WHAT A YEAR! As the year comes to an end I have been reflecting on my own ups and downs and trying to find my bearings again. It has definitely been challenging at times. In the recent past I have been dealing with some injuries and noticing that my soon to be 50 year old body doesn’t recover quite the same way I am used to!
This past week I had a headache that simply wouldn’t go away, and if you were unfortunate enough to see me you may have encountered a very grumpy person. Now that it has gone away I can see how my mind would focus on “why” it started hurting instead of what made it feel better at this moment.
I kept complaining about how “I couldn’t concentrate on anything” instead noticing that the pain was “telling” me that my headache was coming from my neck. So clearly what I needed to concentrate on was what the pain was showing me because that is exactly what I have spent the last almost 25 years teaching patients.
When my wife helped me with neck mobilizations and manual therapy techniques I use in the clinic, I definitely felt better. But instead of following my own advice, I simply went back to my list of responsibilities I wanted to get done, despite the fact I couldn’t really concentrate and I didn’t really get anything done. I definitely found myself doing exactly what my patients do...ignoring their pain and worse yet avoiding the very thing that makes them feel better. Weird!
So today I thought I would share some of the recommendations I offer to my patients that have had the most beneficial results. And hopefully “I” will be smarter next time and follow these guidelines myself.
First things first...it is important to understand that pain is not a problem as much as it is a clue. Your body is showing you that it is not happy about something...or that we need to pay attention to something. It is important to figure out what the pain is trying to show us and how to prioritize what to focus on so we can find a solution.
Pain is often the body’s way of guiding us back to health and well-being. Let me share how pain can guide us.
The location of pain and the duration of pain are often more important than the intensity of pain when determining the severity of the condition. And therefore more important for identifying the course of treatment.
Let me give you a couple examples.
• Take your left hand and grab your right index finger...bend it backwards slowly until you feel a strong stretch. Notice that as you apply more force the location of where you feel something grows. The more strain to the tissue the bigger the area of symptoms. This often happens as the condition worsens. A degenerated hip for example can start as a pinch in the groin and eventually encompass most of the thigh and pelvis.
• Next, imagine taking a hammer and hitting your thigh muscles...the harder you hit the thigh the bigger the bruise. Similarly the bigger the area of pain the more likely the issue is more significant. Think of lower back pain as compared with sciatica. In both cases the source starts in the back but sciatic pain travels all the way to the toes. The further down the leg the pain goes the more serious the condition.
Typically the bigger the area of symptoms the more severe the condition. It can also inform us of the status of the condition, meaning is the condition getting better or getting worse. If the area is getting bigger the condition is getting worse. Whereas when the area gets smaller, the condition is likely improving. For example if you had sciatic pain that traveled to your toes but now it is in your lower back and buttocks...that means you are getting better.
It is important to meet pain where it is at this moment. Two of the most common mistakes patients make is doing too much too soon or not doing not doing enough soon enough. Generally when things are improving we don’t want to interfere with the progress by adding to it just for the sake of adding. Whereas if the condition is getting worse we want to change the course somehow so it will start to improve. Having a physical therapist guide you will make all the difference.
The duration of pain is another clue that often matters more than the intensity of pain. For example, I rarely get worried about a patient that describes their pain as 10 out of 10...but it only lasts for a split second or a few minutes. I am way more concerned when a patient has pain that goes from a 3/10 to a 5/10...but stays a 5 out of 10 for 3-5 days. The longer duration tells me this is significant.
Meaning even though the intensity only changed from mild (3/10) to moderate(5/10)...the fact that it stayed increased for 3-5 days (i.e. longer duration) is more concerning for me. In this scenario, whatever is being done is making the condition worse. I would change the approach to stop the regression. Whereas a spike in pain (i.e. a brief 10/10) only tells me to be cautious but doesn’t provide enough information as to whether or not I should proceed or should change course.
The intensity of pain can be important of course, but it is also fairly easy to figure out by looking at someone instead of asking them to tell me how intense the pain is. Someone that comes into the clinic in severe pain often has a noticeable appearance. The look on their face, their demeanor, the sweat on their forehead from obvious distress, the controlled way they move, etc.
To help translate the clues, I recommend that you write a few things down.
1. What is guaranteed to make you worse?
• Worse means that your symptoms increase and STAY increased for several hours or days.
• Worse also means that the location of symptoms is bigger or travels further away from the main source of pain.(i.e. Nerve pain travels from the back down the leg).
2. What is guaranteed to make you better?
• Better means that your symptoms decrease and STAY decreased.
• Better also means that the location of symptoms is smaller or gets closer to the site of injury/trauma.
3. Stick with moment to moment assessment.
• Forget yesterday and focus on just now..right now.
If I had listened to my own advice, I would have remembered that when the patient (me) finds what makes them better, that doing more will help them (me) feel better. The most effective treatment is to do more of what helps and stop doing what makes it worse (as defined above). It sounds simple but it is absolutely the starting point and will often lead to better results...faster! Knowing that location of symptoms and duration of symptoms are a better guide will hopefully help you to focus on what is helping so you can improve your pain and get back to the life you want to live!
I would like to take the opportunity to say thank you to my staff for doing such great work throughout this difficult year, also to the patients we are privileged to treat for working hard and taking care of yourselves. Also I would like to thank the community for being so nice and supportive to me and my family!
We are here to help so please feel free to contact us at 518-306-6894 or on our website, www.goodemotept.com. We are seeing patients in the clinic and will continue to stay open for in person care. We are following all NYS and CDC guidelines for COVID-19 and offering virtual therapy for those that prefer to stay at home.
Happy Holidays and Happy New Year!