Evaluation of a patient’s symptoms can be a very challenging process. One of the first goals I have during the assessment process is identifying patterns with their pain response. In other words, when do the individuals symptoms feel better and when do they feel worse. It is important to remember that not all pain is created equal, the centralization phenomenon (which can be reviewed here) helps us dictate what a “good symptom is versus a bad symptom”. A quick review, informs us that the location of the pain is more important than the intensity of the pain. Any pain that is closer to the spine, versus the buttocks, leg, or foot, is a better pain or symptom.
Knowing what a “good versus bad symptom” is vital in the recovery process. Many patients come into therapy extremelydepressed as they tell me, “there is no pattern, sometime my butt hurts, sometimes, my thigh and even sometimes my calf!”. If this sounds like you, then I will tell you exactly what I tell my patients – GREAT!!!!
If the symptoms vary, then in almost every instance there is a distinguishable pattern. You just haven’t noticed, because you don’t know how to, YET! Your job, along with your therapists help, is to identify the pattern.
When treating patients, I often tell them, “if you aren’t sure what a “good” symptom versus a “bad” symptom, then trying to treat yourself is like playing darts with a blind fold”. This means that without having the proper knowledge to treat yourself your more than likely going to fail or miss the board. Having the right knowledge gives you a point of reference, just like taking the blind fold off when playing darts. With the proper knowledge and direction, now it’s your time to execute. Having a point of reference regarding good and bad symptoms gives you a chance to self-treat and hit your target of reducing symptoms!
This is where the Patient Response Approach comes in. With the help of your therapists, you can now evaluate and assess your symptom response during specific exercises, during a treatment session, and in between treatment sessions.
Conceptually, the process is actually quite simple; exercises and spinal positioning are assessed individually by you and your therapist during a treatment session. Activities that produce positive symptoms are noted. Activities that produce a negative symptom response are discarded. As more positive exercises are noted, they are continued to be grouped together to be performed during treatment sessions and possibly as a home exercise program. Each treatment session is continued to be evaluated so that each patient has the right exercise grouping.
Individual exercises and activities are given for patients to continue to be performed as a home exercise program. Home exercise programs are continually evaluated for effectiveness in pain management and positive symptom response. Your therapist should continually be assessing your pain response in between session.
The Patient response approach can be extremely effective in treating low back pain and promoting self-efficacy. Patients become engaged in their treatment because it makes sense and ultimately their treatments make them feels good. The most important reason why the Patient Response Approach is so successful because it is predicated on complete customization of exercises that work specifically to your body. You just have to learn what a good and bad symptom is first!