S E3: Ep 3 – Why moving more when you are in pain can be a good thing

Hello and welcome to the Pain Free Living Podcast.

My name's Bob Allen and my aim is to help you to live pain free.

Let's begin and welcome to another episode of the Pain Free Living Podcast with me, Bob Allen, and me, Louise Gordon.

I'm an osteopath.

And you, Louise?

Well, I'm not an osteopath, so I am a change coach and consultant.

So I work with individuals and businesses to navigate change.

And I'm here because I like asking.

Lots of questions and I'm here because I like answering them.

And what are we talking about today, Louise?

Today, Bob, we are talking about kinesiophobia.

I hadn't heard of the term kinesiophobia before, but I can identify with kinesiophobia.

So Bob, what is kinesiophobia?

So, Louise, kinesophobia, as its name suggests, is fear of movement.

And if you don't know Latin, you probably wouldn't know that.

But yes, kinesophobia is fear of movement.

And it's not a term that's commonly used.

But for anyone that's had pain for any length of time, once we get into it a little bit, they will totally relate to what it's all about.

So, yeah, like it says on the tin, it is a fear of movement.

So tell us a bit more then about this fear of movement.

I see it a lot with people that have had back pain, but it's any kind of long standing pain that you may have, it's a body trying to protect itself.

So if you have had a case of chronic back pain, well, even acute back pain of pain about three or four weeks or more, what you'll know is that moving in a certain way is going to cause pain.

So what you do is you kind of compensate for that by finding another way to move around.

So if, for example, bending forward to pick something up off the floor causes pain, what you'll do is you'll probably bend your knees and then pick something up, or you'll sit down and pick something up, or you'll find another way to, to reduce that pain.

That's great because that just gives the, gives you back a chance to heal.

Movement is good.

So not avoiding moving is a good thing.

But if, if a certain movement, a bigger movement causes pain, you'll reduce the size of that movement.

So you'll start to move less or you'll find another way to, to move to avoid causing that pain, the problem, when it becomes a problem, is where the issue is healed, your back's feeling a bit better, you can move more, etc.

Etc.

But the problem is that your brain, that fantastic organ between your ears, will have learned that moving a certain amount will cause pain.

So what you do is you move less and it's that fear of causing pain which reduces the amount of movement you got.

So that is the definition of kinesophobia.

And I guess then a lot of people must, I'm assuming, must have kinesiophobia.

I know having had an injury, you naturally avoid doing anything to put extra strain, stress on an injury.

And you know, sometimes injuries take quite a while to heal.

Yep.

And then you find that you actually are getting aches and pain somewhere else as a result, because you're maybe walking slightly different or.

And I do totally understand about the back pain that you really don't want to, you really don't want to have that anymore.

So you will avoid doing things if you don't want to aggravate it.

Absolutely.

And you can see it with sport.

Well, yeah, sports people.

So when a sportsman has an injury, they'll have a hamstring tear or something like that.

The advantage that they've got is a professional team with infinite amounts of money to give them massages, physio, they'll have sports psychologists, all to help them overcome that fear of pain or a pain problem.

Unfortunately, the average person in the street does not have that behind them.

So they will then modify their movement to avoid the pain and then that becomes a habit.

Because the brain is very, very good at developing habits.

The brain doesn't know whether a habit is good or bad.

It just knows that by developing that habit we don't have to think about it and it becomes automatic.

It's a bit like a good example is about learning how to drive a car.

As a learner, you get in a car, you then have to think, handbrake, check the mirror, check the side mirrors, all of those things, clutch, brake, all of those things that you have to do.

When you start learning how to drive, after you've been doing that for a while, it becomes automatic.

You don't have to think about it anymore.

That's what we call neuroplasticity and brain's ability to learn something.

And then, you know, basically it's minimizing the amount of energy that the brain has to use to be able to perform that skill.

The downside of it does that as well, where pain is involved and it's.

A natural, a natural reaction.

And it is a natural reaction.

It's a body trying to protect itself, but the body isn't clever enough to know that it no longer needs to do that protection.

So unless you train or unless you've got somebody to help you through that, then you're always going to do it.

