If a zebra in the safari injures his leg, he keeps moving as much as possible because he needs to survive. If a human injures his leg, he may stop moving because he is too scared to move. This fear of movement (kinesiophobia) is rooted in the belief that pain is harmful and threatening. For the same reason Zebras Don’t Get Ulcers, zebras do not become fearful of movement. Zebras are too busy surviving to worry about pain, movement or threats other than that lion over on the next ridge. On the other hand, humans can get all wrapped up in worry; worry about not being able to go to work, worry about not being able to keep up with the house, worry about the unknown, and worry about future. These threats to basic livelihood promote anxiety, pain and the fear of movement.
Once someone becomes paralyzed in fear, that person will avoid activities. Imagine if a zebra avoided foraging on the safari, seeking water in the heat, or running when a lion approached. A zebra that avoids basic activities of daily living does not survive long. In humans, that avoidance behavior is equally maladaptive but in a different way. In humans, avoidance behavior impacts health more than it directly impacts survival skills. Physical health declines from lack of movement as the body becomes deconditioned. Mental health declines from lack of movement as the person becomes more depressed. As the overall health declines while the fear of movement grows, the pain will become worse and the cycle will perpetuate itself. If you are stuck in this fear of movement cycle, you need a way to stop it.
The first place to start is with your belief that pain is harmful. You need to realize that pain is normal and protective. You need to realize that pain does not necessarily mean that harm is being done. By challenging your belief that pain is threatening, you might be able to break the fear cycle. An excellent book that can help you do this is called Explain Pain by David Butler. Understanding where pain comes from, what pain means, and why pain continues to persist can help you reduce the threat value of pain. After reading this book, you could walk away with the comfort in knowing that some “hurts won’t harm.”
Once the fear is managed by a different belief system, then it is time to move. Or at least think about moving. You can start with a technique called mindful movement. By imagining yourself walking on a beach, feeling each step, and being aware of each muscle, you can lay down a non-threatening movement pathway in the brain. People who practice mindful movement report a sense of freedom, body awareness and presence in the moment. Preparing the brain for movement is a small but important step.
Actual movement requires even more thought. First, find an activity you want to do. Then, find your baseline activity tolerance that will not cause any type of flare-ups. Plan your progression week by week, month by month; constantly building on the time in which you participate in your chosen activity. All of this is outlined by Dr. Butler in his book Explain Pain. He reminds readers to be gentle on yourself and if you do flare-up, don’t freak out. This therapeutic intervention, Graded Exposure, is going mainstream for the treatment of many types of painful conditions like back pain, neck pain and complex regional pain syndrome. When done properly, graded exposure rebalances the brain. Instead of being all wrapped up in anxiety, fear and pain, the brain can once again send out messages about movement and survival. Graded exposure works for other phobias like the fear of heights, spiders and flying. Graded exposure also works for the fear of movement.
Getting back to the injured zebra in the safari; this zebra knows that avoiding activity, doing nothing, waiting for something to happen, or believing someone will fix the problem does not help it survive. In the safari, the zebra has many things to fear but movement is not one of them. Instead, the zebra like you has to actively cope with his pain and dismiss any fear of movement. This zebra will find different ways to moves, develop easier routes to travel and ways to live with the pain. These types of active coping strategies can also be deployed in your life. If you learn more about pain, explore different ways to move like mindful movement, and make plans to gradually move more with a graded exposure intervention, you might be able to start doing more of what you enjoy doing with no fear.
Specialist in Pain Management and Spine Rehabilitation