Kinesiophobia, fear of movement due to pain

The kinesiophobia it is the fact that a person reduces activity when they suffer damage is part of the body's own physiology. What happens when we are injured? The first thing we feel is pain as a defense mechanism of our body as it alerts us that it is suffering. Nociceptors pick up the painful stimulus, send the signal to the spinal cord and brain where the stimulus is processed, and create a protective response, such as withdrawal of the hand when in contact with very hot water or immobilization of limb or sudden stop of activity during a sprain, fibrillar tear, or acute low back pain.

Kinesiophobia What is it about?

Kinesiophobia, as its name indicates (Kiné = Movement, Phobia = Fear), refers to fear of movement or to perform a specific gesture that has recently caused specific pain. This pain is associated with acute injuries, such as ankle or knee sprains, dislocations, fractures, etc. The problem appears when the perception of pain is so acute that it becomes a traumatic experience and the patient himself avoids performing the movement that caused the pain in the beginning, thus running the risk of the pain becoming chronic due to the lack of mobility.

What are its consequences in our body?

The normal thing is that when a person suffers damage, they avoid the damaging mechanism by limiting their mobility, which is called avoidance immobility. Furthermore, one of the consequences of pain is to make us stop activity and remain at rest as a protective physiological response. Rest time and immobilization are necessary for the inflammation to decrease and the tissue regeneration process to begin, which corresponds to the acute phase of the injury (first 48 hours). If immobilization is prolonged for a long time, tissues atrophy, muscle mass is lost and the risk of chronic injury increases. Avoidance immobility also causes sustained postures that lead to stiffness and favors joint locks. Thus, it is important to know how to identify a disorder of this type to prevent the problem from lasting longer than necessary.

How does a physical therapist deal with such a situation?

We often come across patients whose pain experience has been so traumatic that they show great apprehension about limb mobilization, making recovery from injury difficult. Let's say, for example, that a patient comes to consultation because he has suffered an episode of acute mechanical low back pain, which has generated such intense pain that at the time he was not able to rejoin. After this traumatic experience of pain, the patient limits the movement of his lumbar spine for fear that the episode will be repeated, he presents a limitation to walk normally and of course to carry out any activity of daily life. The physiotherapist must bear in mind that not everyone perceives pain in the same way; there are people who can suffer disturbances in the perception of pain. Therefore, during the examination, you must analyze and identify the degree of pain that the patient suffers in relation to the injury suffered and adapt the treatment regimen or, on the contrary, refer to the corresponding specialist if it turns out not to be within our competence.

What other factors need to be taken into account?

On the other hand, pain is associated with biopsychosocial factors (more difficult to identify in a first interview). There are people who can experience pain in a very traumatic way and thus refuse to move the affected limb again. These types of patients should be listened to, explain the physiological process of recovering from an injury and that feeling pain or discomfort is normal and part of recovery. Manual techniques and adapted exercises are used so that the patient trusts the physiotherapist and also ensures that he is a participant in the treatment, since the patient's involvement is the key to a good recovery prognosis. Multidisciplinary work can be a good method to treat people with pain phobia. Psychological therapy, together with physical therapy, can obtain very good results for the recovery of the patient in addition to optimizing the treatment.

Complications that may appear

If the attitude of phobia lasts for a long time, it can severely affect functional recovery, perpetuating pain and causing great disabilities. Some studies have directly linked kinesiophobia to chronic low back pain, complex regional pain syndrome (SUDECK), or chronic fatigue.

• • According to studies, women report a better acceptance of pain and social support compared to men.
  • The degree of kinesiophobia can be detected through questionnaires such as the Tampa Scale or the pain Anxiety Symptom Scale.
  • One of the most traumatic injuries that become chronic due to kinosphobia is acute low back pain.

yasmina Santiago Advance Medical Consultant Physiotherapist