Flares

[Bubble56]

Does anyone know if a little excess exercise can cause a flare? We are going on a family ski holiday and I want to ski for just a couple of hours ( so I know I can still do it at 63!) I’m a very competent skier but don’t want to upset my PMR - I’m tapering down to 10mg having been diagnosed October 2019.

[DorsetLady PMRGCAuk volunteer]

Not necessarily - but just take it easy - difficult for a competitor maybe, but it’s really in your hands.

Maybe one of the shorter runs, and not every day!

And don’t taper just before you go, or while away. Leave it until you get back home.

Enjoy.

[Suffererc in reply to DorsetLady]

It did for me. I am no expert but excess walking really put me backwards.

[DorsetLady PMRGCAuk volunteer in reply to Suffererc]

Yes, the answer I think lies in the “excess”. Easily done, regretted later 🤦🏻‍♀️🤣😂

[SnazzyD]

Listen to your body and don’t commit to anything that doesn’t have bailout points so you can retire at the slightest hint of fatigue. Though if you are anything like me, the too much point happens before the signs to I have to impose set stop points before the event. Tiresome but effective. The most important thing is to enjoy.

[HeronNS]

As the others said, do only what you enjoy and be careful not to get carried away because you are having so much fun. Remember that advice to always leave a party when you are having the most fun? Stop the skiing while you are still feeling great and want to do more. You can't, just now, do that little bit more. I don't know that exertion causes flares as such but it can certainly contribute to feeling not so great the next day. Better to have a couple of good runs one day and save energy for a couple more the next day. As you are a skilled skier just be aware that your muscles are not at the moment as strong as they were before PMR/pred, nor are they as resilient so your recovery time will take longer. I'm sure there are other fun but relaxing activities that take place at ski resorts, so enjoy them too.

Have a great time! I personally have always done well while on holiday, but mine consist of sightseeing, not hard physical activity!

[PMRpro Ambassador]

When did you last ski? And have you been "in training" with PMR? Be warned that repetitive actions will overload muscles and the DOMS (Delayed onset muscle soreness) will be worse than you are used to and take longer to resolve.

I skied for the first 9 years of PMR, both with and without pred. What I DID have to do was start with a few short runs and build it up slowly - but I live at the bottom of a ski run, it wasn't dependent on a week's holiday. And even as an experienced skier - I would say initially stick to one level below your usual top and stick to shorter runs - I could do a lot more if I did short runs because the rest on the lift was essential for recovery of the muscles.

And this was a point where more short runs was infinitely prefable to fewer harder ones - as I liked being out in the sun more than spending all day rushing to another run. As a local, "gemuetlich" is preferable - unhurried or comfortable. It results in less damage! As you would have gathered if you had been with me last Saturday in the local ED!!!

I DO have confess to having used topical ibuprofen on my quads before skiing It did help a bit.

[Pym1 in reply to PMRpro]

Agree wholeheartedly and with experience!

[Maisie1958]

I haven’t skied for over 30 years and certainly wasn’t competent then but I’d say go for it. Like HeronNS I’ve always felt better on holidays. It’s not that long since your diagnosis so do be careful not to overdo it but I think doing what you enjoy makes such a difference mentally it’s worth the risk of feeling a bit off physically. I’ve continued to ride the pony but not to the standard before- she doesn’t mind nor do I. I think you have to be kind to yourself and not be competitive-even if it’s only with oneself . All good wishes.

[Twinwood]

Hi, I'm in almost the same boat. Diagnosed PMR early December 19, started on 15mg and am down to 11mg. Going skiing in a week and hoping to ski 4 out of 6 days (reserving a couple of rest days as necessary). I won't be taking on anything remotely near my competence level...shortish runs with lots of stops and stacking early while I'm still hopefully feeling ok. Bit worried about falling as I haven't got much power in my shoulders to get back up...that's what friends are for I guess? Have a great time!

[Pym1 in reply to Twinwood]

😂 Me too, was down to 3.5 but trips home o UK for a funeral and back to Switzerland must have caused more stress than I realised because I had a flare and self-medicated back up to 8.5 which has helped a bit. What happened to the early diagnosis ‘it will probably be ok in a couple of years’?

