Do you know the difference between a sign and a symptom?

There are 2 very important pieces of information that doctors should be gathering at every appointment. A chart note from you appointment is called a S.O.A.P note with the S being for Subjective and the O being for Objective. Subjective is correlated to a symptom you are having. This is something the patient is experiencing, but cannot be seen from the outside. This could include headaches, dizziness, pain, nausea, fatigue, etc. Then there is the Objective information which is correlated to a sign. This is something the doctor can see in a bedside exam, videonystagmography, balance exam, cognitive assessment, palpation to the spine for hypertonic muscles or stuck joints, blood work, imaging, etc.

Much of the work that practitioners like me do, those who focus on concussion rehabilitation in particular, is subjective. Meaning I rely on what the patient is reporting to me in order to track how they are healing and improving. This is why keeping a journal is a very helpful thing to do while going through any rehabilitation model.

It can often be frustrating for patients to feel that maybe they “aren’t better” even though they have been carefully following a treatment plan. But tracking a headache frequency and noting they used to be daily and are now a few times a week or that intensity has gone from a 8/10 on an oral pain scale (OPS) to an average of 3/10 is a positive change for the better. Or that they used to have dizziness when tracking anything with their eyes and now they can watch a movie without dizziness or nausea. These are the little wins and must be recognized.

Look, we would all like healing to linear; a nice smooth line in a positive direction. The reality is that most healing, and certainly most concussion healing, just isn’t. It’s more of a wavy line moving up and down with, hopefully, a positive upward trajectory. You may have good days and bad days and it is important to track these by journaling to figure out what the triggers are that make you feel better or less well. There are far too manner factors for any practitioner to be able to guess what the culprit is. Working together by sharing symptoms you’re experiencing and explaining signs being seen by your doctor is an important part of the doctor-patient relationship. And as long as your overall healing trajectory is moving in the positive direction (even with ups and downs) then you can be assured you are getting better.

So, keep a journal. Follow and recognize patterns. Make lifestyle modifications that need to be made asking for help from family, friends, your doctors, etc to get the support you need to heal. And know the difference between signs and symptoms because concussions (and many other metabolic and neurological conditions BTW) are not always visible to the outside world.