One step forward…

Recently I had a conversation with a client who arrived frustrated to his session because we tried something new at his previous session. His pain had flared up. His whole reason for coming to therapy (and this is the most common reason) was to RESOLVE his pain and feel better. Despite having made, in my opinion, a lot of functional improvement, he was discouraged.

This was the perfect time perfect time to back off the activity we had been doing and modify it so that it did not flare him up! It was also the perfect time for a little lesson on “what progress in PT looks like” that I give clients regularly. 

Improvement with injuries and movement dysfunction is not linear. We see ups and downs on the way to healing, and your therapist, who keeps track of your goals throughout the therapy process, can look back at what was bothering you when you first came in and tell you how far you’ve come. The dips in progress that result in a flare-up of pain are often from us pushing into something new that gets our sensitive system on alert. In that case we need to back off and modify the program. Things will then get back into smoother sailing so we can still progress toward goals.

This experience brought up a lesson on how my client could monitor and appreciate his own progress between visits.

I will use back pain with shopping as an example, but you can insert any activity that concerns you (sex, sports, working at your desk) in it’s place. 

Progress in PT looks like: 

1. Being able to do MORE at the SAME LEVEL of pain. Say you had 5/10 back pain that increased to 8/10 after one hour of shopping, and now you have 5/10 back pain with 90 minutes of shopping. 
2. Having less intense pain: Your back pain level with 60 minutes of shopping used to be a 5/10 and now it is a 2/10.
3. Having pain less often: Your low back pain during shopping happens third or every other time instead of every time you go shopping, like it used to.
4. Pain comes on later in an activity: Your back pain used to come on as soon as you got out of the car to shop. Now it starts about 10 minutes into the shopping trip.
5. Pain settles down faster: Your post-shopping back pain used to need all evening to go back down and get comfortable. Now it takes only about 20 minutes (and if you are a patient at Foundational Concepts, you already have some techniques to speed up that process!)
6. Pain is easier to settle down: You need a lower dose of meds (though always follow your doctor’s advice on medicines and dosage schedule), or you no longer need to apply ice or heat, or you just need to do a few short techniques to ease the pain. You are more confident that you can ease symptoms as they come up. 

Since we are talking about real life here, and not life in a perfect bubble, we will see any and all of the above happening, and you may see different manifestations with different activities. 

The client in question was given more resources for pain management and he left our visit realizing where he had made progress and where we needed to change course. Your therapist is a great ally and can help you by looking back in your chart to show you how far you have come. They should also be able to help you get out of that flare-up and discuss your individual goals for a pain free and dysfunction-free life.

• Marla Jacquinot, DPT