By Mara Towne, PT, DPT
Pain. Even reading the word evokes a negative feeling for most people. This can be especially true when a person has been dealing with pain for several months or years! Pain is a protective mechanism. Without pain we would not be able to live. However, when pain becomes chronic, it no longer protects us and often hinders our day to day activities. Chronic pain consumes people’s lives. Often people have numerous tests and appointments with different specialists trying to find the source of their pain. With all this back and forth, you can lose your sense of self in the process. It is very challenging to know what you can do to manage your pain on your own. Where can you begin?
This blog is part 1 of a series in which we will unravel what people can do to manage their pain at home with help and support from their physical therapist. The materials and information in this blog are from an excellent continuing education course called, Transforming Your Clinical Practice: Integrating Cognitive, Behavioral and Motivational Skills into Physical Therapy presented by Kristin R. Archer PhD, DPT and Stephen T. Wegener PhD, ABPP of Vanderbilt University. The handouts attached are reproduced and distributed with their expressed permission.
Back to the question, where can you begin? The first step is to fill out a Graded Activity Hierarchy. If you are currently in physical therapy, then you can fill this out with your therapist. However, if you are not, there are examples attached to this blog and a blank sheet too so you can fill it out on your own. The Graded Activity Hierarchy allows you to really assess your day to day activities and assign a level of difficulty to each task. For example, many people would say that brushing their teeth is at a level 0 on a 0-10 scale. Yes, standing to brush your teeth might be painful but the act of brushing your teeth often does not cause much pain (unless you have jaw issues). Conversely, something like going back to work might be a level 10 on the scale because it entails getting dressed, making breakfast, lunch, standing or sitting for several hours a day, etc.
Grading activities has been incredibly eye opening for people. One patient remarked that she did not realize until she filled out this chart that she was doing 3-4 tasks a day which she graded at 8-10 level and learned how to better pace her activities throughout the week by having this realization. When pain is controlling your life it’s not uncommon for people to say “everything hurts”. However, when you take the time to do this activity you realize some tasks are definitely harder than others. Once you have a clearer sense of which activities are 2-3/10 and which activities are 8-10/10 you can begin to develop specific goals for how you are going to perform your 10/10 activities with less pain. This brings us to step 2 of the journey, goal setting.
Goal setting is difficult! We all live in a high paced world. Carving out time for us is a challenge. However, without precise goals, we lose focus. After you have completed your Graded Activity Hierarchy it’s time to fill out the Activity Goal Worksheet. Again, it can be very helpful to have a therapist’s assistance when filling this out, but we have attached a form to try at home. If you need help, we’re here!
One of the most important aspects of goal setting is pacing. When a person has been dealing with pain for months or years, there is understandably a strong desire to get back to the things he or she enjoys doing. However, if a person hasn’t been able to walk 2 miles in 2-3 years, then he or she is not going to be able to just walk outside and do that. Pacing is extremely important. Think about your long term goal of walking 2 miles and then break it down into manageable pieces. For example, try to walk a ¼ mile 1-2 times a week for 2-3 weeks to start. The activity is walking the goal is a ¼ mile 1-2 times a week. The last column of the Activity Goal Worksheet titled “Confidence Level” requires self reflection. We all have a tendency to set unrealistic goals, myself included! Consequently, it is vital to take this last step when writing your goals to assess how likely you are to complete the task of walking a ¼ mile 1-2 times a week (or whatever your goal may be). Again, this is on a 0-10 scale. If your confidence level is less than 7/10, then we need to reevaluate your goal. Perhaps you can only do it once a week versus 1-2 times a week. That’s ok! The purpose is to feel a sense of pride and accomplishment! We want to set ourselves up for success versus beating ourselves up for not completing the goal. It’s all about reframing our mindset. Try your goals out and see how you feel!
This is just the beginning but it sets the foundation for self awareness and healing! Stay tuned for more tips in future blog posts. Please try these activities and let us know what you think! Feel free to email at: email@example.com with any questions or comments!
The time to act is now!