382 | Overcoming Kinesiophobia and Fear of Movement After Pain or Injury

[00:00:05] Welcome to the Optimal Body Podcast. I'm Dr. Jen.

[00:00:08] And I'm Dr. Dom. And we are doctors of physical therapy, bringing you the body tips and physical therapy pearls of wisdom to help you begin to understand your body, relieve your pains and restrictions, and answer your questions.

[00:00:19] Along with expert guests, our goal of the Optimal Body Podcast is really to help you discover what optimal means within your own body. Let's dive in.

[00:00:29] Okay, before we go into this episode, I just wanted to take a little side note. I just got some recent blood work done. And it's been really interesting to see. I don't feel like I have changed my diet a whole lot this pregnancy, but of course, I'm not perfect. And we've been traveling sometimes or having people visit and it's hard to always support your body through just food. So having needed as support through this pregnancy has been so incredibly crucial.

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[00:03:04] So today we're talking about overcoming fear of movement or exercise due to fear of re-injury from a previous injury that you've had or just a previous pain that you've had.

[00:03:17] So how do I get back into not fearing that this movement is going to injure my back again or I'm not going to fall back into that same pattern?

[00:03:27] And so this is very prevalent.

[00:03:30] And I was so surprised when I saw this that it's not like 50 to 70% of adults, not just people who are athletes,

[00:03:37] but adults in general who have had an injury or have had consistent pains that start to develop this.

[00:03:43] They call it kinesiophobia, which essentially means a fear of movement, having to do with that previous injury.

[00:03:50] And it's very natural, like especially if it's a significant injury, something that really impacts our quality of life.

[00:03:57] Why wouldn't we have some sort of fear when going back to similar movements or movements that we feel uncomfortable with after having that injury?

[00:04:06] I mean, and it can also be learned by watching or mimicking the behaviors of others.

[00:04:10] So say you are listening to people who are like, you can only have a neutral spine.

[00:04:15] You can never bend your back or you're watching someone who's like, oh, I did that wrong.

[00:04:20] I need to do this or I need to do that.

[00:04:22] And like that can start to develop in your own brain of like, oh, that's bad.

[00:04:26] And I shouldn't do this.

[00:04:27] And like, oh, I need to fear that.

[00:04:28] And it starts to build this level of anxiety within our own body.

[00:04:33] Quick pause from the episode to talk about one of my absolute favorite ways to improve my health.

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[00:04:50] Wearing barefoot shoes over the last five years has drastically improved my hard and rigid feet.

[00:04:55] The high arches that I have, I have a huge history of foot ankle related problems that is pretty much non-existent present day because I've committed to wearing barefoot shoes over the last five years.

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[00:05:57] All right, let's get back into the episode.

[00:05:59] It sounds counterintuitive because a lot of people talk about how certain movements will cause injuries.

[00:06:05] And the way that we talk about it is like, no, it's not necessarily the movement itself that caused the injury.

[00:06:10] It's being unprepared in our body for that movement that resulted in us going past our body's capacity, whether it's joint, ligament, tendon, whatever, and resulting in injury.

[00:06:21] So, it's not a specific movement that, quote unquote, causes an injury because there are many people that do all sorts of different crazy movements and have no injuries during them.

[00:06:31] Why?

[00:06:31] Because they've prepared their body as such.

[00:06:34] And I think it's interesting because when we talk about, I think this is more related to end of life and falls, but a lot of older adults will start developing fear of movement.

[00:06:45] And we call them fear avoidance behaviors.

[00:06:49] And actually, when you start having a fear of movement or say, yes, I have fear avoidance behaviors.

[00:06:54] I don't want to walk from here to here because I'm afraid of falling.

[00:06:57] It actually increases your risk of falling.

[00:07:00] Same with low back injuries.

[00:07:02] Oh, yes, I have a fear of squats, deadlifts, picking things up from the ground.

[00:07:07] It actually increases the likelihood that you're going to have a back injury.

[00:07:10] And so, I think it's really important to talk about how we can resolve these because having dyskinesiophobia or having fear avoidance behaviors in general might itself be increasing our likelihood of having that injury or pain again that we are afraid of.

