Post-Exertional Malaise: How to Cope with Crashing After Activity

  • By Jennifer Mulder
  • 29 November 2021
  • 8 minute read
Post-Exertional Malaise: How to Cope with Crashing After Activity | The Health Sessions

You’d been looking forward to that special occasion for weeks. You managed your symptoms as best as you could and mustered all your energy to celebrate Thanksgiving with your family, attend your best friend’s wedding or make the annual Christmas party at work this year. And as a ‘reward’, your body crashes hard the day(s) afterwards.

A ‘crash’ is not the normal kind of tiredness you feel after a fun night out, but a flu-like exhaustion that can even make it hard to move your body or string words into coherent sentences. Some people describe a body crash as walking through quicksand, sinking deeper with every step you take. Others experience disorienting brain fog, intense muscle soreness or whole-body pain.

Unfortunately, this worsening of symptoms following (mild) exertion is a common aspect of living with chronic illnesses like MS, chronic Lyme and rheumatism. The most severe form of ‘crashing’, post-exertional malaise, is even a key symptom in myalgic encephalomyelitis, better known as ME/CFS or chronic fatigue syndrome. Even small physical or mental efforts, like going for a longer walk than usual or trying to make conversation in a crowded place, can trigger the onset of post-exertional malaise (PEM) in ME/CFS patients. This can cause a health setback that lasts for days or sometimes even weeks. PEM is one of the main reasons why it’s such a challenge to pace your energy and work on recovery from ME/CFS.

Of course it’s best to avoid push-and-crash cycles and overexerting yourself, but life isn’t always predictable and manipulable. Sometimes the simplest activity can set off symptoms. Even changes in your routines, like staying up late and sleeping in, eating festive foods and drinking alcohol may send you on a downward spiral. Not to mention that some things in life are worth pushing your limits for, even if it means crashing hard afterwards.

Whenever possible, I strongly advise you to become an expert at pacing, take pre-emptive rest before events, plan recovery time afterwards and stop activity as soon as you notice the warning signs of a crash. But for the inevitable moments when you can’t prevent a collapse, what can you do to best cope with crashing caused by overexertion? 

What works well for your specific situation, depends a lot on your illness and the symptoms you experience, but here are some general coping tips. Always seek advice from your doctor or other medical professionals when you experience serious symptoms or if your symptoms persist long after the triggering event. 

Post-Exertional Malaise: How to Cope with Crashing After Activity | The Health Sessions
Image by Ketut Subiyanto via

5 Tips to Cope with Crashing After Activity

1. Don’t fight it.

Crashing after activity feels so unfair. Why do you have to ‘pay for’ having fun one time? Especially post-exertional malaise following the slightest physical or mental effort like may seem like punishment or revenge from your body. But as valid as these thoughts and feelings are, they aren’t helping you to feel better or cope well with the situation.

Of course you have every right to be frustrated and upset, but try not to get stuck in negative thinking patterns or let your emotions spiral out of control.

Mind your self-talk. Do you notice that your train of thoughts is filled with overgeneralization (“Nothing ever goes my way, why does this always happen to me?”) or should statements, like ‘I shouldn’t feel this way, this is not supposed to happen’? Don’t fall into these thinking traps, but take a step back and see if you can replace these negative thoughts with still realistic but more helpful thoughts. Speak to yourself the way you would comfort a hurting child. Changing your thinking patterns isn’t easy, but it’s an important tool for (preventing) depression and anxiety and bringing you more inner peace.

Also, don’t blame yourself for crashing after simple activities or feel guilty for needing rest. Don’t try to push through the fatigue and pain to prove you’re not lazy or a quitter. Right now, your body functions differently than that of healthy people. As much as that sucks, that’s not your fault and the most helpful thing you can do is to take really good care of yourself. Experiment with constructive ways to manage your sadness, discouragement and resentment, no matter if that’s mindfulness, positive distractions or finding practical solutions to your problems.

The first step to coping well with a crash or post-exertional malaise is accepting the situation you’re in.

2. Give yourself time and space to rest.

If you have a dinner party or shopping day coming up, plan plenty of time to rest up afterwards. You don’t need the additional pressure of having to keep going when your body’s begging for a time-out. How much time and space you need to recover depends on your specific situation: for a few people a rest day will be enough, others need to take it slow for days, and some need weeks to recuperate.

