|The other morning I received a sad face (with a tear) text emoticon. The “Mr. Sad Face” text included phrases such as: flared up, frustrated, not getting better, and really upset. My patient shared that she recently re-aggravated her hip and lower back, while out for a walk. She said the pain was similar to the first time she experienced pain in those areas. My patient was very discouraged because she had been working on these issues for at least a month. She felt as though she was not improving. I asked her if she thought the problem had not improved at all, or if the problem had gotten better, but had just “flared up” today. My patient said that she thought it had been improving but, now, with her present symptoms, she concluded that it was not getting better, after all. As I spoke with her, I realized that during our initial time together, I may have omitted one of the key elements for injury resolution success. I wanted to share my advice with you. As we traverse the rocky path of resolving health issues, it is important to keep perspective. In other words, to keep our eyes on the end goal, and not get derailed by episodes, in which we are fooled into thinking that we are not progressing. Listen closely. When your body is going through a healing process, it is not a direct path from injury to resolution. There will be difficult times along the way. Often, as our bodies heal, we will experience “flare-ups” that resemble, in intensity, the original problem. It does not mean that you are not healing. In fact, these episodes can signal that your body is working towards a resolution. Some practitioners call these episodes “healing crisis” (as your body experiences a breakthrough). In fact, I see this situation quite often as patients start to challenge their bodies instinctively.
Let me use my patient as an example:
My patient walks the same route every day for exercise. For many weeks she has been walking in a more guarded way, whether consciously or subconsciously. On her walk today, my patient exerted additional effort because her musculature was performing more harmoniously, and her pain signals were dampened. The additional muscle recruitment was just enough to challenge the injured area. In most cases kissing the line of ability is a good way to see how your progress is coming along, but occasionally you can do too much. Factors such as: stress, dehydration, sleep deprivation, general health and nutrition can pretty much guarantee that you will have a “flare up” or two, as you journey on your healing path. As long as the “flare ups” do not create long-term setbacks, I let my patients know that they should not be overly concerned about them. The idea is that the “flare ups” will diminish (i.e. get further and further apart) as their bodies become stronger and better conditioned.
…Back to my patient, she interpreted her “flare up” as a signal that she was not making adequate progress. Well, in order to identify, if you are healing, or aggravating a condition, it is important to ask yourself the following question, “What is the DIF?“
“DIF” stands for: duration, intensity and frequency.
If a patient can report that over time the duration of the pain, or how long the pain episode lasts is decreasing, then he or she is improving. If the patient can say that the intensity of the pain has changed from an 8 to a 7.5, he or she is improving. If the patient can ascertain that there are fewer episodes in a set amount of time, or duration, then he or she is improving. If ANY, or a combination of these factors, are positive then the patient is moving in the right direction. Looking at your condition this way is sometimes much more effective than simply asking the question, “Is it better?”
It is important that patients understand that injuries are complex. The injury you exhibit may be a signal from your body, or a “last straw,” so to speak. Moreover, your signals may indicate that there is a series of underlying postural, compensatory, deconditioned, and/or muscle weakness issues that need to be addressed. Dissecting these complex patterns can take time and patience. Having a simple way to note little changes in progress can be helpful. “What’s the DIF?”
The following day the patient texted me again, and reported that her hip pain was gone. Smiley emoticon. Her “flare up” was over. The duration of this “flare up” was indeed significantly less than other episodes. Clear-headed, my patient realized that she hadn’t actually experienced a really “bad” “flare up” in a long time. She is headed in the right direction.
Remember to assess your progress by asking yourself, “What is the DIF?” . I suspect you will find the little improvements, along the way, quite revealing. In addition, you will have an easier time keeping your eyes on the long-term goals of: better health, a stronger body, and resolution of worrisome health concerns.