I’ve found friends really sympathetic and helpful. I feel a wimp holding people up more than I did, but hey, I’m still here and there are lots of other things to do.

Have fun.

Pym1

[Bubble56]

Thank you all for your helpful , and I must say, encouraging comments. I skied last year ( and every year for 27 years) I’m very much looking forward to our trip to France and I KNOW that even if I just ski half a day it will help me feel I haven’t “ given up”. You have made me feel better, thank you.

[Blearyeyed]

You will need to be careful.

Skiing does use alot of physical energy and needs joint flexibility and muscle strength.

You would put it in the same bracket of full body exercise of running , raquet sports , horse riding, road cycling or aerobic / circuit training all of which will bring next day Fatigue and Rebound Body Pain and could give PMR Pain as well as Non PMR pain.

Don't taper in the week before your trip or during , allow rest days after your trip before a taper starts also .

Adding in general extra Stress activities of being on holiday , travel and the weather there are alot of triggers for PMR Activity to increase.

I'd suggest if you are going to try it , don't do it on the first few or last few days of your trip when others stresses will have made you tired.

Warming your joints before may reduce the Pain caused as well as doing no more than 15/20 mins slope activity at a time , no matter how good you feel while your doing it , then having a gentle cool down and rest and a relaxed evening after.

If you have said you will do it to others but do feel it will be too much once you get there don't just do it , you won't be letting anyone down by needing to say No , or making simpler , shorter skiing choices if you do take part .

This may allow you to have a go without bringing on a Flare of any sort of Pain or the need to increase you steroids later.

Have a lovely break

[Bubble56]

Sounds very sensible, thank you.

[Pollyanna16]

In my experience the trick is to know when to stop! Try not to have long days which can be tricky when you are in a group I know. Or perhaps have a day off here & there. Enjoy the wonderful snow & blue skies, it will uplift you. After a 5 year break (due to arthritic knees rather than PMR)joined my husband & friends last year & took my walking boots & sticks. Was able to meet them for lunch a couple of times & just loved being out in the mountains again. Enjoy ❄️⛄️

[Noosat]

Just be very careful and monitor your body. However, don't think that every pain is a PMR flare. Do you have other issues, such as any form of arthritis ?When you get on the slopes try to relax your body. Have a great time.

[PMRnewbie2017]

GO!!!!

I can't ski this year because OH is booked for a knee replacement but we went twice last year when I was on 6mg. We didn't do a lot but the fantastic snow (12 foot in Austria!) was a tonic in itself. If you fall over getting up can be harder than you remember because those damn muscles aren't as strong but if you are competent, do as others have suggested and don't ski the blacks!! Take some Ibuprofen or similar to mop up exercise induced inflammation. Enjoy yourself.

As for over exertion causing a flare? I'm not so sure. Sure your muscles will complain but does this cause your immune system to pump out more Interleukin 6 and cause a true clinical flare ??????????

[RecentPMRdiag]

Hi Bubble56,

I am about 1 month behind you (diagnosed in late Nov 19) and have just returned from my annual ski trip. I went with some trepidation, treating everyday day skiing as a bonus, and prepared to have many days in the chalet, if required. In the end I managed 6 days skiing in a week and found the long days of travel to and from the Alps much more challenging than the skiing.

A couple of points that I couldn't see in the other replies:

o I assume you are doing Alpine downhill. X country - would be very challenging in comparison to the Alpine. I stuck to red/blue/greens - just one cheeky black on the penultimate day. I had to ski within my previous abilities and endurance as the Pred reduces my feel for muscle and joint fatigue.

o I felt the cold much more than pre-PMR (probably due to less fat now; less muscle to create heat; less oxygen to the remaining muscles). Mittens, extra leggings helped with the icy chairlifts in the mornings!

o My skin was a bit tender – especially around the top of ski boots (I used Neutrogena Norwegian hand cream - seems like vaseline) before and after putting on my socks.

oI have lost a lot of leg muscle, so knees are less stable, even though I now weigh less – so had my knee braces on

everyday, and did some remedial exercises for leg strengthening in the weeks before.

oEating and drinking healthily can be problematic – we self-cater so could take porridge etc. and took extra effort on hydration.