[00:07:27] And this is where it becomes really important of the language that clinicians ourselves get to be responsible for and what we're saying and how we're presenting information.

[00:07:36] Because if we're presenting information that makes it seem like you're fragile, right?

[00:07:43] If my hands can put something back into place just by this quick manipulation or this quick thing within my hands, well, then if you step off a curb rung or if you accidentally trip or if you're lifting something super heavy, couldn't that mean that your body is going to go out of place again?

[00:08:05] Wouldn't that mess up alignments of something?

[00:08:08] Like, we then believe that we have this fragility within the body if our SI is not aligned, if our pelvis is rotated, if we're told all of these things continuously.

[00:08:20] Or if because we've had pain and this happens a lot, you have patients who then see one therapist to another therapist to a chiro to an osteopath to, you know, and they start to see so many different people who are telling them all these different messages.

[00:08:34] Oh, this is why you have pain because of this structure within your body.

[00:08:37] This is why you have pain because, oh, we can look at this x-ray and see that this is happening, you know?

[00:08:41] And then they have their laundry list of the 50 things that they have ever heard from any provider.

[00:08:46] I mean, me just saying that, doesn't that give you anxiety just starting to hear all of these things within your body?

[00:08:53] So, of course, you start to feel like you're fearing movement because you have all these issues within the body going on, which we know for a fact that we can't look at an image.

[00:09:04] And we've talked about this so often.

[00:09:06] We cannot look at an image and dictate, oh, because you have this going on, this is why you have pain.

[00:09:11] Could it be part of the story?

[00:09:13] Could it be a contributor?

[00:09:13] Sure, but we cannot say that you have this disc problem.

[00:09:17] This is why you have pain because many people can have disc problems and have no pain.

[00:09:22] Yeah, and I thought that's where you were going to start with like the images and whether it's an orthopedic doctor or somebody who's interpreting your image saying like, oh my gosh, this is the worst.

[00:09:32] The worst I've ever seen.

[00:09:33] The worst image I've ever seen.

[00:09:34] Or just coming out of a surgery or you herniated a disc and maybe you have a microdissectomy surgery.

[00:09:42] And then the doctor saying, well, you can't do this.

[00:09:45] Don't bend over and lift stuff up.

[00:09:47] Don't do that.

[00:09:48] And while that might be a precaution for a certain amount of time after a microdissectomy, which is a minimally invasive surgery and precautions are what they are.

[00:09:55] But that's the seeding ground for these types of fears like, oh, I can't bend over.

[00:10:01] Like, oh, it's been past a week or two weeks or however long he told me to wait.

[00:10:05] But I'm going to wait a little longer because I don't want to start picking stuff up yet and risk.

[00:10:08] I don't want to re-injure it.

[00:10:10] And risk herniating a disc again.

[00:10:11] Like, it already starts to seed that doubt and sow that doubt that I can't return to that because I'm going to hurt myself again.

[00:10:18] When in reality, not returning to that, we're deconditioning our body's ability to be prepared and be supported within that movement.

[00:10:26] Like I mentioned at the beginning.

[00:10:27] So, we need to, best we can, start working back to those things.

[00:10:32] But how do we do that when we have fear?

[00:10:34] Because fear is a very real thing, just like pain is a very real thing.

[00:10:37] And we're not trying to say neither of those exist.

[00:10:40] Right.

[00:10:41] They are, in fact, very real and very difficult to overcome in many cases.

[00:10:46] Yeah.

[00:10:46] So, we have to start addressing it.

[00:10:47] Okay.

[00:10:48] How can I start to step back in and understand when this fear is causing more anxiety in my body?

[00:10:54] And I think those, so we want to start to address like what signs and symptoms should I look out for within my body where, okay, this movement might not feel safe and I'll probably be in more pain tomorrow.

[00:11:07] Right?

[00:11:37] And I think that's a different reaction that I'm feeling right in this moment.

[00:12:07] Take a deep breath in around my low rib cage and belly area.

[00:12:12] And as I exhale, get those muscles to relax.

