Using Self-Tracking to Hack Musculoskeletal Pain

I’m a doctor of physical therapy, a personal trainer and a bike fitter over in Oakland just across the bay, and I have a clinic that is focused on data driven assessment and treatment and accurate measurement as well as wearables and self-tracking.

I’m talking about the hypochondriac’s diary. The dictionary definition of a hypochondriac is somebody who is abnormally anxious about their health. I would not describe myself of being that way, perhaps just abnormally interested and I think there’s a subset of people in this room that would fall into that caliber.

So I’ll first tell you what this diary is and then kind of what I’ve done or how I’ve used it. And then a little bit about some ways that I think it could be used and really developed further because it’s in its infancy right now.

So what is the diary? It’s a place that I’m able to record things, physical events, pain, thanks to Jay for introducing the talk like of chronic pain, but entering these feelings as well as the region in which they occur.

And the idea this practice came from a desire to have patients come in to my physical therapy practice with better history, you know actually knowing kind of what happened. So a lot of the times they just don’t know when things started, and for some problems that’s a key variable.

So I had to test that on myself. I was like all right I’ll just start tracking what I’m feeling, both things that are painful but just other sensations related to my body. And even broader perspective of just musculoskeletal problems but also colds and flu and stuff like that.

So it started as an Evernote file just putting in today only when I ate something and felt weird or interesting then moved it to a numbers doc and finally out to a Google sheet still in a spreadsheet format.

So why? The first reason is to see early warning signs. Before pain is chronic, pain is a useful signal of damage or potential damage. And if you can identify early warning signs maybe you can prevent things from becoming chronic.

But two is also to unravel cause and effect that’s delayed. Anytime there’s a delay in the feedback loop, people get lost right away. So when you have data and you have basically what you’re feeling, your symptoms, you can start to correlate with other things in your life.

Looking at an example of my left shoulder, so I went back into my database for the last three years and this is the entries by region. And about 20% of them are shoulder, so I was okay, what’s going on, what’s been going on with my shoulder in the last couple of years. So I found out that I started having pain in 2012, went away in a couple of days, came up again later that year, then again.

Every single time it came up, it was after some type of pushing or pressing motion and that was sort of the theme. And what I found is, if I treated some trigger points that I had in my deltoid right before doing a pressing motion, as well as making some changes in my technique it didn’t seem to happen. And it’s the further tracking that we’ll see whether that plays out.

So the summery of what I’ve learned is that I did a physical exam on myself and had an exam done on me, so make sure there’s no medical problem, and then found that the symptoms always had the same cause.

And then it’s not until I’ve tracked it for another year or so that I’ll really know. Because a lot of different problems have come and gone, and that’s one of the most powerful things about this is like lots of things happen to us and we get better. But I’ve also seen how my own memories have become confabulated. And telling a story, oh I had that pain and it hurt when I bent over and I looked back on my data, I was actually bending backwards what hurt me.

So some things that I think could be better about this, it could be an app, with the body chart and some way of actually quantifying the input, because right now I’m just making notes, and some able way to capture other and correlate other data points.

So I’m very excited to hear your questions and we’re going to break out a little bit more about this. Especially with what Jay introduced regards to pain. Because the actual tracking of pain can in some ways make the pain worse. And when I look to see what devices are out there regard to pain tracking, the two or three apps that I found were all made by lawyers to in order to tally up the expenses and damages, so that you can have you know a prove how hurt you are, which is perhaps the worst way to think about pain according to modern pain science.