Reload’s Approach to Setting Pain Management Goals
Monitoring Pain Positively to Deliver Positive Progress in Pain Management
Pain is multifactorial. It affects you in many ways. It can affect how you go about your day to day life, cause behavioral changes, and cause you to think negatively about certain activities or movement.
While a major part of our work at Reload is helping clients overcome their pain and injuries, we can’t promise “pain-free”. No one can. It’s not always possible to control the cause of the pain – whether it is mechanical, emotional, or psychological.
Therefore, we tend to focus more on function, asking questions like:
Can you do more?
Can you get stronger?
Can you walk longer?
Can you lift your kids up again?
This is the ultimate goal of pain management – to improve function and allow you to return to what you were doing before your pain took away your ability to function as you wish.
In this article, Physical Therapist Dr. Gary Wang helps to explain our approach to accomplishing your goals for pain management.
The importance of setting functional goals in pain management
“When you work on performance, lifestyle changes, and small changes in your life, the pain often gets better,” says Gary. “As you open up your window of movement and opportunity, you usually do better.”
When physical therapy can help someone live their life better and more fully, the pain becomes secondary. This isn’t to say that the pain is unimportant. But taking away that fixation on the pain makes living life easier. Once this happens, movement increases, and reducing the pain becomes easier.
This is why it’s important to have a functional goal in pain management.
5 examples of a functional goal for pain management
Each client is unique, with individual functional goals. But what are functional pain management goals? What types of pain management goals might you decide are crucial to you?
Here are five common examples of functional goals for pain management:
Proper sleep – poor quality sleep may be leading to short-term and long-term health issues. These may include poor cognition and memory, a reduction in performance and productivity, and anxiety or depression.
Walking – not being able to walk any distance can affect many aspects of health. It can cause you to rate your health lower, and lead to issues such as depression, tiredness, weakness, and decreased respiratory function.
Reduced reliance on pain medication – while commonly used to treat pain, reliance on medication can not only progress to addiction but can also help to mask the pain and make it difficult to identify whether or not an exercise is beneficial for the client. Unmasking pain is critical in the effective long-term treatment of the underlying causes of pain.
Return to work – being able to work effectively is a crucial aspect of our lives, both for financial health and, more importantly, our physical and mental health.
Improving social life – pain, or the fear of it, can have a detrimental effect on your ability to socialize and connect with people. In turn, this can lead to isolation and poor mental health.
Managing expectations for pain management goals
‘No pain, no gain!’
How many times have you heard this?
But pain can stop you from working out or exercising. It can stop you from taking part in activities, and stop you from leading a full and active life. As Gary explains:
“When people run into pain, it becomes a barrier. Let’s say that most things hurt someone ─ like stairs, squatting, walking in line, or running. The person then says, ‘I would love to start exercising. I just can’t find the exercise that doesn’t hurt me’. So, they don’t exercise, and their condition never improves.
“Our job is to find you a safe starting point that has less pain than you’re used to feeling or almost no pain, and then that’s where you start. And most of the time, we’re able to find something that doesn’t hurt. I think that’s the most important thing.
“It gives us a safe starting point. Then we build it out, and then as you start to do more, more things start to become less painful, and then we start to build out your repertoire of exercises.”
How we help clients set functional goals in pain management
Having said that we want to reduce the chances of exacerbating the pain, it’s also crucial to understand that there’s a balancing act here.
“You don’t want to do something that hurts you, but also, you don’t want to mark off a whole exercise as bad for you just because it hurt one time,” says Gary. “As a trainer or physical therapist, it’s not our job to say, ‘Don’t do that exercise because it hurts you.’ Rather, we should find a different version of the exercise that works better for you.”
What does this look like in practice? Gary cites the following example:
“If a squat hurts your knee, maybe the weight was too heavy, or the squat was too low. We can make the exercise easier and work our way up so that it doesn’t hurt your knee anymore.
“There’s always going to be some level of pain when you’re challenging your body. So, we use a scale of 0 to 10, with 0 to 3 being a green light and 5 to 7 being a yellow light. Above seven, it’s a red light:
“If you feel a green light pain, you can still proceed with the exercise.