[00:12:15] Can I slow down the response?

[00:12:18] And that's really what we're looking for.

[00:12:20] Can I slow down this anxious response in that activity?

[00:12:24] How do I modify it?

[00:12:25] How do I pause it?

[00:12:26] And how do I address it and acknowledge it?

[00:12:30] And if we can't, if I'm still feeling that tightening, stiffening, okay, I can back off and I can tell my body, thank you for telling me that this doesn't feel ready yet.

[00:12:39] I think like continuing to talk to yourself to acknowledge like this doesn't feel comfortable and that's okay.

[00:12:46] Like you're not expected at a certain timeline to get back into whatever movement that therapist might have told you you're supposed to get back into or on a specific time on it.

[00:12:55] Or your friend who, you know, well, they got back from this injury this much faster and this is what they were able to do.

[00:13:02] It's time to stop comparing your journey to someone else's and start acknowledging your body and just what it needs in that moment.

[00:13:08] And depending on how long this has been going on or how long you have had fear about specific movements, it's going to, we're going to have to take different approaches for every individual.

[00:13:18] This is a very specific condition based on the previous injury you had.

[00:13:24] If it's not an injury, then the pain that you're dealing with and the movements that you associate that fear with.

[00:13:32] And this is why seeing somebody in person who can help guide you through this is so beneficial because there are so many techniques that they can bring in that you may not have thought of.

[00:13:40] What Jen brought up just now with the deadlift example or essentially picking something up off the ground and feeling comfortable was a modified version of the actual movement itself.

[00:13:52] If that doesn't seem possible right away, if getting to the edge of the bed and supporting yourself and starting to do that hinge is like, nope, it throws me into a spasm.

[00:14:02] What are other activities that we can just add more activity in that doesn't cause pain?

[00:14:08] Is it just going on a walk around the block and then progressively walking longer distance?

[00:14:14] If walking is fair game and you have minimal or no pain doing that, how can we just get ourselves on a progressive walking program?

[00:14:21] Because that's going to build in so many physiologic effects from the movement, from being outside, that it's going to have a lot of impact on those chronic pain patterns that we've been building.

[00:14:32] So doing different activities or if that deadlift isn't feeling good, does it feel okay to sit down into a chair and then stand back up?

[00:14:42] While that's more of a squat pattern versus a deadlift pattern, similar components, you're using similar muscles.

[00:14:49] Can we just stand and sit from a chair or even a higher surface?

[00:14:53] Like if the edge of your bed is higher, can I sit my bottom down and then stand back up from there?

[00:14:58] And there's a lot of ways that we can start building resilience into these muscles, movement patterns and building confidence within ourself and our system.

[00:15:05] This is what I can do.

[00:15:07] I am able.

[00:15:08] I have a strong body.

[00:15:10] It can be massively beneficial.

[00:15:12] And sometimes that's where it's like, sometimes, you know, you're going to want to say, okay, how can I use my breath pattern to my best benefit and take a breath in as I lower and take a breath out as I come up?

[00:15:24] And how can I utilize my body and kind of think about it that way?

[00:15:27] Where for others, the more thought that you put into it, the more overwhelmed it becomes because am I breathing correctly?

[00:15:34] Am I doing this right?

[00:15:35] Am I squatting in the way that I'm supposed to?

[00:15:38] Am I rotating?

[00:15:39] You know, like there's so much more that becomes anxiety driven.

[00:15:41] So maybe going on a walk with a friend, listening or calling someone.

[00:15:46] So these distraction methods are really great methods as well to take you away from that anxiety of thinking about what could be potential in your pain and just getting you back into the movement.

[00:15:57] And this is where we also saw, you know, virtual reality activity exposure.

[00:16:02] Which is something you see used in more and more clinics for different applications.

[00:16:05] But even like a lot of virtual reality, you know, you're doing a game as you're trying to get into movement.

[00:16:12] And so now instead of thinking of how I'm squatting or going in or how far I can squat or what feels good for me right now, I'm just trying to dodge something or I'm just trying to move or I'm going lateral.

[00:16:24] Like it's going to put you in a lot of different things without having to overthink it.