Just in case

oTake extra Pred. in case you need to increase for a while

oBrief your party on the condition and local medical contacts

oTake a local language conversion of the steroid card info.

oSpeak to your insurers – I have always used the BMC. Their medical helpline seemed to understand PMR.

Enjoy your trip!

[Bubble56 in reply to RecentPMRdiag]

Thank you very much for your extremely useful tips. I am looking forward to it and I will just be pleased with a little skiing. The snow and fresh air and family fun will be uplifting.

[daworm]

I wouldn’t say I’ve had a flair, just some “extra” stiffness and soreness nothing that lasted too long....and I’ve certainly “pushed the envelope” a few times in the last 2 1/2 years....GO FOR IT!

[Joydeck]

I 'm 70, almost 2½ years into PMR, and regularly ski both downhill and cross-country seven hours a day without ill effect.

[PMRpro Ambassador in reply to Joydeck]

Ah - but the point is you have been doing it "regularly". Once I was trained up each season I had no problems. The first 3 weeks was rather different though.

[Joydeck in reply to PMRpro]

Regularly? Yes, I have maintained a high level of daily exercise since starting pred. Just as I did before PMR.

In the six weeks before starting pred, my exercise was limited by PMR pain. Nevertheless, I managed a couple of hours of less strenuous exercise each day.

[PMRpro Ambassador in reply to Joydeck]

That was my point - with PMR the skiing discussion does depend on whether you have been doing it steadily and by its very nature - skiing goes into abeyance in summer!

[Pym1]

I know your concerns. I’m currently in the Swiss Alps watching snow falling and debating whether to go out!

I’m 75, developed PMR 2.5 years ago and am still working on a routine to help me keep skiing.

On the subject of exercise itself I reckon it helps to relieve my symptoms. I cycle when I’m at home but find more than an hour is a bit OTT

The first ski I had about 4 months after diagnosis when I was probably taking about 12.5mg Pred. I was alarmed by how tired my thighs were even after short runs, and how quickly they ‘went’. I’m into my third season post PMR now but do get tired - that might just be anno domini anyway.

My suggestion would be to make sure you pace yourself AND from experience if it’s going well there’s a temptation to push on! Careful, you might pay for it later.

I’ve also found it helps to warm up well, not just ‘hands, shoulders, knees and toes’ but really get warm and stretch well at the end of the day.

Get out there and enjoy it!

Good luck,

Pym

[PMRpro Ambassador in reply to Pym1]

Exactly! At the start of every season skiing with PMR, with or without pred, I needed a few weeks to build up from 3 short runs to not needing to count the short runs - but having the rest on the lift was the only way it worked. I couldn't do a run the same length as even 2 short ones in one - even when I spent the entire morning on the short ones. It took until about February skiing 2 or 3 times a week before I could confidently set off on our longer ones.

[Pym1]

As it’s pretty much ‘white-out’ here in Wengen today I have had time to read all this thread.

So many similar experiences I think we could start a new group - PMRski !

It’s been really comforting to be reminded that there are so many people ploughing this furrow and with very similar views.

Many thanks to everyone who has posted - and for starting this thread.

Ski safe, everyone!

Pym1

[PMRpro Ambassador in reply to Pym1]

Quite a lack of lifts in places here - only one off on our mountain though - but all due to wind which is no doubt making skiing unpleasant ... But then, I have very high standards when it comes to skiing weather ...

[Bubble56]

A propos my question on skiing, I have skied and took your advice.... several vins chaud and rests and the therapeutic value of it outweighs any pain I’m feeling! I felt “normal” again and it was fantastic. It’s so easy to become self absorbed with this condition- do what you can to get pleasure.

Thank you for all your advice.⛷😃

[Hidden in reply to Bubble56]

Great stuff!!