Licensed Physical Therapists & Physiotherapists
- Licensed Physical Therapists & Physiotherapists
TRACKING YOUR PAIN FORM
INTRO TO S.L.A.P.
Series of 6 Videos Introducing SLAP
THE MEASUREMENT CHART
The Measurement Chart is a tool to document the findings of your System Limitations Evaluation. It is a great tool to:
- visualize the impact of mechanics on your spine and
- indicate what you need to address
To get a measurement chart for your use:
The PT Measurements Video
50 minutes, demonstrates the recommended measurements.
The PTC Course
Provides information about this approach to pain.
It includes identifying subgroups of pain, reviewing patterns of pain, recommendations of what to pursue and avoid/modify based on patterns. It also outlines the recommended evaluation and assessment.
Note: Decreasing the video time from 2 days to 3 ½ hours resulted in obvious edit points.
Short Informational Videos
More on Describing Your Pain
More on Treatment: Listen until the end.
Example: Back Pain when Sitting: Short introduction of a protective and corrective program.
Roller Coaster Analogy: Short Video to encourage initial effort.
Rescue Your Back: Digital Book
A guide to use while you work with a licensed physical therapist.
Chapters 6 and 7 helps with developing the corrective exercise program.
Chapter 5 helps to; track your pain, identify positions of the spine that increase pain,
develop a Protective Program which is a plan of how to move through the day and protect your
back, and pursue a Quick Relief Strategy to be able to independently decrease your pain.
Chapter 4 outlines the evaluation recommended (SLAP)
Chapter 2 outlines subgroups providing the most important information for each group to focus on.
It matters that the patient understands about what is happening to their body.
They are the 24 hour a day, 7 day a week manager of their body. The patient should be able to link:
- The pain that occurs with specific positions
- To the limitations in their mechanics needed for those specific positions,
- To the impact on their spine from the limitations in mechanics needed for those specific positions/activities.
The evaluation recommended (S.L.A.P.) is outlined in Chapter 4 of Rescue Your Back.
The measurements are demonstrated in the PT Measurement Video 50 minute video in the subscriptions section.
The overall approach is reviewed in the PTC three hour video in the subscription section.
Following is a cheat sheet for monitors and measurements. This is provided as an aid to success.
Monitors and measurements
Monitors - Overview
From the History:
- Have the patient list every pain/symptom they have
- Have them track each pain per the tracking instructions above.
- From the information they record identify the positions that increase each pain/symptom.
- Develop a monitor for each painful activity.
A monitor is a measurable statement about the pain related to a specific position or activity. I try to develop a monitor for each position/activity that is painful, such as, walking, standing, sitting, lying down, or ability to sleep through the night. This helps us monitor the positive and negative impact on the back pain from things such as, exercises, activities, treatments etc.
Monitors - Example
Examples of Monitors
I wake up 2 times a night with a 6/10 pain in the center of my low back the size of an orange.
I am on back when this happens so I roll onto my side, bend my hips and knees, and it takes 15 minutes for the pain to subside enough so I can get back to sleep.
Standing, Walking and Being On Feet at Home
When standing still the low back pain starts after 5 minutes it is a 1/10 and by 10 minutes it is a 4/10.
When walking on a level surface the pain starts at 10 minutes and is a 2/10.
When walking downhill the pain starts immediately and is a 2/10 and by 5 minutes it is a 5/10.
Walking uphill is pain free.
When I am on my feet doing household chores that involve bending forward with weight on my arms I am pain free.
At the grocery store I lean on the cart and I am pain free on my feet for 45 minutes.
The radiating pain down my left leg starts immediately when I sit on a low couch, I avoid low couches.
When I sit on a firm chair for dinner the pain starts at 10 minutes and is a 2/10, at 20 minutes it is a 3/10 and at 30 minutes it is a 6/10.
When I sit in a recliner I can be pain free for an hour, I have to get up because I am stiff.
Time you can ‘count on’
We work to determine the amount of time the patient can count on before the pain starts/increases when that time varies from day to day.
For example, they can count on being able to stand still pain free for 15 minutes. At times they may be pain free for longer then 15 minutes, however they can always count on being pain free for 15 minutes.
After we start their exercise program if they have pain before 15 minutes it could indicate that I started an exercises too early, or they pushed an exercise too hard, or some other information we need to learn about.
