The Boom and Bust Cycle in FND

One of the most frustrating things about living with FND can be the way your symptoms and energy can change from one day to another.

You may have a day when you feel surprisingly well. Your symptoms might be quieter, your energy may have returned and you may suddenly feel that you can do all the things you have been unable to do.

It can be tempting to think:

“I feel good today, so I'm going to make the most of it.”

You might catch up on housework, go shopping, meet friends, work on a project, exercise, go out for the day or try to complete everything you've had to put off.

At the time, it can feel fantastic.

Then the following day — or sometimes later that same day — everything catches up with you.

Your fatigue can become overwhelming. Pain may increase. Tremors, weakness, movement difficulties, speech problems or other FND symptoms may become more noticeable. You may need to spend much of the next day, or several days, recovering.

This is often described as the boom and bust cycle.

What is “boom and bust”?

The boom is the period when you feel better and have more energy or fewer symptoms.

Because you feel capable, you do more.

The bust comes afterwards, when your body and nervous system struggle to cope with everything you have asked of them.

It can look something like this:

Feeling better → doing more → feeling good → doing even more → exceeding your available capacity → symptoms increase → exhaustion → recovery → feeling better → doing more again.

This can become a repeating cycle.

It is important to understand that this isn't about a lack of willpower or poor decision-making. In fact, it is very understandable.

If you have spent days or weeks struggling to do things, having a good day can feel like an opportunity to get your life back.

You may also feel that you need to make the most of the opportunity because you don't know when you will feel that good again.

Why does it happen?

Our energy isn't necessarily an unlimited resource that we can simply spend because we feel better.

When symptoms improve, the underlying factors that have contributed to fatigue or reduced tolerance may not have completely disappeared.

You may still have limited physical, cognitive or emotional capacity even though you temporarily feel much better.

This is particularly important with FND because symptoms can fluctuate considerably.

For example, you might normally manage a 20-minute walk comfortably. On a good day, you might feel so well that you decide to walk for an hour.

The problem may not become apparent immediately.

You finish the walk thinking:

“That was fine. I feel great.”

But later that evening, or the following day, you may experience a significant increase in symptoms.

The activity itself wasn't necessarily “bad”. The difficulty was that the amount exceeded what your body could comfortably recover from at that time.

The danger of the good day

A good day is not a bad thing.

It is important not to become frightened of feeling better or to deliberately restrict yourself whenever your symptoms improve.

Instead, a good day can be an opportunity to practise pacing.

One of the hardest things to learn is that feeling better doesn't necessarily mean that you have to do everything you've been unable to do.

You don't have to “cash in” all your energy at once.

Imagine that you have been given a small increase in your available energy. You could spend all of it in one afternoon, or you could spread it across several days.

The second approach may allow you to do more overall.

Learning your baseline

One of the most useful ways of managing boom and bust is to work out what you can consistently manage.

This is sometimes called finding your baseline.

For example, perhaps you can usually walk for 15 minutes without causing a significant increase in your symptoms.

On a good day, you might feel able to walk for 30 or 40 minutes.

Instead of immediately doubling your activity, you could consider keeping your activity closer to your usual manageable level for a period of time.

The aim isn't to stay at the lowest level forever.

Instead, once your activity becomes more consistent, you can gradually increase it when appropriate.

This is where advice from a healthcare professional, particularly a physiotherapist or occupational therapist familiar with FND, can be helpful.

Pacing rather than pushing

Pacing means spreading your activities and energy more evenly, rather than repeatedly going from doing everything to doing almost nothing.

Instead of:

“I feel good, so I'll do everything today.”

try:

“I feel good today, so what is the most useful thing I can do without using everything I have?”

This might mean:

• Doing one major household task rather than five.
• Taking breaks before you become exhausted.
• Stopping an activity while you still have some energy left.
• Spreading jobs across several days.
• Alternating demanding activities with easier ones.
• Allowing recovery time after something particularly demanding.
• Keeping enjoyable activities in your routine rather than only doing them on good days.

The goal is consistency, not maximum output.

Don't wait until you are exhausted

One of the biggest challenges with pacing is recognising when to stop.

If you wait until you are completely exhausted, you may already have gone too far.

