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Avoiding Fear Avoidance


When you become injured, it is easy to start feeling fearful of movement. Fear avoidance is defined as the avoidance of movements or activities based on the fear of increased pain or re-injury. While it is important to be cautious when moving after an injury, it is also important to make sure we are still getting enough movement. It may feel best to go to the old school RICE method of Rest, Ice, Compression, Elevation, but that method has actually been refuted due to lack of evidence for helping the healing process. Even if it does feel good to rest with an ice pack or heating pad (we would recommend heat over ice per current research), it is actually better to get some gentle movement in. The current guideline of PEACE & LOVE is actually evidence based and can help promote healing. 

You may have heard the phrases “motion is lotion” or “movement is medicine”, this means that movement is a key component of healing. There is research that shows that after a low back injury, if normal movement is avoided as we are guarding and stiffening up with our muscles, the muscles in the low back can turn to fat which is irreversible. While it may feel like you are protecting yourself, stiffening up due to fear is actually way worse for you than moving freely. While you should probably avoid lifting your one rep max or running your max distance after an acute injury, it is important to move for blood flow to the muscle and to avoid stiffness. You should never be told that you should never run, lift or play your sport again to avoid injury. Instead, it is important to find a pain free version of your normal training rather than stopping movement all together. Start small, try some short walking, even for a minute, and see how you feel. A good goal to strive for would be at least 5 minutes of gentle movement for every waking hour. When you’re moving, try to avoid being rigid, remember, your body is built to move in all planes of motion. Try to replicate your normal movement pattern as best as you can. As your tolerance increases, you can start adding longer walks and gentle body weight movements such as squats or lunges. These movements should help to build your confidence that your body is meant to move and is not going to break or become more injured with movement. As your confidence builds, you can consider restarting some light training. If you are lifting, decrease your load and reps and gradually build up each session based on your tolerance. If you are running, decrease your pace and distance, and start gradually increasing cadence and mileage each session based on your tolerance. 

To start, it may be helpful to set some goals for yourself when it comes to increasing your movement after an injury. Setting a SMART goal can allow you to keep your goals realistic and increase the chances of accomplishing your goals. You can start with the very basic goals suggested above and then progress to setting more advanced goals to get you back to your prior level of performance as time goes on. 

If you feel you need guidance through this process, a physical therapist is a great place to start. Physical therapists are experts in human movement and rehabilitation. We can help you gradually return to your sport while safely rehabilitating your injury and preventing future injuries. If you are worried about returning to sport after an injury, book a call with one of our experts and we will game plan a program to get you back to your sport with confidence that you can move safely!

Dr. Kylie Miller

Performance Physical Therapist

Wilmington, NC

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