“I’m better!” my client stated after I asked him how he was doing. “Much better.”

“Really?” I inquired. “How do you know?”

He looked at me incredulously, then realized I was serious. “How is it that you really know you’re better?”

“I know I’m better because I’ve been so much more active in the last five days. I cleaned the garage and worked on straightening up the basement, neither of which have been possible in the last month. I couldn’t have lifted boxes and moved things around without suffering the consequences the next day. I was a little bit sore, but that’s it. That is a significant improvement from how it has been in the past.”

“I guess you really are better,” I teased, as we shared this little victory together.

There is an important lesson in this conversation and it revolves around how we measure improvement with regard to musculoskeletal pain and discomfort. In the past, it has been common to ask people to report their level of pain on a 1-10 scale, called the verbal reporting scale. This effort is fraught with problems, with two main issues that make the scale often unreliable.

First, what is your reference point on this scale?  I’ve had people tell me their pain is an eight, but they have been quite active, with very little impact in their daily life. That hardly fits the description of an eight. In addition, I would posit that if you have never had a kidney stone, you don’t really know what a 10 is! To use a scale of any sort, you need a reference point around which to calibrate.

Secondly, the present experience of pain is not always the best indicator of improvement in the larger sense. Pain levels fluctuate significantly for a host of reasons. Is this really the best reflection of a longer trend? One way to think about this is comparing pain to tiredness after activity. When I first started serious cycling, I was tired after a ten-mile ride. Now, I get tired after a fifty-mile ride. In both cases, if you asked me whether I was tired, the answer is yes. Obviously, that isn’t the whole story; there is an enormous difference between a ten-mile ride and a fifty-mile ride. Tiredness isn’t the best way to measure improvement.

To that end, I’d like to introduce you to a new pain scale that uses function as an additional reference point. A seven on this scale means that the pain is the focus of my attention and it causes me to avoid many of my normal daily activities. This is much more understandable to everyone concerned. In my clinic, we have these scales printed and laminated in every room. My massage therapy staff and our clients have really appreciated this resource. I invite you to do the same. Read further about this scale in a blog post I wrote for the Massage Therapy Foundation. At the end of the post, there is a downloadable .pdf you can print and use in your practice. This is just one of the many resources available to you from the Massage Therapy Foundation. Explore them fully at www.massagetherapyfoundation.org

Douglas Nelson, LMT, BCTMB
President, Massage Therapy Foundation