Episode 149: Not all Post-Exertional Malaise (PEM) is the same
Not all post-exertional malaise (PEM) is driven by the same physiology — and understanding the difference can completely change how you approach pacing and recovery. In this episode, Anna breaks down the three most common patterns of post-exertional crashes seen in clinical practice: autonomic “hit the wall” crashes, metabolic “wired but exhausted” responses, and delayed immune-driven flares. You’ll learn why timing matters, how different symptom patterns reflect different underlying mechanisms, and why applying the wrong strategy can stall progress.