How to do physical therapy without PEM?


Well-Known Member
How can I modify my PT program so that I don't get PEM/overtraining but still progress in my recovery?

Background: I had a procedure on Dec. 2nd to restore ROM (range of motion) in my shoulder, which had been frozen since March. I've been in PT since, and now I'm mostly out of the "maintain ROM" phase and in the"restore muscle strength" phase.

Between steroid withdrawal symptoms, renewed yeast overgrowth from Christmas treats (sugar, gluten, starch, and dairy), and possible overexertion during therapy, it's hard to be sure just what's happening, but I think my program is too intense and I'm dealing with PEM. I've gotten myself back on the Wahls Paleo program I was following before the holidays, so hopefully the yeast and gut problems will clear up soon.


Active Member
My theory on why physical exertion triggers PEM is that the exertion damages muscle cells (microtears), which activates the immune cells to clean up the damage, which in turn activates the brain's immune cells, which, since they also regulate/assist/maintain other brain cells, results in experienced symptoms. Restoring muscle strength involved intentionally causing those microtears (to trigger rebuilding with more/stronger cells), so that's inescapable. Maybe look for some method to reduce immune activation or cytokine production in the affected muscles?

FWIW, I found that cumin (cuminum cyminum: the spice in curries) was 100% effective in blocking my physically-induced PEM. A level tsp of ground cumin was my effective dosage, and each dose lasted 3 days. After taking cumin every 3 days for ~2 years, I stopped having PEM even without the cumin, and remain PEM-free after several years. I've posted about it before, here and on Phoenix Rising and S4ME, and others have tried it with some reporting mild benefits, but no one else reporting the full benefits I experienced. It seems to have only a small chance of working for most PWME, but a package of no-name ground cumin is really cheap and unlikely to cause any negative effects, so it's like a cheap lottery ticket: maybe you'll get lucky. The worst negative result reported is that some people really hate the taste. I didn't love the taste, but it was a small price to pay for being PEM-free.

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