been challenging for me even as other symptoms have vanished. I do t consciously fear movement but sometimes have pain disproportionate to my exertion afterwards. It’s PDP, I’m sure of it. Darn unconscious!

I have been full on doing things, and I think we have to accept that we will ache . I've been doing stuff for the first time in years. I tell myself it's good ache as I'm using my body again. I'm experienced a few extra symptoms because my stupid brain is worried about a long trop to grandchild and long days out. I'm glad you put this on today as it makes it so much clearer. I know my brain is doing it.

I’m trying and hope this helps, no harm in trying. Watching your quick start videos. I could be wrong, but this only appears to be a small piece of the puzzle according to recovery advice from the FLCCC for those with fatigue and PEM related to Long Haul Covid Syndrome.

Lol I just finished 3 days of heavy duty yard work. Was I tired afterwards? Heck yeah! Got in the jacuzzi, stretched some achey muscles and went to bed happy. Feeling good today...thx..love how your vids just hit the target 🎉❤

Tysm Dan for touching on this. I'm one of your listeners that has struggled with fatigue for many years. I have been a massage therapist my whole adult life, part of what sent me to crash (abusing my body in earlier years) I've been doing recovery for a year. Doing massage is what crashes me. So I've been wondering (I know anything is possible) but how I can train my brain that doing massage is ok, safe. Because I've tried and it doesn't seem to be getting the message yet. It's hard to remember a time when doing massage didn't fatigue me. I stopped for 6 weeks and gradually went back. I haven't progressed in increasing yet.

Hey Dan. Huge fan of your work here. I’m a lot better since starting TMS work6 months ago. Not 100% just yet. But. I have a counter argument to PEM some proponents would debate and I’d like your take on it. I’m a MD and have done mbs courses, so don’t think I’m against you theory. But some peeps would argue that there actually is a muscle necrosis on muscle biopsy in people with pem. And also lower oxygen levels, mitochondria issues and lower oxygen intake peripherically. I have a theory that explained all of this, but it makes it harder to argue doctors with this theory. Your take please?

Found myself telling myself "I'm unfit" . It's a real effort to do another length of the park field. Even attending a social event does the same. I need PDP tattooed on my wrist🤔

Also known as an Adrenaline Dump. 💤💤

Agree

Boom

Hi Dan, I hope you're doing well! I've got a question about changing a level of pain when on vacation or in another location. I would be grateful if you could point me to the right direction. For the last year I observed that when I'm away from home in some different country, doesn't matter if on vacation or working remotely, my pains very significantly lower or even disappear for the whole period. But as soon as I'm back home, it gradually returns within a few days. While being at home or in a different country, I have pretty the same level of physical activities and stress. Do you think it's just a conditioned response? It's as if the brain considers being at home dangerous. But consciously I'm not aware about any "dangers" here.

Fatigue/energy are determined by the brain. What they r trying to describe with PEM is a real thing but people get really fixated and scared of PEM and that is where the problems roll in. I think this constant reminder of the symptoms are caused by the brain perceiving danger is necessary bc for some reason we have a hard time holding onto that thought

What are your thoughts on mold exposure?

Yes and no.

Hi Dan, would you say that AFIB is caused from PDP? I was working in the yard and I felt really out of breath and tired, my heart was out of rhythm so I had to stop and rest.

Hi Dan! I'm going through a bad flu and I was wondering, which tools/mindset that apply for PDP could work in this case?

Hi Dan, can you talk about RLS(Restless Legs Syndrom)? I get it if i drink caffein. Do you think it is PDP too?

Sir can in avascular necrosis ,can this tms applies Because in avn ,there is necrosis of hip joint Can avn pain be eliminated completely

Very interesting…

Can this be during(!) the activity (like sitting) after a while also?

Phone is ringing. I think it's Dr Google

it can happen after sex too, just sayin....I think it was Jamie Foxx did a bit, how his legs gave out after sex and he would just conk out asleep, but his wife was ready to paint the whole house.

I am inherently safe and okay 🩷🩷 your only infection is fear