Video and Transcript: Treating Pain with Small Object Identification

Hi, everyone! Dr. Orit Hickman here from Pain Science Physical Therapy. 

In some of my earlier videos, I talked about this concept of cortical smudging which is where your sensory system is not behaving properly, and so that impacts your motor system’s ability to function. And, from a practical standpoint, what you might notice as a person who is experiencing persistent pain or even recent pain is that you might have difficulty [with] holding things, gripping things, [and] dropping things. You might notice that you have balance issues, difficulty with going up and down the stairs, [and] difficulty with walking for long periods of time. 

So, depending on where the pain is in your body, there is a way to treat-there’s lots of ways to treat your sensory system. One of the most common things that we do is an activity called Small Object Identification. So, this is going to be where you have small objects, and you can pick some objects throughout the house that you have that are easy to grab and that are also similar in size and shape. 

So, I have a binder slip right here. It’s going to be kind of hard to see. Right? I have a binder clip. I have a hair clip. I have a-let’s say a small magnet. [I have a] nut and bolt. And, let’s say the letter X. Ok? 

So, for-if I’m having pain in my upper body. Let’s say I’m having neck pain, shoulder pain, elbow, wrist, and hand. Then, what I would ask a patient to do is I would either place an object in the hand in the side that doesn’t hurt and then the side that does hurt or I would have them have like a bucket at home where they would put objects inside, and then they would have to root around in the bucket-in the box or the bucket and find the objects. And so, that would be the type of thing-so let’s say somebody-you know is-let’s say empty out this bucket of letters, and I’ll put my small objects in there right now. And, there we go. And, I close my eyes. And, let’s say right now I have right shoulder pain. This is something that I have dealt with on and off for a while. And so, I would-I have issues with my ability to control where my shoulder is in space. I’ll have pain before I even go to lift my arm. So, this is an activity that I would do for myself. Right? I’d close my eyes. I’d reach in with my left hand, which doesn’t hurt. And, I would go, “Ok. [This is] the letter X. This is a binder clip. This is-what else have I got in here? I’ve got a hair clip.”Right? And, I would do that on the left hand. And then, I take my right hand: “Ok. That’s the letter X. That’s the binder clip. What else have I got in here?” I would find the nut and the bolt. Now, you want the objects to be similar in size and shape. And then, what’s interesting is that when I go to lift my right arm, it’s not as painful as when I did it the first time. My range of motion wasn’t significantly different, but before I lifted my right arm-when I lifted my right arm earlier, it was actually painful. When I lifted it this next time, it wasn’t painful until I got to the very end of the motion, and then it’s like, “Ah, I don’t feel so good.” So, maybe I’ll do more of this. Right? So, maybe we’ll grab some other letters, and we’ll throw them in the bucket. And, I’ll close my eyes. And, I have to figure out, “Ok, that’s a division. I think that’s the letter N. I hope you guys-yup. That’s the letter N. Ooo, that one is kind of tough. I think this might be a lower case H, and it is.” Right? And then, I’m going to lift my arm up. There’s no pain this time. Oh! There’s no pain! That’s awesome! Ok, so there’s no pain at all. I didn’t have any pain even at the end of the motion, and I was able to keep my arm up for a period of time, which typically I can’t do. So, with upper body pain, we’d have patients do Small Object Identification. What that is it’s an activity for the sensory system. 

Let’s say you’re having low back pain. [I’m] not having any low back pain right now, but you would do the same activity with your feet. So, you would put objects-let’s say-on a tray on the floor. And, you would use your feet to try to find the objects. And, that is another way to start to treat the sensory system. 

So, [it’s an] important concept. Right? A lot of times, we go to physical therapy, and your clinicians are like, “Wow your shoulder is weak” or “Your back is weak” [or] “Your core strength is not great.” Whatever the reason is, from a muscular standpoint, if you’ve had pain for a persistent period of time, you have an underlying sensory problem as well. It’s just not getting addressed unless your physical therapist is aware of it. 

So, this is a simple activity that you can do: the Small Object Identification. Give it a try. Let me know what you think. And if you-I’m still kind of amazed. My shoulder really doesn’t hurt. It’s really cool. So, check it out. Put some comments down below. I would love to hear from you. And, I’ll include some more videos on how you can treat your sensory system. Have a great day!