Reassessment Where the Scores Moved But the Pain Did Not
A 41-year-old warehouse supervisor is at session 4 (week 3) of an SFMA-guided plan for 12 weeks of intermittent central low back pain. At baseline: multi-segmental flexion DP with pain at the left anterior hip; multi-segmental extension FP; single leg stance left DN; overhead deep squat DP. Today: multi-segmental flexion DN with no pain; multi-segmental extension FN; single leg stance left DN unchanged; overhead deep squat DN with no pain and the same heel rise. The numeric pain rating is unchanged at 5/10, but his sitting tolerance has gone from 20 to 50 minutes, and the pain has moved from the left anterior hip to a broad central low back ache that no longer relates to any tested pattern. He asks, "Am I better or not?" and you have 8 minutes of documentation.
1. Interpret the score changes and the changed pain location. What do they mean and what do they not mean?
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What they mean: the painful pattern converted to a non-painful dysfunctional pattern and the FP resolved. Those are real changes in the movement system, and multi-segmental flexion is now a treatable restriction rather than a protected one.
What they do not mean: that the nociceptive driver has resolved. The rating is unchanged, so declaring victory from the scores alone would be wrong.
The most informative finding is the relocation. Pain that was reliably reproduced by a specific pattern is now a broad ache that no pattern reproduces. That shift suggests the remaining pain is no longer pattern-specific - it may be more related to sustained postures, load or sensitisation than to the movement restriction you have been treating.
Also weigh: sitting tolerance improved from 20 to 50 minutes, which is a functional outcome and arguably the most meaningful number in the note. Numeric ratings drift and anchor differently between sessions; do not let a single 5/10 outweigh a doubling of tolerance.
Conclusion: partial change, real but incomplete, with a new clinical question.
2. What goes in the note today, given 8 minutes?
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Baseline versus today, pattern by pattern, with the score and the symptom response recorded separately - "DN, no pain" is different information from "DN".
The location change in the patient's own words, because that is the finding that changes the reasoning.
The outcome measures: numeric rating 5/10 unchanged, with a note that it is unchanged; sitting tolerance 20 to 50 minutes.
The driver, the dose given, and the clinical decision with one line of rationale.
The unresolved item: single leg stance left remains DN and is now the remaining top-tier dysfunction.
Plan and re-test date.
Write it in a form the next clinician could act on without you: what changed, what did not, and what you concluded from the mismatch. That final sentence is the part most notes omit and the only part that carries judgement.
3. Do you progress, hold, or change direction? Justify your choice.
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Progress partially, and change focus. Multi-segmental flexion is now DN, so range work into the previously protected restriction is legitimate; continue it. Single leg stance left is unchanged and is now the largest remaining dysfunction - if it has not been broken out, break it out before assuming it needs more of the same exercise.
Do not add load or volume while the pain rating is static and the symptom is not reproducing with any tested pattern; increasing dose now would be guesswork.
Hold the broader question: if two more weeks of consistent work leaves the pain unchanged and no pattern reproduces it, the problem has moved outside what the movement screen addresses. That is a conversation with the referring clinician, not a reason to keep screening until something hurts.
Document the decision rule now, not after the fact, so the next reassessment is judged against a stated criterion rather than a feeling.