Fear avoidance behaviour and how it may be slowing down your recovery:
/
Quick Summary for those who don’t have the time to read:
Check out the image below it explains the basics of the theory of fear-avoidance behaviour and how it can affect your recovery.
Fear can be affecting your behaviour in small ways which could be hindering/slowing your recovery.
Self-awareness of your own understanding of pain and how you deal with is important to reflect on to be able to alter it.
Talk to your physio for any concerns throughout your entire rehab not just in the first appointment- rehab concerns, time frames, normal pain ranges or just to check your understanding of pain and how it works (hint: it’s complicated).
The fear avoidance model was first created to explain why patients who initially presented with typical lower back pain developed chronic back pain and the associated disability of such a condition. However the theory can be applied to every injury and is useful to keep in mind when facing your own recovery.
As seen above, the theory is fairly simple. Two patients who face the same injury and who have the same “pain experience” have different fear-related mindsets regarding their injury. One is “fearful” and one has “no fear.” Realistically no fear and absolute fear don’t really capture the spectrum of the human condition, however thinking more as a see-saw scale, if fear outweighs the non-fear behaviour then that patent will be more likely to take the “pain catastrophising" pathway. From here, "pain-related fear” and “avoidance/hypervigilace” all contribute in part to the patient’s poor recovery, leading to “disuse, depression, disability.”
In contrast, the patient who has “no fear” (realistically reduced fear), confronts the injury and recovers. Now this model sounds in all honesty a little depressing and has a stark black and whiteness to it, not visibly taking into account the multitude of other factors that contribute to fearful behaviour as well as the recovery process. However understanding the fear avoidance model in perhaps reduced starkness may be the key to a thriving recovery.
Now what does this model, in its reduced-starkness look like with typical injury? Theoretically, say you injure your shoulder, you’ve started physiotherapy and you’re doing your exercises for the most part but it still hurts to do some simple everyday tasks, such as wiping the surfaces at home. Because it hurts you use your other arm to wipe the surfaces and maybe you do your exercises every other day instead because even though you’re doing them its still sore so maybe they’re doing more damage, but you’re not really sure.
Because you’re not doing the exercises as diligently and because you’re favouring your other arm your shoulder loses some of the endurance that it was building with the exercises and everyday exposure to load. Now you’re aware of the injury it every time you go to do a task that requires your shoulder, maybe you even call one your “bad shoulder” nonchalantly in passing, not realising the connotations that bad/good categorisation hold.
Now this doesn’t always have to lead to “disuse, depression and disability” but it can lead to extended periods of pain, reduced adherence to exercises, reduced exposure to normal every day load (which is what you want to get it back to) and therefore a longer period of recovery.
Now what do you do with this information?
Just keeping an awareness of the different tendencies that people can have towards injury/pain and the different (generalised) consequences of these during your own recovery can be enough to steer things in a more positive direction. A great tip for an optimal recovery can be just to keep in touch with your physio! Don’t be afraid to ask all the questions and don’t leave them to be answered by your own assumptions or your friends experiences with a similar injury. A simple explanation from your physio can be enough to put your mind at ease and keep you on the right track for a healthy recovery.
If you have an old injury that still “niggles” at you, don’t be afraid to get in touch with us (or your own physio), there’s always something that can be done to improve things whether that be a better understanding or strengthening things up after all confrontation is key!
By Claire Crawford
Bsc Sport and Exercise Science
Current Masters of Physiotherapy Student