And a classic example that I see a lot is where people have had, had an ankle injury, because.

So say you, say you sprain, you have a severe sprain on your right ankle.

What you do is you shift 60% of your weight onto the good side, the left ankle or the left, the left side, and say 40% on the right side.

As the pain reduces and things improve, the weight kind of slowly shifts back, you start getting more confidence in the ankle and you'll start to use it more.

The downside is that unless you then have somebody who can help you to rehab that you tend to always have an imbalance.

So the weight may be 52% on the left, 48% on the right, but it's never quite the same.

Ankle sprains can be recurring and ankle sprains can be recurring because the ankle has never been rehabbed properly.

So the good news is that that good old neuroplasticity, the way the brain can remember stuff, if you've learned a habit which is not serving you, so like I said, so you're putting more, more weight on one side than the other, you can also unlearn that habit.

You have to deliberately do the training and exercise to do that, but you can unlearn it as well.

So the classic with low back pain is that it can last a while.

So you learn how to not bend the lower portion of your back.

What this can result in is that you've got compensations going on which can then lead to recurring back pain.

And I see it quite often where people will have low back pain once, twice, two, three, four times a year, because what happens is they get into a routine of something and then the back decides one day that we're done.

It can cause them excruciating back pain for a while.

They'll change their habits, but as the pain reduces, they'll go back to the old habits that cause a problem and it happens again.

So what I have to do is to teach them how to use their back properly and then the problem becomes no problem.

Right.

So, yeah, it is possible to unlearn kinesophobia, but it can take some support from people that know what they're doing to help you through that process, what's your standard approach?

Then you've got a client and you identify there's some kinesiophobia.

What's your next steps?

Right, so the first thing is to teach them that the movement is actually okay.

And that can take a while in itself because although they may not consciously think my back, you know, if I do this, my back's going to go.

Actually a lot of people think that.

And it is quite conscious that I won't do this because the last time I did this, it caused this problem.

So what I have to do is to find where they are in terms of movement and then I start from there and then I kind of coach them through over time with rehab exercises, just conversation to say, okay, when you hurt your back or when you injured this body part, this is what happened.

Now let's get a bit of movement in there, let's get you moving a bit more and a bit more.

And then you progress that to the point where actually the brain understands that they can do this movement and it's not going to cause a problem.

Right.

So it depends on the person.

It can take time, but yeah, it can be done.

And is part of that on the kind of the education side as well in terms of explaining what's going on in terms of what then what their body is naturally doing.

Yeah.

And, and that's one of the things that I always do is if I'm treating someone then I will always explain what I'm doing, why I'm doing it and the benefits of doing it.

Yeah, for me that's really key because it gets, it gets you the buy in from the person you're talking to.

And they are more likely to follow your advice than not because they understand that this is what they need to do to get better.

But they understand exactly why they're doing it as opposed to just giving them a sheet of exercises and say, go away and do those and you'll be fine.

So yeah, explanation really, really, really important and that's a big part of what I do.

And so what's your recommendation to anybody listening, watching this in terms of they're aware that they might now are thinking, I think I've got kinesiophobia, you know, I've injured my knee and I'm aware that I'm walking slightly different.

What's your advice?

Yeah, my advice would be to find somebody that can talk you through that.

You know, it's, yeah, I don't, I don't, I don't want to shout and advertise my own business, but actually I do.

You need to find somebody that actually understands what the problem is, what's going on.

Yeah.

And they can guide you through the process for resolving that issue.

Yeah, yeah, yeah.

Cool.

Thank you very much, Bob.

Learnt something new there.

Thank you, Louise.

As always, today's podcast is all about kinesiophobia, fear of movement, because your brain thinks that it's going to cause you some pain.

If you've got any questions and you want to know more about kinesophobia, or if you want some ideas about who you can go and see, because I've got a list of trusted practitioners, so if you're not in my part of the world, I can generally point you in the direction of somebody who should be able to help.

If you enjoyed the episode, please tell all your friends and family, leave some comments on whichever podcast supplier provider that you listen to this on, and yeah, we'll see you next time.