Instead, try to notice the earlier signs that your body and nervous system are reaching their limits.

These might include:

• Increasing fatigue
• Increasing pain
• Tremor becoming more noticeable
• Increasing weakness
• Difficulty concentrating
• Feeling overwhelmed
• Increased sensory sensitivity
• Becoming irritable or emotional
• Feeling “wired” but exhausted
• Finding it increasingly difficult to control symptoms

These warning signs can be your body's way of telling you:

“I need a break.”

Taking that break isn't giving up.

It is part of pacing.

The 24-hour rule

For some people, the consequences of doing too much aren't obvious immediately.

You may complete an activity and feel completely fine.

The problem might appear several hours later or the following day.

This is why it can be useful to consider:

“How did I feel later that day and the next day?”

rather than judging an activity solely by how you felt while doing it.

If you repeatedly notice that a particular level of activity results in a significant increase in symptoms the following day, that information can help you understand your current limits.

Keeping a simple activity and symptom diary can sometimes help identify these patterns.

Rest is not failure

Rest can sometimes feel frustrating.

Especially when you finally have a good day, sitting down and resting can feel like wasting an opportunity.

But rest is not the opposite of being productive.

Rest is part of managing your available energy.

Think about your energy like a battery.

If you continually run it down to zero, you may spend much longer waiting for it to recover.

Taking regular breaks before you reach empty may help you stay more consistent.

Rest also doesn't necessarily mean lying completely still all day. It could mean reducing stimulation, sitting somewhere quiet, switching to a less demanding activity, or simply giving yourself time without having to achieve anything.

Be careful with the “catch-up” mentality

It is completely understandable to think:

“I've been unable to do this for three days, so now that I feel better I need to catch up.”

Unfortunately, this can be exactly what keeps the boom-and-bust cycle going.

There will always be jobs waiting.

There will always be emails, cleaning, shopping, paperwork and other things that could be done.

Trying to complete everything on a good day can leave you with even less capacity afterwards.

Instead, ask yourself:

“What actually needs to be done today?”

and:

“What could wait?”

Not everything needs to be completed just because you can do it today.

A good day doesn't have to become a great day

This can be one of the hardest lessons.

If you normally feel unwell and suddenly wake up feeling much better, it is natural to become excited.

You may want to make the most of it.

But sometimes the best thing you can do with a good day is have a good day without trying to turn it into an exceptional one.

Enjoy the improvement.

Do something you enjoy.

See someone you care about.

Complete something important.

But leave something in reserve.

That can help break the cycle of:

Boom → Bust → Recovery → Boom → Bust.

Managing the boom and bust cycle

There is no single pacing strategy that works for everyone with FND.

However, some principles may help:

1. Find your current baseline

Work out what you can do reasonably consistently without causing a significant worsening of symptoms.

2. Don't automatically increase activity on a good day

Feeling better is encouraging, but it doesn't necessarily mean your capacity has permanently increased.

3. Take breaks before you need them

Don't wait until you are completely exhausted.

4. Spread activities out

Where possible, avoid putting all of your demanding activities into one day.

5. Alternate activities

Follow a demanding activity with something less demanding.

6. Consider the next day

Notice whether an activity affects your symptoms later that day or the following day.

7. Build gradually

If your baseline becomes more stable, increases in activity can be gradual rather than large jumps.

8. Keep enjoyable activities

Your life shouldn't become entirely about managing symptoms. Make room for things that give you pleasure and meaning.

9. Don't blame yourself for a crash

Sometimes you will get the balance wrong. That doesn't mean you have failed.

10. Work with your healthcare team

A physiotherapist, occupational therapist or other clinician with experience of FND can help you develop an appropriate activity and pacing plan, particularly if your symptoms significantly restrict your daily life.

Breaking the cycle

The aim of pacing isn't to make you do less forever.

It is about finding a way to make your activity more sustainable.

Instead of having occasional days where you can do everything followed by several days where you can do almost nothing, the goal is to gradually find a level of activity that you can maintain more consistently.

Over time, that may allow you to increase what you can do without repeatedly pushing yourself into a significant flare.

And remember:

A good day isn't an invitation to empty the tank.

Sometimes the best way to make tomorrow a better day is to leave a little energy in the tank today.