10/21/2025
I am exhausted all the time. Everyone keeps telling me to exercise more. But then I feel more exhausted… sometimes with flu-like symptoms and being ill in bed for one or more day(s) after. Does this sound familiar?
Some level of feeling tired is normal after exercise… especially when you have autonomic dysfunction. But there’s a subset of individuals who feel ill after, often delayed and prolonged and out of proportion to the stimulus or event that triggered this feeling.
For example, someone makes cookies or goes to the grocery store and the day or two later isn’t able to get out of bed due to feeling ill for several days.
This is post-exertional malaise (PEM). This requires a different approach to physical therapy. Swipe through to learn more and check out our live with for more!
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Hi! I’m Emily Rich, OT, an occupational therapist specializing in conditions such as postural orthostatic tachycardia syndrome (POTS), Ehlers-Danlos syndromes (EDS) and hypermobility spectrum disorders, and related conditions such as MCAS, ME/CFS, long-COVID, and more. Join me here where I share about things I value as a patient, researcher, and a provider.