“If it’s a yellow light pain, you need to proceed with caution and make adjustments to the exercise.
“A red light pain is a sharp, stabbing, or shooting pain and is not productive to getting better, so we stay away from those exercises for now & revisited it again later”
We take a balanced approach to how we apply this ‘rule of pain’. In our first session with a client, we discuss the pain scale and then learn how challenging an exercise is according to this scale:
For example, if a lunge caused a 7/10 pain and had a difficulty level of 3/10, it would be too much pain and too easy an exercise;
But if a squat caused a 2/10 pain and had a difficulty level of 3/10, it’s not hard enough to improve your fitness and pain.
The sweet spot is when you find an exercise that’s challenging enough, such as a squat that has a difficulty level of 7/10 and a pain level of 2-3/10.
That’s when you’re safe, not irritated, and can get stronger.
Encouraging our patients to get back to movement
Helping our patients return to movement is part of our everyday work here at Reload. Often, someone who has been living with chronic pain for a long time.
“I remember a patient who had restricted their movement so much, because of their pain, that when they first came to me, they had a whole list of things they couldn’t do. They couldn’t run. They couldn’t jump. And not only because they physically couldn’t, but because they hadn’t tried in so long. They didn’t know whether they could do these things,” says Gary. “My first job was to show them that they have evidence that they’re able to do it.”
Gary started by checking the client’s strength. For example, testing on a single-leg squat and seeing if they could hold a split-leg squat for at least 60 seconds.
“Then, we progressed to hopping on two legs, marching in place, lifting their feet off the ground, and doing a little running in place,” Gary continues. “We also worked on strength training and exposure to movement at deeper levels.”
From here, Gary progressed through several more exercises, putting things together. Running in place. Running for 10 meters. At each step, measuring the impact on pain.
“If the knee ached, we backed off a bit,” explains Gary. “We rested a little longer in between sets. Then we tried again with a little less intensity.
“The second time round, it was usually better.”
In such cases, it could be the muscles that support the joint or the psychological aspect that makes the movement seem anxious or intimidating. Whichever it is, the body is on guard. But there is no real reason activity should be impossible.
“I pushed the client to do what I knew they could do, and at a pace at which they were comfortable,” says Gary. “Eventually, we got to the point where they were pushing a sled against resistance and doing short accelerations and sprints.
“This person hadn’t been able to run or jump for about 20 years. But here’s the thing: it’s not that they couldn’t do it. It’s just that no one said it was okay to do it.”
This story demonstrates a key quality of the best physical therapists. Understanding their clients’ needs, goals, and conditions. And being there to guide, support, encourage, and show them that they can do something.
“It’s not about saying we’re going to go from post-op knee surgery to training them to get back to that,” says Gary. “It’s about having someone to say it’s okay."
It’s crucial not to miss anything
Healthcare providers and medical professionals can sometimes make life-changing decisions without realizing it. They move too quickly, and miss some basics out – because the patient or client can do activities that the healthcare professionals consider more advanced.
For example, it’s possible to skip squats and do something else instead. And because the client does this more advanced exercise without pain, we don’t circle back to squats. But it turns out that squats are the thing that hurt their knee the most. So, they have this negative emotion about squats which isn’t tackled. So, the client leaves thinking they can’t do squats.
“This happens a lot with doctors, surgeons, physical therapists, and pain management professionals,” says Gary. “It’s easy to say ‘Don’t do that in the short term’, but it’s always ‘Don’t do that for now’ that gets forgotten.”
It’s crucial to accentuate the part of the message that says, ‘Don’t do that until I can show you how to do it,’ or ‘Until you collect all the pieces you need to do it, and then do it really well’.
“We are guilty of this as a profession, and that’s why I say the time we have with clients is our most valuable asset,” says Gary. “Listening and educating are more important than any of the exercises we know how to do or show. If we can’t put it into perspective for someone and frame it as a little piece of a big-picture goal, then we’re not doing our job.”
What is it that makes Reload so different from traditional physical therapy clinics?
Schedule an appointment to start with a comprehensive 90-minute body evaluation, and discover the human-centered approach that could make a real difference to you.
