The best way to track improvement (or lack of improvement and worsening) with self treatment or clinician based treatment is to accurately record your baseline symptoms.
Why bother with baseline symptoms?
Baseline symptoms essentially tell us what we are starting with. Later you will revisit your baseline symptoms to determine whether there is any change. You may be surprised to hear this, but you NEED to write your baseline symptoms down. You will not remember (accurately). Most people who have dealt with back or nerve problems have been forced to block the pain and discomfort in order to get on with their lives. While this is important for survival, it’s also important to specifically note what you are feeling so you can tell when real change happens following intervention. It’s true that if you start a program and then wait 4 weeks you will likely be able to know, overall, if the program was good, bad, or had no impact on you at all. And to be honest this is how many programs, physical therapists, and chiropractors treat. But this method of evaluation is essentially GUESSING (“this is probably good for you”). Follow a program without truly knowing it’s benefit – in a few weeks or months you will be able to tell if there is a difference. In a few weeks or months you will know if it was worth the time and effort.
I don’t know about you, but I don’t have the time or energy to put into a multi week or month program which may, or may not, help me. The McKenzie method of evaluation and treatment seeks to carefully and progressively find corrective movements and exercises which cause rapid changes in symptoms. The idea is to quickly discover if you are benefitting from an exercise or not. Take away the guessing. If an exercise is helpful I want to find out within minutes so I can put all my energy and focus into it for the rest of the day or week to make sure I get better. If an exercise is not helpful I want to stop immediately and go find something better. No one should live in the grey area. To determine quickly if an exercise or activity is changing your symptoms, you need to write down (or tell a trustworthy individual to help you keep track of) your baseline experiences so that you have something to compare your future experiences to.
What Should I Write Down?
Here is a picture of the McKenzie Institute USA ‘Lumbar Spine Assessment’ form where you can see some of the common symptoms clinicians should be asking about:
The full form is available here, at the mckenzieinstituteusa.org website.
Common baseline symptoms:
Pain/discomfort – this includes burning, aching, tingling, numbness, stabbing. Where is the farthest spot from your spine you feel it and at what intensity from 0-10 scale? 0 is no pain and 10 is let’s go to the emergency room.
Weakness – This may present as feeling unsteady on your feet. It might be difficulty with stairs. It might feel like your knee or ankle will collapse. When do you feel weak and in what way?
Difficulty sleeping: Does the pain wake you up at night or keep you from falling asleep. How many hours of sleep do you lose because of your problem?
Real life functional problems: how far can you walk before you have to stop? How long can you sit before you have to get up? Does your problem interfere with doing laundry, dishes, gardening, or playing with the kids?
Once you have identified the baseline symptoms which apply the most to your situation, write them down in a measurable way.
For tracking the effect of exercises and activities quickly it is best to use symptoms which can be checked quickly. These include:
-Pain/discomfort – location and intensity.
-Functional activities – Walking, squatting, or stairs for instance.
If you have pain at rest, this is a great baseline to keep track of. If you only have pain during an activity such as walking or stairs, you will need to recheck these activities after each exercise you do to determine if change occurred. As a reminder, we do not advocate for dwelling on your pain and problems every moment of every day. Baseline symptoms are specifically meant to be focused on immediately before and after some type of intervention to determine if anything changed as the result of the intervention.
Great! Now you have your baseline symptoms. You have something to check before and after postural correction, before and after various exercises, and before and after manual techniques such as mobilization.
A note for a few: Although less common, some people only have pain or discomfort with a prolonged activity; walking or running more than 15 minutes, for instance. These symptoms are often more difficult to keep track of. If this is you, keep heart. Your self assessment can still be done, but it will be more tedious and time consuming. Write down your baseline symptoms and retest later. If you find a helpful exercise it will be worth the effort.
What baseline symptom are you most excited to improve?
Dr. Charles Baldi
Ortho and spine specialist
Doctor of physical therapy
Baldi Movement Group LLC
www.baldimovementgroup.com
ContactUs@baldimovementgroup.com
(610) 484-4487