Written By: Dr. Malerie James, PT

Picture this. You’re at the crag with your crew. You’ve been working on your project hard today and you’ve almost got it. Just a little harder pull at the crux… you go for it! POP. Oh no, what was that??

After a week of rest, some ice and stretching, your shoulder feels better. You can do some push-ups and pull-ups without any significant pain, and you’ve been itching to get back out there. You decide to give that project another try, but this time something feels… off. You can’t push yourself as hard as you could last week, you pop off easier warm up climbs, and you’re very aware of every sensation around that shoulder. What’s the deal? 

After an injury, fear of movement can creep in. This is referred to as kinesiophobia.

After an injury or trauma, the central nervous system responds by elevating heart rate, increasing blood flow to the area of injury, and releasing chemicals like adrenaline and histamines to help protect and heal. Initially, all of these things are helpful because pain and swelling let you know that you’ve done too much and need to back off the injured area. When the central nervous system kicks into overdrive and responds to the FEAR of pain with specific movements or situations, it can be limiting your ability to return to the things you love to do. Avoiding movement can lead to hypervigilance, prolonged recovery time, and even chronic pain.

Kinesiophobia includes three elements:

Threatening stimulus (activity or movement)

• joint position

• loading a previously injured tissue

• big move on an exposed climb

• running through a talus field

Increased Sympathetic Arousal (Fight or Flight)

• elevated heart rate

• increased blood pressure

• high respiratory rate

• sweating

Defensive behavior

• muscle guarding

• pulling back from your limits

• compensatory movements (other muscle groups trying to help out)

• emotional response

To overcome kinesiophobia, it is important to set functional objectives (SMART goals), learn how to regulate and progress safe movement, and gradually expose yourself to fearful activities. 

The best way to determine where to start is to figure out what motions, activities, or physical stress creates a fear response. This might be the sport, the place you were injured, or the specific joint position that your shoulder was in when you were injured. Any stimulus that creates a fearful response can be graded to give the central nervous system a small dose of the movement without the associated pain response. Gradually increasing the intensity of the stimulus and managing the response will eventually result in full return to the movement without pain or fear!

Learning how to manage the sympathetic arousal (fight or flight reaction) can help you progress the graded exposure. Activities like deep breathing, guided imagery and relaxation techniques like mantras, routine warm up with active meditation can all be effective in reducing the central nervous system's response to that threatening stimulus.

Awareness and management of the defensive behaviors (for example, activating the upper traps to hike up your shoulders, clenching your fists, overgripping, or holding your breath) can help you readjust and refocus your energy into the activity itself. Body awareness, meditation, and guided imagery can all be used to help you recognize and correct any compensatory patterns or guarding in a safe space, so when you transition into a real world scenario it is easier to manage these defensive behaviors.

References:

ÇEVİK SALDIRAN, T., ATICI, E., ÖZTÜRK, Z., AKGÖL, A. C., ÖZKESKİN, M., AYDIN, G., GÜLER, B., YEŞİLKAYA, B., & TAŞÇILAR, L. N. (2020). Lower Limb Injury History in Elite Athletes: Relationship with Kinesiophobia and Effect on Physical Performance. Turkiye Klinikleri Journal of Sports Sciences, 12(1), 1–8. https://doi.org/10.5336/sportsci.2019-70271

George, S. Z., & Zeppieri, G. (2009). Physical Therapy Utilization of Graded Exposure for Patients With Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy, 39(7), 496–505. https://doi.org/10.2519/jospt.2009.2983

Kinesiophobia. (2021). Physiopedia. https://www.physio-pedia.com/Kinesiophobia

Monticone, M., Ambrosini, E., Rocca, B., Cazzaniga, D., Liquori, V., & Foti, C. (2015). Group-based task-oriented exercises aimed at managing kinesiophobia improved disability in chronic low back pain. European Journal of Pain, 20(4), 541–551. https://doi.org/10.1002/ejp.756