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Lyme Disease Message Board

Lyme Disease Board Index

Re: Herx???
May 1, 2005
Hey Mydad,
Sorry I did not mean to insult you if I did. Yes we disagree no big deal. It is just everything I have read and most docs including mine say exercise is good but if you are too sick then no way. But if you are able to exercise you should continue to do so but never over due it.

It was late last night and I should have elaborated but duprey summed it up well. Again sorry I was not picking on you and in hind sight I should have reworded my post. Yes my name is Michael. We have way to many Michaels in our family (wifes) and when we have a get together you never know who is calling which Michael.

Dr B reommends the following and keep in mind these are very ill people that are not able to exercise.
Because of the extreme fatigue and body pain, many Lyme sufferers end up spending inordinate amounts of time in bed, and get far less exercise than they did before they became ill. This begins a debilitating downward spiral that can be very difficult to reverse.

As a result, Lyme patients are stiff, weak, tired, have poor stamina, and are at increased risk for cardiovascular disease and diabetes. Antibiotic treatment alone cannot correct these effects. Therefore, it is necessary to prescribe physical therapy, the extent of which depends on an individual patients' condition, followed by a graded exercise program.

The earliest phase involves multiple modalities (massage, heat, TENS, MENS, ultrasound, etc.) and aggressive range of motion exercises supervised by a physical therapist, to relieve discomfort and to promote better sleep and flexibility. The goal of physical therapy is to prepare the patient for the required, gym-based exercise program. This starts with stretching and mild muscular toning. Then, the program must expand to include muscular conditioning and strengthening, ideally under the supervision of a credentialed exercise physiologist. “Body sculpture” classes are ideal. Aerobics are not recommended until the patient has fully recovered.


Relieve pain and muscle spasms utilizing multiple modalities as available and as indicated: massage, heat, ultrasound, TENS, "micro amp", etc.
Increase mobility while protecting damaged and weakened joints, tendons, and ligaments, to increase range of motion and relieve stiffness.
Physical therapy alone is not enough. The role of physical therapy here is to prepare the patient for the required, preferably gym-based, exercise program outlined below.
EXERCISE Begin with a private trainer for careful direction and education.

PATIENT EDUCATION AND MANAGEMENT (to be done during the initial one-on-one sessions and reinforced at all visits thereafter):

Instruct patients on correct exercise technique, including proper warm-up, breathing, joint protection, proper body positioning during the exercise, and how to cool-down and stretch afterwards.
Please work one muscle group at a time and perform extensive and extended stretching to each muscle group immediately after each one is exercised, before moving on to the next muscle group.
A careful interview should be performed at the start of each session to make apparent the effects, both good and bad, from the prior visit's therapy, and adjust therapy accordingly.

Aerobic exercises are NOT allowed, not even low impact variety, until stamina improves.
Conditioning: work to improve strength and reverse the poor conditioning that results from Lyme, through a whole-body exercise program, consisting of light calisthenics and weight lifting, using small weights and many repetitions. This can be accomplished in exercise classes called “stretch and tone,” or “body sculpture,” or can be achieved with exercise machines, or carefully with free weights.
Each session should last one hour. If the patient is unable to continue for the whole hour, then modify the program to decrease the intensity to allow him/her to do so.
Exercise no more often than every other day. The patient may need to start by exercise every 4th or 5th day initially, and as his/her abilities improve, work out more often, but NEVER two days in a row. The days in between exercise sessions should be spent resting.
This whole-body conditioning program is what is required to achieve wellness. Simply placing the patient on a treadmill or an exercise bike is not acceptable (except briefly, as part of a warm-up), nor is a simple walking program.

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