Clinical Safety Grading Framework

Not all movement risk is physical.

Grade safety the nervous system can feel.

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🔹 Purpose: To help clinicians assess and grade the perceived safety of an exercise or intervention—not just its biomechanical load. This framework expands beyond tissue tolerance to include emotional, contextual, and narrative safety.

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🔹 Why This Matters: If a movement feels threatening—even if it’s “mechanically sound”—it may trigger guarding or pain. But if a movement feels safe, it becomes a message: You can trust this. This framework helps you build that trust intentionally.

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🌀How to Use It:

Before prescribing movement or activity, run it through the following five lenses.

Grade each from 0–2:

▫️ 0 = Potentially threatening

▫️ 1 = Neutral / Unknown

▫️ 2 = Actively safety-promoting

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🧠 The 5 Safety Lenses:

1. Physical Load

▫️ Does the movement challenge the body appropriately?

▫️ Is it scaled to avoid mechanical threat or overload?

✅ Example: Starting with partial range, or unloaded version

2. Contextual Meaning

▫️ What does this movement symbolize to the patient?

▫️ Is it tied to fear, failure, or previous flare-ups?

✅ Example: Patient avoids stairs since injury—start with step taps in a different location

3. Relational Safety

▫️ Do they feel seen and supported by you during the task?

▫️ Are you present, calm, and attuned—not rushed or distracted?

✅ Example: Making eye contact and checking in before initiating movement

4. Cognitive Narrative

▫️ What belief are they holding about this movement?

▫️ Are you introducing helpful language that reframes risk?

✅ Example: “This is a movement your body can re-learn, gently.”

5. Autonomy & Permission

▫️ Do they feel in control of the pace and ability to pause?

▫️ Have you invited them to opt in—not just follow directions?

✅ Example: “Let’s explore this together—you tell me if it’s too much.”

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🧾 Scoring Interpretation:

▫️ 8–10: Movement likely to promote safety and adaptability

▫️ 5–7: Use with caution—may need modification or more support

▫️ <5: Consider reframing, adjusting, or delaying this movement

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🧠 Bonus: Safety = Capability

When safety is felt, capacity increases.

You’re not lowering the bar—you’re clearing the path.

This resource is part of The Wondering Clinician Toolkit. It’s not medical advice—just a tool to support learning, reflection, and healing. Always consult your clinician when needed.