Of course, you don’t aways know when activity will lead to a crash – if only it were that simple. But when post-exertional malaise is an unfortunate recurring part of your life, have a back-up plan for bad days. Simplify your schedule, stock your freezer with healthy meals and have an extra supply of groceries and over-the-counter drugs for when you’re too ill to go out.

Also, having a quiet place to retreat and recharge helps to put your mind at ease – no loud noises or piles of laundry staring you in the face – and give your body and brain real rest. Speaking of which…

Post-Exertional Malaise: How to Cope with Crashing After Activity | The Health Sessions
Image above and top image by Ivan Samkov via

3. Get real rest.

When you think of resting, chances are you picture yourself chilling on the couch or curled up in bed with your favorite show. But did you know that you could make rest days more restorative?

You see, true restoration comes from activating your relaxation response, a kind of built-in tranquilizer that gets your nervous system out of fight-or-flight mode and into a state of rest and digest. During the relaxation response, your breathing slows down, your heart rate and blood pressure lower, and your muscles relax. In this state of restoration, your body focuses on supporting digestion and immunity.

And the great thing is, you have the power to evoke this relaxation response whenever you want to.

Instead of scrolling through your social media feed yet again, try activities that truly relax your body and mind. Take a warm bath while listening to soft music, visualize relaxing scenarios, do breathing exercises or gentle yoga in bed – anything that both releases tension from your muscles, slows down our your breathing and heart rate, and calms your mind.

And that includes minding your mental diet. Binge-watching Netflix seems like the ideal entertainment for rest days – and sometimes it is – but don’t underestimate the impact of sensory stimulation and emotional processing on how you feel. Ideally, real rest would also include activities that quiet your mind, like mindfulness and meditation. If you feel well enough, you could also clear your head by going for a stroll around the block or spend time in nature (spoonie-proof).

Whatever works for you, give yourself the real rest you badly need.

4. Keep your baseline of daily activities up when you can.

If you’ve been struggling with health problems for a while, you probably know how one crash can set back your overall fitness level for weeks. This decline in muscle mass and strength following a period of bed rest and inactivity is called deconditioning. Research shows that deconditioning caused by illness can lead to falls, immobility and reduced daily functioning, which in turn may result in a loss of independence. That’s why chronically ill people often have to balance between giving their body that much-needed break and not losing the health progress they’ve made.

To prevent deconditioning during a prolonged crash or post-exertional malaise, pacing experts advise to keep your baseline of daily activities up. That means you aim to stick to the simplest version of your daily routines. What that baseline of activities looks like totally depends on your personal health and lifestyle. Some people will still get dressed but in comfy clothes, ditch their workout but still head outside for some fresh air and manage to whip up an easy but nourishing meal. Others might have to swap their shower for a quick wash or wet wipes, stretch in bed instead of going for a walk and sit down at the table for dinner, even though they’d rather stay in bed.

You do not want to push your limits during a crash, but try to keep somewhat active within your boundaries.

Post-Exertional Malaise: How to Cope with Crashing After Activity | The Health Sessions
Save these tips for later.

5. Pace yourself carefully in the period after a crash.

As you’re starting to feel the crash or post-exertional malaise wear off, it’s tempting to pick things up where you left off. You might even overcompensate to make up for lost time, especially if it took a while to recover. But, as boring as it may be, it’s best to manage your energy carefully in the period after a crash.

If possible, keep your schedule and work load light, and make sure you alternate activities with breaks to avoid overexertion. Give yourself enough buffer time – extra time to get things done so you don’t have to stress and hurry when things don’t go as expected.  You could also set simple rules for yourself to help you decide when to push through the pain and fatigue and when it’s time to stop and rest.

Pacing isn’t always easy and life doesn’t always go as planned. But finding a balance between activity and rest that works for you will improve your daily functioning and quality of life.

You can’t always prevent a crash from happening, and even with these coping tips, you may still need time and space to recover from exertion. But hopefully the strategies above will take the edge off your crash and help you get back on your feet again.

What helps you to cope with crashing after activity or post-exertional malaise? 

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