By Paul Kochoa, PT, DPT, CGFI
Movement, it’s how we get around and interact with our world. But what happens when we become afraid of moving? That’s kinesiophobia. It’s the fear of moving. In the world of physiotherapy, it is a well documented disorder where a person believes that movement can cause more injury and pain.
Pain itself is a multi-dimensional sensation, and is a subject unto itself. Pain is a reaction to a noxious stimulus. That stimulus can be from a multitude of origins in our body or our environment. If left unremitted and untreated, pain can change the brain causing further problems. Stimuli that was once before benign can be misinterpreted as painful. This central nervous system change can set up a cycle of immobility leading to tightness leading to more pain with movement.
Kinesiophobia is correlated with chronic pain. Understanding this relationship can be a difficult task for a physiotherapist, but remains important in order to address the dysfunctions that can cause the cycle of pain, immobility, and fear of moving. The psychosocial as well as the physical components to pain should be considered during rehabilitation.
Physiotherapy is about restoring normal movement and function. Educating the patient that diagnostic tests, measures and a thorough physical evaluation can rule out any structural or medical problems that can preclude therapy and movement is the other half of the equation. Understanding the reasons for pain and treating it successfully requires a team approach, a team consisting of the patient and the physiotherapist.
Combining the physical and the psychosocial aspects of pain and kinesiophobia can result in better outcomes. Physiotherapist can guide a patient in understanding what causes movement dysfunctions and how to control them. Kinesiophobia doesn’t have to be as debilitating as it can be.
Once the physiotherapist can gain the trust of the patient, gentle return to normal movement can be a start once pain levels can be controlled. Deep breathing exercises, relaxation techniques, and other passive interventions can decrease the intensity of the pain. Returning to normal movement is an important step in breaking the kinesiophobia pain cycle. Gentle stretches and soft tissue or myofascial techniques can mobilize soft tissue and break up adhesions in the connective tissue structures. Showing the patient how to move carefully and self-mobilize soft tissue can give the patient control over kinesiophobia.
Pain and fear of movement can be addressed successfully if the physiotherapist can show the patient that they can control the pain and dysfunction and not be a victim of their own movement avoidance behaviors.