Is it gonna hurt? Fear of pain and fear of movement

Pain and fear of feeling pain can interfuse so that sometimes it’s hard to distinguish the two. It’s the fear of pain that makes us grip to protect the part that hurts, to try to keep everything still, or at least within a restricted pain free range of motion. It’s like we want to build an imaginary fortress around the painful area, mobilise our own tissue to shield and protect. The mere thought of how it would hurt to make an uncontrolled movement is frightening and sends chills of discomfort down the spine. After a while this fear may lead to an altered pattern of movement. You learn to move around the pain and never have to go directly into it. Thinking that if you only keep everything absolutely still it will heal. This is useful when it comes to a broken arm, but not so much when it comes to back pain.

I was told, by one of the numerous physiotherapists I have seen, that I had unstable shoulder blades and lack of strength in my upper back. The way I interpreted that information was that I had to keep everything stable and in place in order to avoid pain in my neck and shoulders. And so I gripped. I tried to move my arms without moving the shoulder blades, which is definitely not useful because the shoulder blades will have to move when the arms elevate above shoulder height. That, I have come to realise, was a non-constructive fear of movement. I have had it with my lower back as well, trying to keep everything stable and move slowly and carefully to avoid visiting that painful range of motion. 

Fear of pain, leading to fear of movement. There is even a term for it: kinesiophobia: an excessive, irrational and deliberating fear of physical movement activity.

Often what happens when we go to see a specialist, a physician or physiotherapist, is we get a diagnosis or some sort of explanation as to why we’re having pain. We may even be told to be careful, avoid heavy lifting or uncontrolled movements. Peter O’Sullivan, the radical physiotherapist, holds the view that health professionals should try to give patients a different view on the pain. Instead of talking about the back pain as being caused by structural damage, wear and tear, bulging discs, etc., the message should be that those things are normal and that there is no need to worry about them. Instead treatment should be focused on giving pain patients ways to know their pain better and ways to move out of their pain cycle. The back should be trusted to move in its normal way, according to Peter O’Sullivan.

I like to think of the spine as the trunk of a tree. Tremendously strong, stable and yet flexible.

Pain may create a sense of vulnerability. Your body is a piece of the world that is yours and yours only. Its home to your mind, your consciousness and perhaps even your soul and it is supposed to be a safe home. Your body is also the entity through which you interact with the rest of the world, you move around, walk, talk and dress. You express yourself through your body. No wonder we may experience some desperation when the body is not working properly. Having a painful body truly puts the entire world at bay. As a counter mechanism we try to move in such away that allows us to avoid pain. As long as we manage to live our lives around the pain we can keep the illusion that we have a well functioning body that does not hurt, and this restores a sense of security. However, it does not work in the long run. Instead of moving around the pain, we can try to move right into it, accept it and take care of it. the way we would take care of an old relative whose company we may not really like but who still deserves our love and care. This takes courage. And it takes guidance. A good yoga teacher is one that you can trust never to take your body to places that can be harmful. She will encourage you to enhance your range of motion slowly and to increase your knowledge about your pain so that you can handle it consciously and eventually become pain free. 

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