Wednesday, 5 November 2014

Chronic Fatigue: the physical impact

Chronic fatigue is so much more than being tired all the time. Fatigue affects your muscles and the amount of energy you have to physically move. Imagine you have just done the hardest workout of your life – completed a marathon; beat all your PB's in the box; walked the length of Hadrian's Wall in a week. Your muscles feel like sandbags, you feel wobbly and shaky and have no inclination to move. That's fatigue.
Now imagine that that happens every day through simple activities like having a shower, or walking to the shop and recovery is always incomplete. The thing is chronic fatigue isn't just tired limbs it is far more insipid, affecting every part of the body. I'll start with the obvious and then get down to the effects that you might not expect.

The NHS Choices website uses this as their picture for fatigue. It's not completely inaccurate.


As described above, limbs are the most obvious areas affected by fatigue, something most people are familiar with. Limbs that feel heavy and tired; muscles feel weak; doing anything feels like an effort; the muscles might hurt and ache; joints hurt; there may be pins and needles or numbness.
Depending on how severe it is this might mean slower movement, some unsteadiness, or even difficulty with smaller movements like making a cup of tea.

Core Muscles

The next easiest to comprehend is fatigue of the core muscles. I'm including abdominal, back and neck muscles here. You might have experienced fatigue of the core muscles following a work out session or if you have neck or back pain.
As above the muscles become painful or achey, feel tender to touch and are generally tired.
Fatigue of the core muscles means that holding a good posture is difficult, which can further exacerbate pain and discomfort. It can become difficult to sit upright or hold your head up without support.

Smaller muscles

Hands, fingers, feet, facial muscles. All those little muscles that we use almost without thinking. They react just like limb muscles. Aching and weak, slow to move. In the hands this can make holding things difficult so I have to stop knitting or put down my book, maybe use two hands to cradle a cup of tea instead of holding the mug by the handle. With the facial muscles this can make expressions and speech difficult, droopy eyelids and week smiles. In me this is often accompanied by partial paralysis of my face and/or numbness or tingling.

picture from

Intercostal muscles and Diaphragm

Your intercostal muscles sit between your ribs and are responsible for lifting and expanding the chest. They come in several sets and all can become fatigued. The thoracic diaphragm is the broad sheet of muscle at the base of our ribs, separating the lungs from the abdominal organs (along with a load of membranes). The diaphragm is also crucial in the mechanical act of breathing, contracting and relaxing to allow air in and out of the lungs.
The limbs and core muscles are the more obvious targets of fatigue as we see them physically doing something. We can see and feel when our legs are moving, when we are bending and stretching; that these muscles become fatigued makes sense.
The intercostal muscles however are less noticed. Their movement is for the most part involuntary. As long as we are breathing they are moving. We might suppose then that if we do something that increases the breathing rate then the diaphragm and intercostal muscles will work more and therefore become fatigued. This is only part of the story. In reality they are working all the time and thus using energy all the time.
Limbs and core muscles may be first to show the affect of fatigue however, if the fatigue becomes extreme before you are able to get any rest or recharge, then intercostal muscles and diaphragm can become affected. This means that breathing can become laboured, the chest hurts and feels heavy or like somebody is pressing down. Laboured breathing has never helped anybody feel more refreshed.

The digestive system

Your mouth and jaw are made up of muscles which must chew and move food. Then you need to swallow, employing your tongue, soft palate and throat to move chewed food down your digestive tract in to your stomach and gut. The stomach contains layers of smooth muscle used to churn the food as it digests, it is guarded by two sphincters (top and bottom) rings of smooth muscle that control the flow of food matter into and out of the stomach. Once the food has been broken down in the stomach it passes into the small intestine, and then into the large intestine, long tubes of specialised tissue and smooth muscle.
These muscles move involuntarily, we can't consciously control them but, they do move a lot. They move to break down the food and to keep it moving so that proper digestion can occur. They move to stop blockages occurring and to prevent food from 'backing up'.
When a body becomes seriously fatigued these functions can slow down. Just as limbs can become sluggish and slow moving, unreliable and weak, the smooth muscles of the gut and the muscles of the throat and mouth can become unreliable. This makes eating not just difficult but dangerous.

'Too tired to eat' doesn't just mean I am too tired to make myself some food, or too tired to lift a slice of pizza to my mouth, it can mean I am too tired to chew. That my throat is too fatigued to swallow efficiently and choking or gagging is a real risk. It can mean that my digestive system isn't functioning efficiently and food is just sitting there. Nutrients aren't being absorbed, worsening the fatigue, and waste material isn't being processed correctly.

The Heart

OK I'm going to confess, I haven't personally experienced this but it is something that concerns me. If everything else can get fatigued, why not that hard working muscle the heart? Maybe that's not possible or likely but if you have some information about this let me know.

Now, not all of these things happen every time I get fatigued. It's a sliding scale: first the limbs and muscles which have been directly affected get tired, then my core muscles get tired and I slump. My facial muscles get tired and it is difficult to talk properly. By this point I am usually in some sort of forced rest simply because I can barely sit upright any more. But if I continue to push through and exert myself, then I start finding breathing tough, and only in extreme circumstances do I find eating/digesting a difficulty. But this is all fatigue. This is all the result of the chronic fatigue caused by CFS/ME and other illnesses such as Chronic Lyme Disease, Rheumatoid Arthritis, and Lupus to name but a few. 

This is 'just' the physical fatigue. CFS/ME and other similar illnesses can also cause a myriad of other physical symptoms as well as cognitive fatigue known as brain fog.
Fatigue isn't just tired. Fatigue is much much more.

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