The Spoon Theory For Chronic Illness Explained

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Chronic pain is one of those “invisible illnesses” because there are typically no outward signs.  This causes a social problem where friends and loved ones may have difficulty relating to your pain or understand your daily challenges. This can be frustrating and cause you to feel isolated and alone.

 Yet there are thousands of others out there with similar challenges.

One such person is Christine Miserandino. One day Christine was talking to a friend who was struggling to understand her physical and mental energy limitations. During the chat Christine grabbed a bunch of spoons and explained that each spoon represented an amount of energy required to complete a task. Later, she fully fleshed out this concept into Spoon Theory.

Her Spoon Theory Explained There’s a Finite Number of “Spoons” Each Day

When spoons are gone, so was the energy to perform tasks.  While others only needed 3 spoons to bathe and dress, because of her chronic illness she needed 8, often running out of spoons before the day was done.

Like spoons, our bodies use Metabolic Equivalents or METS to perform tasks.   The MET level*of a task represents the typical energy (oxygen) required to perform that task. It’s  based on the energy costs sitting at rest or lying down (1 MET).  

For example, a task with a MET level of 3 uses 3x the energy used to sit at rest or be lying down.  Daily personal care tasks (e.g. brushing your teeth, taking your medications, talking and eating) score anywhere from 1 -2.5 METs depending on how they are performed (i.e. sitting or standing).  As the task becomes more challenging, the MET level increases: MET level chart for daily.

With Chronic Illness Your Body Has To Work Harder

This results in consuming more energy or spoons, resulting in a higher Met level

It seems objective, yet we are often our worst enemy, dismissing conceptually easy tasks by what we did, not by how it felt to do it.  

Recognizing your perceived energy expenditure of a task, and factoring in your pain will give you a much better idea of your personal workload. This self-awareness especially applies to activities taken for granted as “no work” .

Getting in touch with your body is the first step to understanding energy conservation strategies.  Ask yourself how hard did it feel performing the task, regardless of what it was. 

Or put another way, how many spoons did it cost you?

The RPE: Are You In Touch With Your Body?

The below medically validated BORG Rate of Perceived Exertion chart (BORG RPE) used clinically quantifies the amount of effort perceived exerted.

Rate of Perceived Exertion chart

Rate of Perceived Exertion chart

RPE is subjective since it’s different for everyone, similar to the pain scale. RPE tries to quantify the pain and effort to perform any individual task. You can use the modified scale of 1-10 or the traditional scale of 6-20.  If you are number adverse, you can simply use the qualifiers typed alongside it.  

You can use RPE as a tool to practice awareness of how much effort your body spends on certain tasks. It’s also helpful to identify other’s effort awarenessWhen a person is sweating and breathing hard, yet tells me that the walk to the bathroom they took was a “3/10” or “11/20” on the RPE scale, I know they are not getting it.  It was more of a “hard to very hard” activity.

When you are determining your score, think also of how long you could perform the activity.  Could you continue the task for more than 1 min, 3-5 minutes, 10 min, 20 min or longer? If you are giving yourself a low RPE score but can only perform the task for 5 minutes, you are not in touch with how you “feel”.

Don’t Have Unrealistic Expectations

It is what it is. And once you understand how you feel; you can begin to improve it.

Jay Berger of RehabSmarter is a Physical Therapy Specialist on Wellacopia

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