What is 5% better?

🎙️ Episode 65 – What is 5% Better?

Podcast: Talking Rehab with Dr. Fred Bagares
Length: ~13 minutes

Description:
When a patient tells you they're “only 5% better,” what do you do with that? For some, it sounds like failure. But for rehab clinicians, that 5% could be the spark that changes everything.

In this episode of Talking Rehab, Dr. Fred Bagares unpacks the deeper meaning behind small gains, the psychology of progress, and how pain may not be the best marker for recovery. From subtle shifts to signs of momentum, he explores why tracking real-world wins—not just pain scores—might be the key to helping patients rebuild not just function, but identity.

⏱️ Timestamps + Episode Guide

[00:00:00] What is rehab? + Podcast intro
[00:01:00] The patient story: a limp, an injection, and a vague “5% better”
[00:02:00] What 5% really means in clinical decision-making
[00:03:00] Pain is noisy—why it's not always the best indicator of progress
[00:04:00] External influences on pain perception (sleep, stress, weather)
[00:05:00] Subtle signs of recovery: function, not just pain
[00:06:00] Rehab momentum: how sleep can signal real improvement
[00:07:00] Reframing recovery: repetition, trust, and invisible milestones
[00:08:00] 5% as a turning point, not a finish line
[00:09:00] Why great clinicians dig deeper into small wins
[00:10:00] Tracking the right metrics: ease, motion, movement by choice
[00:11:00] Coaching better reflection: "What felt easier this week?"
[00:12:00] Identity and recovery: why 5% might mean “I’m still in there”
[00:13:00] Wrap-up: honoring the small wins and building from them

🧠 Key Takeaway:
5% isn’t failure. It’s data. It’s a signal. It’s the start of a comeback.

💬 Question for You:
What would 10% better look like in your life?

🔁 If this episode resonated, please share it with a colleague or patient who’s struggling with slow progress. Let’s reframe recovery—one small win at a time.