On the other hand if they become able to count on standing pain free for 30 minutes it could be a good indication that their corrective exercise program is effectively addressing their mechanical problems.
There are different ways to describe pain in measurable terms.
The circumstances surrounding the onset/increase of pain can provide the pattern needed to describe the pain in measurable terms.
For example, when people switch positions frequently at work it could be difficult to track the time they sit, stand or walk before their pain increases. Their description could be that they start work at 7:00 am, the pain starts around 10:00 am and is a 3/10, at noon it increases to a 5/10, and at 3:30 pm it is an 8/10. We would discuss the activities they do in between those times and how they contribute to the escalating pain.
For many people the pain varies day to day and week to week. When I initially ask people about what brings their pain on they often respond by saying, “I don’t know, it depends.”
I reply, “That is what we need to do, we need to find out what it depends on.”
Monitors vs Goals
Monitors versus Goals
Monitor, in this approach, means monitoring the pain.
A monitor is a measurable description of pain related to a specific position or activity.
It is developed from the information the patient tracks and records.
The PT helps by identifying patterns from the information the patient tracks and describe the pain related to each position in measurable terms -the monitors. The monitors are refined as more information is learned and the patient progresses.
Most monitors are about activities and positions including walking, standing, sitting, lying down etc.
The process of developing the monitors’ helps the patient learn about the specific positions of the back that increase their pain including extension, flexion, lateral flexion and rotation.
The monitors also:
- help the patient learn to control their pain by having learned about the impact of the very specific positions that increase their pain. For example the patient learns to decrease the arch in their low back as needed to decrease their low back pain and to decrease flexion to decrease their neck pain.
- help the patient predict the pain, for example: if I wear the heels instead of the flat shoes my pain will be a 5/10 by noon, if I walk up that hill my pain will be a 3/10, if I sit in the blue chair the pain will be a 2/10.
- help the PT more efficiently identify the impact of the recent exercises and activities in each patient session.
- help track measurable improvement just like goals.
Goals typically focus on one specific measureable condition in the future, for example,
‘By 2 weeks the Patient will decrease their low back pain to a 2/10 when standing for 1 hour.’
The information used to set goals depends on the patient and the provider.
When life happens such as having to stand 3 hours at a funeral instead of sitting at their desk as expected, the patient might not meet the goal because the next day the standing back is 3/10 when standing for an hour.
Where as if they tracked their pain with monitors they might realize how much better than are because the last time they stood for 3 hours their back pain was an 8/10, this time it was a 5/10. Last time the pain the next day was a 5/10 and this time it was a 3/10.
Monitors and goals both help measure progress.
Monitors are not perfect however they help the PT and patient see the overall picture in measurable terms.
Prior to taking the measurements make a hypothesis of what limited range of motion you expect to find based on the positions that increase the pain.
When the patient reports that they have pain in sitting, tell them your hypothesis is that they are limited in hip flexion range of motion. When taking the hip flexion measurement point out the limitation. Just past that point the patient often feels the back flatten and the pain come on. This helps them understand how the limited motion specifically impacts their back pain. FYI: The measurements are important however I continue to learn a lot about their mechanical involvement while building their exercise program.
The measurements recommended are demonstrated in The PT Measurements Video in the subscription section of this website and listed in Chapter 4 of Rescue Your Back.
The Measurement Chart is a great educational tool for the patients to visualize how the measurements impact the spine and the activities.
Re-measurements are also helpful to progress the program.
NOTE: Prior to COVID I would often tell patients that I believe that the measurable information they track, and the subsequent monitors we develop are just as important as the in-person physical measurements for figuring out what is happening mechanically, building their daily management program, building their daily exercise program, and measurably seeing their body’s response to their programs.
Using telemedicine in the time of COVID I focus on having the patient diligently track their pain.
From that measurable information we:
- develop monitors
- make a list of possible limitations in range of motion
- develop a daily stretching, stabilization and strengthening program tailored to their reports of pain
- develop a protective program of what to pursue that decreases their pain and what to avoid/modify that increases their pain.
The measurable information that people track about their pain helps in measurable terms throughout. Initially they help identify the problems in range of motion that are impacting their tolerance to a position, over time they help to measure the progress and evaluate the inevitable issues that arise.