[00:16:28] And sometimes the overthinking can lead to a lot more anxiety and fear.

[00:16:32] Outside of that, there's so many other ways to adapt movements.

[00:16:36] Like there is adaptive yoga where you can do yoga type movements seated.

[00:16:41] In a chair.

[00:16:41] In a chair.

[00:16:42] And just get yourself moving through your back, through your spine, lifting your legs, standing and sitting from the chair while using support.

[00:16:50] That can get you doing, again, different components of movement or just the movement that is comfortable for you right now.

[00:16:58] Aquatic exercises can be, you know, very beneficial and very comfortable for a lot of people because the water itself helps to put pressure around your body to give you tactile feedback.

[00:17:10] So it kind of will help gate the pain a little bit or the pain response.

[00:17:14] And it gives you the buoyancy.

[00:17:15] So you might be able to do some movements where on land, they scare you in the water, you feel more supported.

[00:17:22] And I thought it was interesting.

[00:17:24] There was one study I was looking at that said even just patient education alone.

[00:17:28] So if you get with a good provider, who's not going to put the fear of fragility in you about like, oh, your body's so frail.

[00:17:36] Like if they're actually just educating you on the injury that happened or the pain that you're having, the ability that you have in your body and giving you confidence through education.

[00:17:46] The study showed that it reduced kinesiophobia scores around people using certain metrics.

[00:17:53] And I think these people were just trying to do straight leg raises and a couple other activities.

[00:17:57] But just the education alone reduced their fear around those certain movements.

[00:18:02] Yeah.

[00:18:02] And you can also, this is where it could be beneficial to use cognitive behavioral therapy alongside seeing a physical therapist so that you're not just relying on movement, but like rewiring that nervous system and those neural pathways so that you don't feel so anxious and scared of the movement that you're approaching.

[00:18:20] And this is where I will say that it's so important not to focus on like the end result of where you're trying to get to or comparing your journey to someone else's or putting these expectations on yourself can be so harmful in this way because then we start to build up.

[00:18:38] Well, I'm not good enough.

[00:18:39] I'm not doing enough.

[00:18:40] I'm not.

[00:18:41] And that really doesn't do well with fear and anxiety.

[00:18:44] So it's like, how could I keep a journal, even if it's just like the notes in your phone of like, I was able to get out of bed and didn't think about my pain today.

[00:18:51] I was able to sit down on the toilet and go to the restroom and not think about it.

[00:18:56] Like those are wins that we want to be noting and keeping track of because we don't realize how much that we might forget about pain or not feel it in a certain movement.

[00:19:07] And that is proof to your body that, oh, my body can do this movement and not feel pain because what overwhelms us is like what we can't do and what we're feeling all the time.

[00:19:19] We feel like it's like constant and it's just.

[00:19:21] But then if we start taking note and actually writing it down of like, oh, when that happened, I didn't do that or I was able to do that.

[00:19:29] When we're able to like come back to those small wins, we're able to then gradually build on this bigger picture to get us back eventually to where we want to be or close to that.

[00:19:41] And so how can that look and and how can you set up your environment to start taking those smaller wins?

[00:19:47] And then the last thing I'll add in is just support.

[00:19:50] You know, if you have people around you who are judging your journey or don't believe your journey or don't believe you should be in pain or whatever it may be.

[00:19:57] Probably not the best people to have around you right now, like have people that are supporting you and cheering you on and looking at those small little wins and saying that's amazing.

[00:20:07] And that's ultimately where having a professional eye, having someone that you're with, whether it's a physical therapist or like you mentioned, some sort of counselor, cognitive behavioral therapist, psychologist to help set those goals and help set those realistic goals in order to celebrate the wins that help you work back towards the quality of life that you are desiring.

[00:20:27] Yeah.

[00:20:27] It's huge.

[00:20:28] It puts the power back in your hands.

[00:20:29] It helps you focus on what you can do, what you are achieving rather than the things that you can't.

[00:20:36] Thanks so much for joining us for another PT Pearl.

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[00:21:07] And of course, we'll see you next time on the Optimal Body Podcast.

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