A clinical program of Energize Occupational Therapy Services
Rest and Recovery in Chronic Pain
People living with chronic pain are often encouraged to rest when symptoms increase. Rest can be necessary and valuable. However, stopping an activity does not always mean that the body is recovering, and recovery does not always require stopping completely.
A person may be sitting or lying down while still holding muscular tension, concentrating intensely, monitoring symptoms or coping with emotional stress. Although one activity has stopped, the overall physical, cognitive or emotional demand may remain high.
Stopping completely may not be possible. People still need to care for themselves and their families, participate in work and manage everyday responsibilities.
I developed the terms “Active-Working” and “Working-Recovery” to describe different levels and types of effort. They are not diagnoses or rigid categories. They describe how demands can change within and between activities.
“Active-Working”
“Active-Working” involves greater physical, cognitive or emotional effort.
This could include preparing a meal, lifting objects, completing work that requires sustained concentration, managing a stressful conversation or functioning in a busy environment. Many activities involve more than one type of effort.
“Active-Working” is not inherently harmful. It is a necessary and meaningful part of life. The concern is not that effort is being used, but that demands may continue to accumulate without being recognized or adjusted.
Pain, weakness, fatigue, muscle guarding and concentration can also affect how demanding an activity feels. Two people completing the same task may use very different levels of effort.
“Working-Recovery”
“Working-Recovery” involves changing how an activity is performed, increasing physical support or switching to a lighter activity so that some demands can decrease while the person continues participating.
This might involve sitting for part of a task, supporting the arms or back, changing position, reducing repetition or alternating a demanding task with one that requires less effort. Cognitive and emotional demands may also need to be considered.
The change needs to be meaningful for the particular person. An activity that feels restorative to one person may still require considerable effort from someone else. “Working-Recovery” cannot be defined by a universal list of light activities.
It also does not mean that all effort stops or that symptoms immediately disappear. It means that the overall demand has been intentionally changed or reduced.
“Working-Recovery” Is Not Pushing Through
“Working-Recovery” is not a way of ignoring pain or continuing an activity at any cost. If a modification does not meaningfully provide an opportunity for recovery, it does not support ongoing functioning.
"Working-Recovery" also respects that there are times when changing an activity is not enough. A person may need to stop, rest more fully or reconsider what they are doing. New, severe or concerning symptoms may require medical assessment rather than a pacing strategy.
Balancing Support and Challenge
The goal is not to remain in “Working-Recovery” all the time. Physical support and reduced demands can help settle symptoms and make participation possible. However, when demands remain reduced for longer than needed, the body may have fewer opportunities to maintain or develop strength, endurance and activity tolerance. Over time, this can contribute to deconditioning.
“Active-Working” provides challenge, while “Working-Recovery” creates opportunities to reduce and recover from that challenge. Both have a role. The appropriate balance depends on the person, the activity, their current abilities and how their symptoms respond.
Preventing deconditioning does not mean removing support too quickly, pushing through symptoms or assuming that more activity is always better. It means using support deliberately while preserving appropriate opportunities for movement and effort.
Moving Between Different States
“Active-Working” and “Working-Recovery” can be alternated in response to the person’s signals rather than only following a fixed schedule. A person may move between them several times during an activity or throughout the day.
Recognizing when to make that transition depends partly on noticing early changes in tension, posture, breathing, concentration, fatigue or pain. This connects “Working-Recovery” with interoceptive awareness: recognizing what the body is communicating before symptoms become overwhelming.
Rest and activity do not always need to be opposites. The goal is to develop more options than either pushing through without adjustment or stopping completely—and to make more deliberate choices about when challenge, support or fuller recovery is needed.
References
National Institute of Neurological Disorders and Stroke. (2026, March 13). Pain. https://www.ninds.nih.gov/health-information/disorders/pain
World Health Organization. (2023). WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. https://www.who.int/publications/i/item/9789240081789