Kinesiophobia: how fear of moving can disrupt health – 29/09/2020

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As I have already explained, kinesiophobia can be defined as a state in which the person feels an excessive, irrational and debilitating fear of physical movement or a certain activity, for fear of pain or injury.

It is important to understand that fear is a natural reaction of the body, which aims to protect it, but becomes a disorder when it disables or impairs the person’s quality of life, interrupting the course of treatments or directly interfering in its activities of life.

Generally, kinesiophobia is associated with low levels of physical activity and chronic pain in the body. In clinics and medical offices, it is an important aspect that directly influences rehabilitation strategies, impacting the success of a treatment. People with severe kinesiophobia may be limited in their activities and stop performing common tasks, which leads them to a cycle of more sedentary lifestyle and physical inactivity.

This avoidance behavior keeps the person not only from being physically and mentally healthy, but can also harm the treatment of various diseases. See below what are the main ones.

Chronic Low Back Pain

The problem, which I have already addressed here in the column, is very common worldwide. When thinking about treating chronic low back pain, the conservative gold standard is exercise – physical therapy. However, when thinking about treating a person with low back pain associated with a condition with kinesiophobia, it is necessary to consider a work to re-educate the beliefs of that individual.

Those who have chronic pain usually can already create a pattern of recognition of movements or certain positions that generate pain relief in the lower back, but likewise, they believe that certain movements cause pain or even cause an injury to the spine. This fear leads the individual to avoid these movements and, in the worst case, to avoid moving in general, generating a reduction in strength and control of muscle activity in the back and abdomen, completely hindering the course of treatment.

osteoporosis

Another topic already addressed in the column was about this systemic skeletal disease that causes weakening of the bones and increases the risk of fractures. What can osteoporosis have to do with fear of movement pain?

Believe me, this disease can be directly impacted by kinesiophobia. Lack of adequate information or education about a disease can create illogical expectations and beliefs that limit treatment. Many people affected by osteoporosis and even osteopenia have an irrational fear of fracturing bones with some physical exercise and loads. Studies show that individuals with osteoporosis have significantly higher levels of kinesiophobia, compared to healthy individuals.

Migraine

Studies report that the prevalence of kinesiophobia in individuals with migraine is 53%, and this condition is still associated with severe cutaneous allodynia, that is, greater sensitivity to touch associated with discomfort.

In the case of migraine, what draws the most attention in affected individuals is the belief that physical activity could not help control or even relieve pain. Still, those who have migraines and kinesiophobia believe that exercise can be harmful to headache.

Impact of kinesiophobia on health and clinical rehabilitation

  • It is important to understand that about 50% to 70% of chronic pain cases develop kinesiophobia.
  • Generally, kinesiophobia is accompanied by the nocebo effect, which is the act of generating a negative expectation that something will make the person worse, leading to catastrophizing pain.
  • Specific education strategies must be implemented, since negative beliefs related to exercise are present.
  • Depressed patients had greater pain intensity, greater fear of movement and physical activity.

Physical activity is essential to maintain muscle, joint, bone health and all other aspects of health not only associated with the conditions mentioned.

Individuals must be educated and advised about the importance of the activity to overcome kinesiophobia and thus carry out the most appropriate treatment. Often, psychological support and monitoring may be necessary. It is common for those with kinesiophobia not to adhere to a treatment that involves exercise and only choose to follow the drug treatment – considered more “safe”. Treatment with a multidisciplinary approach is effective in these cases of kinesiophobia.

* Collaboration Dra. Juliana Satake Physiotherapist at LA POSTURE and Dra. Renata Luri Physiotherapist Phd at Unifesp.

References:

– Benatto MT, Bevilaqua-Grossi D, Carvalho GF, Bragatto MM, Pinheiro CF, Straceri Lodovichi S, Dach F, Fernández-de-Las-Peñas C, Florencio LL. Kinesiophobia Is Associated with Migraine. Pain Med. 2019 Apr 1; ​​20 (4): 846-851. doi: 10.1093 / pm / pny206. PMID: 30462312.

– Benz, Laurence N.; Flynn, Timothy W. Placebo, nocebo, and expectations: leveraging positive outcomes. 2013. – George, Steven Z. et al. Clinical investigation of pain-related fear and pain catastrophizing for patients with low back pain. The Clinical journal of pain, v. 27, n. 2, p. 108-115, 2011

– Das De S., Vranceanu A., Ring D. C. Contribution of kinesophobia and catastrophic thinking to upper-extremity-specific disability. Journal of Bone and Joint Surgery A. 2013;95(1):76-81. doi: 10.2106/JBJS.L.00064.

– Lüning Bergsten C., Lundberg M., Lindberg P., Elfving B. Change in kinesiophobia and its relation to activity limitation after multidisciplinary rehabilitation in patients with chronic back pain. Disability and Rehabilitation. 2012;34(10):852-858. doi: 10.3109/09638288.2011.624247.

– Luque-Suarez A, Martinez-Calderon J, Falla D. Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. Br J Sports Med. 2019 May;53(9):554-559. doi: 10.1136/bjsports-2017-098673. Epub 2018 Apr 17. PMID: 29666064

– Martinez-Calderon J, Flores-Cortes M, Morales-Asencio JM, Luque-Suarez A. Pain-Related Fear, Pain Intensity and Function in Individuals With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. J Pain. 2019 Dec;20(12):1394-1415. doi: 10.1016/j.jpain.2019.04.009. Epub 2019 May 4. PMID: 31063874.

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