Transcript

0:00

What is rehab or rehabilitation? My name is Fred, be Garris, a board certified sports and spine medicine physician in Virginia Beach, Virginia. After 10 years of practice, I still find musculoskeletal medicine both fascinating and challenging. I. This podcast is about the lingering thoughts and questions I've had after residency and fellowship. My hope is to spark discussion, challenge, dogma, and share my experiences in musculoskeletal medicine. Welcome to The Talking Rehab Podcast. I. So I'll set the scenario for a very particular patient interaction. I had a patient come in recently that I did an injection for their knee and I sent them for physical therapy. And they came in with a limp, not a big one, but just enough where I could actually see them limp. And it's something that I commonly do where I watch patients walk in, as they're walking. I could tell that it was, just enough to make the hallway walk a little bit longer than it needed to be. And the gate was stiff. The shoulders were guarded. As I was talking to him, he was, fairly polite, but a little bit tense. it was like he didn't wanna be here, but also didn't know where else to go. And I had asked him, what's going on? And they said, it's just some morning stiffness but also they're having some ankle pain, even though I injected the knee and they've tried some stuff. They're not exactly sure what was helping. And so I proceeded to ask, how did therapy go? How did the injection do? And I. it was like a, a sigh where they just said, we did what we always do, we focus on the exercises, we focus on the tendon. and, essentially I said, was there any change? And they paused and said, maybe 5% better. But I don't know. That could just be in my head. and then it was followed up with kind of a shrug of, helplessness, ambiguity. And this is a very common scenario, where I will send someone, offer a treatment, and I wanna, I want to know how they're actually doing, and they give me a, big sigh and say, I'm only about 5% better. And so I have started to try and think about what does 5% better actually mean or what? And plus, why are they telling me? 5%. when I hear the term 5% better, that's pretty close to zero in my book. Usually when I do an A treatment, I'm expecting them to be at least in the 50, 60 80% improvement. So when someone tells me that they're about 5% better, it's very close to nothing. It's almost like they're trying to convey to me that something happened, but it's very minimal. in a way, I would almost prefer that they just say it did 0% better, because when I do certain treatments or certain injections, I want to know if I'm targeting the right structure. And if so, is it actually giving them some relief to do something? Is it giving them some momentum? But, again, very common. People tell me, it's just a little bit better. And it, that's the topic of today's episode is essentially how do we know that we're actually getting better and. pain in general is the most common symptom that physicians will ask about, in the rehab world, we, we monitor it very closely. It's one of the very first questions that we ask a patient, the infamous, how many, out of 10, how please rate your pain. is it up? Is it down? Is it the same? But the problem is that pain is probably not the best marker of improvement, even though it's the most obvious for patients. they come to see me because they hurt. but it is a very, noisy, reactive, inaccurate, marker of progress. and worst of all, it, it can be very, it can be affected by, things that are not necessarily physical. it can be affected by, an a negative interaction that morning. it can be affected by the weather and. this is an area where patients, and sometimes clinicians can get a little bit confused because pain is a, is something that people can report, but it's often affected by things that are, not necessarily objective or easy to control. but pain is affected by everything from whether to how the person feels about themselves, and yet it's what patients and sometimes clinicians use to decide whether or not a treatment is working. It's like measuring a baseball player only by home runs, it's, it puts points on the scoreboard, but it does, it misses the whole story of the player themselves. I think what's going on is that, we're waiting for the big moment. the, I feel amazing, revelation, but we often ignore what's actually happening. there's like the little things, the subtle shifts, that actually make the big difference. Watching someone with knee pains, stand and walk a little bit easier, they can tie their shoes without bracing. They can get up and out, out of their chair more comfortably, sleeping through the night. That's one of the big questions that I, focus on is because when people don't sleep very well, that tells me that the pain is fairly pervasive and, it's one of the first questions I ask, even if someone is continuing to have pain symptoms is, if someone tells me they're 5% better, I will often ask'em, how are they sleeping? And sometimes they'll say, I slept great. And then I will say, previously you were not able to sleep and we put you on a treatment program and you still have pain throughout the day, but you are able to sleep through the night. So in my eyes, I look at that as progress and I'll turn to my patient and say, how would you interpret it? and you can be, you can get some kind of a mixed bag of answers from the patient. it's the point of me asking them and redirecting it to them is not necessarily to prove that anybody's wrong. But to kinda, to understand how they perceive their improvement, these subtle changes, these subtle changes can be sneaky. so you do have to pay attention to them because they are signs of what I call, rehabilitation momentum and, Momentum is, that's really the name of the game when it comes to rehabilitation. I wish I could say that, we can just knock the pain out of the way, make it go down to zero, and that's all that needs to be done in the rehabilitation world. But, that's not exactly how the body works. Sometimes, there are other goals aside from pain that need to be addressed before someone can actually be essentially a hundred percent. Again, I. So here's kinda what you know, the data rarely shows is that, recovery doesn't usually feel like progress. It feels like repetition, like boring sets, half finished stretches, like doing something over and over again until you're nervous to sit until, until you were sick of it, It is like doing something over and over again until your body decides that it can trust it again, and this is why I find the 5% comment actually matters, is it's not the finish line per se, but it is a turning point. It's the first brick in a wall that hasn't been built yet. there is a psychology of a, quote, unquote, a little bit better. patients and humans. we don't evaluate change very rationally. we don't necessarily plot our symptoms nicely on a graph. it's not mathematical in that sense. we often will don't work through it objectively. So we go by feel and we use reference points of how things used to, how we used to be able to do things Sometimes we go by feel or by stories. By weather today seems like it might suck slightly less than yesterday. So when someone says, I think it might be better, they're not just reporting data, they're running a risk assessment. they're deciding whether or not they see the light at the end of the tunnel, and that's the moment that, that we as clinicians need to lean into, It's not something that we need to fix. It's not something that we need to necessarily patronize them, but we do have to notice that those little comments and say, tell me more about that. Tell me more about what 5% means to you. But this is where most clinicians tend to screw it up. we dismiss the small wins. We say that's good and keep moving. Or worse, we go looking for more objective signs, range of motion, resisted strength, and ignore what's actually changed. It's the person, the patient's internal story. the great clinicians, they catch that moment, We dig into it and say, what does that 5% look like in your life? And the answer is always something meaningful. I got to, I got outta bed without limping. I stood to cook dinner. I wasn't scared to lift my kid. That's not noise. like pain, that's not noise. This is the actual signal that we're looking for. Imagine if we, instead of pain scores tracked how many stairs someone climbed without hesitation, how long they stood before shifting, how often they moved because they wanted to, not because they had to. the rehab world might look completely different. people would. Monitor more than just their pain. They would feel less anxious. They would tend to be more honest, they would tend to want to talk more about how they're actually doing. But because those metrics, they're hard to measure. But these are the ones that patients actually care about. So what do we do? What do we do with this? We build tools, not necessarily the high tech ones, but the simple ones. we can start with a weekly question. What felt easier this week? we could have a progress list, like a whiteboard, how many wins for from the past seven days. a common one that I like to ask is out of seven days last week, how many of those were good and how many of them were bad? how about if we were 10% better next week, what would that look like? And, these are not just words, these aren't necessarily gimmicks or tricks, we're trying to give. Patients, some other measure that's actually real. Again, these pain numbers, they're numbers, but they don't have real context, for some people. So by giving patients the words, giving them the scenarios, giving them the familiar situations, we build their reference as opposed to zero out of 10. Because, here's the punchline that nobody says out loud. Rehab isn't just about pain, it's also about the person's identity. When someone loses physical function, they lose part of themselves. They lose their confidence, they lose their role in their family at work and their society. sometimes their sense of worth. So when someone tells me that I'm 5% better. What they might be saying is, I think I'm still in there somewhere. I'm not 0% better. I'm 5% better. And it's our job to help them believe that not. not patronize them, but also walk through that process of asking what 5% better looks like for them. What does 10% better feel look like to them? And with this process of asking them questions and helping them, interpret their journey, this is where we build that rehabilitation momentum with this kind of careful attention to the small things. we bring to life what actually matters the most to these patients. So what do you do when someone tells you that they're only 5% better? You listen, you anchor to it, and you build from it. Because if you know what to look for, 5% isn't a failure. It's the start of a comeback. Thanks again for listening to, thanks again for listening to The Talking Rehab podcast. That's all I have for you today. Thanks again for listening. Thank you for listening to The Talking Rehab podcast. I hope that this podcast stimulates you to question your own practice and how you approach rehabilitation. I truly appreciate your time and attention. If you enjoyed listening, make sure to like and subscribe to the podcast. I wish you a movement filled day. Take care.