Pain and fear of movement go together like corn bread and chili.
Pain is our body’s alarm system. It’s a protective mechanism. So our brain naturally avoids activities that cause pain.
Pain conditions us to avoid touching the hot stove. Or in my case, burning my finger on my first birthday cake candle.
When Pain Goes Wrong
Pain-related fear becomes counterproductive for persistent musculoskeletal pain.
Physiological changes increase pain sensitivity. And pain becomes disproportionate to tissue damage.
Fear of movement (kinesiophobia) and expecting the worst (catastrophization) delay recovery and cause chronic pain (Picavet 2002).
Fear to Freedom
If you’ve read my story, you know I battled chronic low back pain for many years. I felt back pain after deadlifts. Or if I did too much running and jumping. Or if I sat in a chair for too long.
I was afraid of moving wrong and hurting my back.
Then I learned about repeated movements and how to sit with less pain. These strategies fixed my back pain fast. And I felt invincible. I could run, golf, and deadlift without fear of injuring my back.
I felt empowered and energized when the fear of movement melted away. I left years of frustration and ineffective treatments in the rearview.
I knew how to control my pain. And I wasn’t afraid to move anymore.
I felt free.
That’s the gift I aim to give each of my patients. And to you, my readers.
This article explores graded exposure, a creative strategy to conquer pain-related fear. It’s a powerful strategy borrowed from the field of psychology.
What Is Graded Exposure?
Also known as exposure therapy, this technique incrementally exposes the subject to feared activities or objects.
Exposure starts with the least threatening object or activity. Once the individual becomes comfortable with a low-threat stimulus, exposure progresses to more threatening stimuli.
Eventually, the once-frightening stimulus is re-introduced and feels far less scary. Here’s how it works:
Snakes and Graded Exposure
Snakes terrify me. Here’s how I could use graded exposure to overcome my snake phobia:
(As fear dissipates, progress to the next step)
- Look at a picture of a snake
- Watch a video of a live snake
- See a live snake in a cage
- Watch a zookeeper handle a snake outside its cage
- Handle a snake myself
By the final steps, my fear response is dampened and my snake phobia is far less intense.
Graded Exposure for Low Back Pain
Graded exposure is proven to ease chronic low back pain (Leonhardt 2017). Many people with back pain fear lifting heavy objects from the ground. Here’s how graded exposure can alleviate the fear of lifting:
1. Imagine bending forward without pain
2. Bend forward without pain–perfect your hip hinge, like this:
3. Lift a magazine up from the coffee table (light object, high surface)
4. Lift a gallon of milk from the coffee table (heavier object, high surface)
5. Lift a magazine off the floor (light object, low surface)
6. Lift a gallon of milk from the floor (heavier object, low surface)
7. Do dumbbell or kettlebell deadlifts at the gym
8. Do progressively heavier barbell deadlifts at the gym
Fear is normal when movement hurts. Graded exposure is a solid strategy to help you bounce back from injury and overcome pain-related fear.
Take it slow, stay patient and leave fear behind.
Readers: Have you dealt with fear of movement? Has fear of pain or injury kept you from meaningful activities? How did you overcome it? Share your thoughts in the comments.
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