How do we track your progress?
Patient goals: We define patient-centered goals as what you hope to accomplish from physical therapy. While these are typically activity-specific goals, often patients report they just wish to experience less pain. When this is the case, we will likely ask if your pain were to improve, what would you do that you are not currently doing? Some sample ways to track progress in this domain include:
- How long you can perform an activity before stopping
- The intensity of performing an activity
- How long it takes symptoms to settle if they become exacerbated during an activity
Range of motion: Range of motion testing measures how much movement a joint (or series of joints) can bend, straighten, rotate or side-bend. In essence, it is the angle a joint moves from resting position to the limits of motion in a particular direction. This is influenced by joint mobility, soft tissue/muscle flexibility, pain, inflammation and more. Range of motion can be measured both actively (you move your joint) or passively (us moving your body part while your muscles are resting). The former gives us a measure of active tissues (i.e. muscles) ability to control the joint, while the latter gives a quantity of total motion available at the joint. To determine how much range of motion you should have, we look at the following:
- How much range of motion your joints require to achieve your activity-specific goals
- Amount of range of motion prior to an injury or onset of pain
- How much range of motion in your unaffected side of the body
- Normative values for your age, sex and activity levels
We measure range of motion using devices called goniometers and bubble inclinometers. Measuring your range of motion gives us objective data to determine your response to physical therapy treatments.
Strength/Endurance: While there are several ways to measure patients’ strength and endurance, our favorite is to try to stimulate ones’ reported functional limitations. Here are a few examples:
- A patient reports pain and difficulty holding her 15-lb. baby – we will test how long you can hold a 15-lb. weight
- Difficulty carrying groceries – we will test how far you can carry 20- lb. weights across the clinic
- Difficulty lifting heavy objects off the ground – we will test how much weight you can deadlift
We like the above approach as it is most directly related to our patients’ goal. In addition to the above, we measure strength by objectively testing how many pounds of force a body part is capable of generating and endurance by testing how long you can hold your body in various positions.
Body Chart: A body chart is a map of a patient’s symptoms. We look for symptom characteristics including:
- Location of symptoms
- Size/length of painful area
- If symptoms present at more than one body part
- If symptoms are related in multiple painful areas
- Description of symptoms
- Achy, dull, sharp, burning, numbness, tingling, etc.
- Intensity of symptoms
- 0-10 pain scale (current, best and worse)
- If symptoms are constant or intermittent
Here are some examples that would indicate a favorable response to PT:
- Less intense pain (i.e., your pain was an 8/10 and now it is a 4/10)
- Favorable change in symptom descriptors (i.e., sharp pain is now a dull ache)
- Symptoms are more localized and less diffuse
- Less frequency of symptoms (i.e., more constant pain becomes more intermittent)
- More activity (either intensity or duration of painful activity) can be performed prior to symptom exacerbation
Medication Usage: While medications for aches and pains certainly have their place, even the most common over-the-counter medications, such as Tylenol and Advil, are not without side-effects. If we can make you feel better with physical therapy treatments so that you are able to wean off pain medication, we consider that a success. At Sparks Physical Therapy, we do not prescribe or alter medication prescriptions made from other providers.
Pain Pressure Threshold: Pain pressure threshold testing measures how much force can be applied to a body part for the pressure feeling to turn into pain. It can be measured on muscles, joints, tendons and ligaments. Pain pressure threshold is a quick, objective way to measure tissue sensitivity and is beneficial to use in conjunction with pain measures, which tend to fluctuate from day-to-day. The pressure is applied very gradually.
There are no standard norms for pain pressure threshold, so measures will be used as a means to gauge treatment effectiveness over time. If treatments are effective, we would expect more pressure can be applied before the stimulus turns to pain. Monitoring treatment effectiveness allows us to make adjustments in our treatments and dosing based on individual needs of our patients.
Nerve Tension Tests: Nerve tension tests involve various positions to assess peripheral nerve mobility. In other words, nerve tension tests assess how much stretch we can put on the nerves of the arms and legs before eliciting radicular symptoms. Radicular symptoms are often described as sharp, numbness/tingling and more and are frequently accompanied by back/buttock pain (in cases of lower extremity radicular symptoms) or neck/upper back/shoulder pain (in cases of upper extremity radicular symptoms).
Spinal manipulations include positioning of a patient and then performing a single, rapid movement to an area of the spine including cervical (neck), thoracic (upper back) and lumbar (lower back).
Kyphosis refers to the normal rounding of the upper back. Occasionally, people will have excessive rounding and in this case the rounding/kyphosis is referred to as hyperkyphosis (hyper = above normal). This rounding increases naturally as we age and there is no standard definition of hyperkyphosis versus normal changes associated with aging. An increase in kyphosis is more common in women than men. The cause of an increase in kyphosis is due to muscle weakness and impairments in flexibility/mobility.
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