Did you know that kinesiophobia is a thing? I didn’t either until recently. Kinesiophobia is pain-related fear of movement, injury, or re-injury. Kinesiophobia can contribute to the experience of chronic pain: it makes it easier for chronic pain to start, and it can make existing pain to get worse. Kinesiophobia can also become an obstacle toward successful rehabilitation.1
The Tampa Scale of Kinesiophobia
Researchers have recognized that psychological & social factors play a role in the experience and treatment of chronic pain. The term kinesiophobia was first introduced in 1990 by Kori, et. al., along with a way to measure the level of kinesiophobia called the Tampa Scale of Kinesiophobia (TSK).2 The TSK questionnaire features statements of beliefs about pain, exercise, and injury that people are asked to agree or disagree with.
|Sample of Questions from the Tampa Scale of Kinesiophobia|
|“I am afraid that I might injury myself if I exercise.”|
|“Pain always means I have injured by body.”|
|“It is really not safe for a person in my condition to be physically active.”|
The answers are scored such that higher scores indicate stronger kinesiophobia. High TSK scores have been reliably associated with increased probabilities of acute pain turning into chronic pain, avoidance behaviors, and of pain symptoms lasting longer.
I haven’t scored myself on the TSK, but I’m pretty sure I have a touch of kinesiophobia. I told to my wife, recently, that I was going to take a walk around the neighborhood. She invited me to join her in a run, even promising to run slow. My immediate response was “No way, I’ll hurt myself.” I know from previous experience that I can easily stress something around my ankles when I start running after a long period of no exercise. And I really like to avoid pain.
If I Don’t Move, It Won’t Hurt
Kinesiophobia is correlated with avoidance behaviors: the stronger your pain-related fear, the more likely you are to avoid physical activity that triggers the pain. I fall on the spectrum of avoiding things that I know could result in pain. I’ve been walking over the winter to keep up some level of physical activity, but skiing or snowboarding? Nope, nope, nope.
If you’re coping with chronic pain, pain-related fears can keep you from doing everyday activities. Does it hurt when you bend down? You’ll start to avoid bending down and, eventually, may stop bending down altogether.
You don’t even have to experience actual pain to start avoiding physical activity; the anticipation of pain is enough.2
Moving Helps Heal
The consensus in the medical community today is that movement is the key to healing chronic pain. The nervous system has gotten into a state that persistently generates pain experience, and it needs to be reset. Movement helps do the reset. Pain-related fear, though, can keep you from moving.
It’s well known that physical inactivity has an effect on the physiological systems of your body, and not a good one. Inactivity can set up conditions that allow chronic pain to start, and can make chronic pain worse as you slowly restrict your movements to just those that don’t cause pain.
The less active you become, the less mobile you are. The less mobile you are, the more likely that chronic pain will continue, and continue to make you less active.
Physical inactivity can contribute to depression, and depression often makes you more sensitive to pain. And pain can make you avoid doing physical activity.
Get Moving Again
Chronic pain doesn’t have to be debilitating, but you’ll need to start moving again to get out from under it. Become aware of your relationship to pain (e.g. I don’t mind it, It’s a small bother, I will avoid at all costs) and keep that in mind when you’re following an exercise or rehabilitation plan.
It’s OK to have some kinesiophobia, even a lot. When you know that you’re averse to pain, work with your doctors, therapists, trainers, etc. to make a movement plan that takes this into account. You may need to embrace a little pain in the short run to regain mobility and ditch the chronic pain, and it’ll be easier to do when you factor any kinesiophobia into the plan.
Massage for Chronic Pain
Massage is a great first step toward getting moving again, especially if you’re so bogged down with chronic pain that you don’t want to move at all. My Owww! My Pain sessions focus massage around the area of your pain. We get your brain to change how it thinks about the areas that hurt.
We know from the latest pain science that the brain generates your experience of pain. The brain learns to signal pain in part of your body, even though there may be no physiological reason for it. Using focused massage, we help your brain unlearn this pain signaling.
An Owww! My Pain massage feeds the nervous system with novel and soothing sensations from the place where your hurt. The new sensations travel through the nervous system to the brain, coaxing it to calm down and stop signaling pain when it doesn’t need to.
After a series of Owww! My Pain sessions, you may feel able to move again with less debilitating pain. Your pain might just go away altogether, and that makes moving again totally easy.
Crombez G, Vlaeyen JWS, Huets PTHG, Lysens R: Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain 80:329-339, 1999. ↩