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One Step Back, Two Steps Forward | A Guide on How To Navigate Rehabilitation and Gauge Progress

Written by:

Dr. Eric Brown, PT, DPT, OCS

Owner & Physical Therapist of Movement Restoration Physical Therapy (Sioux Falls, SD)

APTA Board-Certified Orthopedic Specialist

If you've ever recovered from an injury, you've likely experienced periods of improvements in your pain and function and setbacks along the way. That being said, having a 'bad day' when you feel more sore or restricted in the things you need to accomplish in your day can be frustrating.

When there is uncertainty in your recovery and the prognosis is not clear, you may start asking yourself:

  • "What am I doing wrong?"

  • "Am I doing the right things?"

  • "Am I broken beyond repair?"

Not only can these self-reflections be disheartening, but one's anxieties and internal struggles can also amplify pain, disability, and suffering.

When appropriate, I always try to combine what I observe in the clinic with the information patients share with me during their visit in order to share a new perspective. During a session, I ask probing questions to really get a sense of whether they are stuck in their progress or just having a quote on quote 'bad day'. In a physical therapy setting, I try to have my patients see the overall picture from when they started to where they are today. Here are several questions I like to ask.

Since starting your journey to recovery...

1. "Are you engaging in your daily activities without as much limitation?"

Are you able to work longer without needing as many breaks? Are you able to complete your daily chores at home without being as hindered? Are you getting back to the things you love without flare-ups? Probing questions like these can help you take a step back and see the bigger picture of how your day is going.

2. "Are the qualities of your symptoms changing?"

Intensity and location are parameters that one can keep track of periodically. Is that sharp, stabbing pain now more dull? Are symptoms now more local to one spot versus more diffuse? Symptoms gradually changing in these ways are generally a good sign of recovery.

3. "Are symptoms not as intense? Are they less frequent? Are they lasting as long as before?"

It's less of a black and white question of "Is there pain or not?" but rather nuance and grey areas of improvement. Comparing the intensity, frequency, and duration of your symptoms over time can be helpful in understanding the nature of your pain.

4. "Are there more 'good' versus 'bad' days in a week?"

Three 'bad days' and four 'good days'? Only one 'bad day'? What's the ratio? You may find that you're getting through your week with greater ease and not realizing it!

5. "Are you able to recover and bounce back from flare-ups more easily?"

If you get knocked down by your symptoms, start taking notice of how long it takes to recover. Instead of being out for a week due to symptoms, are you back in a couple of days, hours, or even minutes?

6. "Have you been reducing the amount of medication you've needed to take?"

Taking fewer NSAIDs, muscle relaxers, and prescription pain medication is a great sign that things are on track. As your daily life activities become more comfortable, you may notice you aren't popping as many pills.

7. "Are you obtaining more restful sleep?" -

Sleep is under-rated and often a missed component of rehabilitation. It is critical for our physical and mental health. Tossing and turning due to pain may keep you up and prevent you from getting into the cycles of deep sleep. That being said, If you're getting through the night feeling rested, getting through your day will be that much easier.

In response to these questions I often hear, "Actually, yes! I guess I have been able to ___(insert activity)___." or "That's right, even though the pain is still there, I'm getting through my workday and sleeping much better". Now the answer to each of these may not be a resounding "Yes!", but if we are seeing a positive trend with any of these questions - that's a great sign!

The Bigger Picture

As you can see, there are nuances to how we together can gauge one's overall progress. If we focus on one parameter such as pain, for example, we may miss the bigger picture. I often tell my patient's progress is non-linear, meaning it has many ups and downs - much like the stock market! If you zoom in on the graph of an individual day of trading it may seem like the investment you've made in yourself is lost. However, if you zoom out a bit you'll see a positive growth trend.

By asking these questions, it's never my intention to downplay or be dismissive of someone's pain and suffering. It is real and not to be dismissed. As a physical therapist, not only do I want to show empathy I also want to show a new way. Sometimes the path towards health is like navigating a trail with trees, bushes, and rocks in the way.

A trained professional can help guide you around these obstacles if you're stuck along your journey. Physical therapists and mental health professionals alike are equipped with the tools and guidance you may need to ensure there is a foothold for you to take the next step along the way.

Therefore, by arming my patients with these self-reflective questions, it is my hope they will be well-equipped to set manageable expectations for their recovery and ultimately reframe their progress with a positive outlook.

And remember, no matter how small, keep putting one more step in front of the other. I'm confident you'll make it!

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