Kinesiophobia & The Fear Avoidance Model

Kinesiophobia was first coined by Miller et al. 1990 as an aspect of the fear avoidance model. The Fear-Avoidance Model illustrates that when a painful event is believed to be threatening, it can create catastrophising thoughts that movement and activity will result in further pain and reinjury (Larsson, Ekvall Hansson, Sundquist, & Jakobsson, 2016).

In simpler terms Kinesiophobia means fear of movement. ‘‘a condition in which a patient has an excessive, irrational and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or re-injury’’ (miller et al. 1990).

As the diagram above illustrates, this fear of movement creates a pain cycle. This not only effects our outcomes from physical intervention, such as rehabilitation exercises. But also has a large effect on mental health. Depression appears to independently predict poor outcomes post-surgery (Svensson et al., 2011). Since kinesiophobia can be a cause of depression, based on Vlaeyen’s fear-avoidance model (Vlaeyen & Linton, 2012), preventing kinesiophobia may reduce depression symptoms.

So what do we do to prevent this? The main take away for TSC clients is that movement is rarely dangerous or likely to cause you more pain, unless otherwise discussed, for conditions such as herniated discs etc. Which, if I perceived that this could be a cause for your pain, I would refer you on to a specialist.

Other than those special cases, for matters such as chronic back pain, movement is key to not just circumventing the fear-avoidance vicious cycle, but is crucial to your rehabilitation and avoiding related onset mental health issues.

It is important to note the difference between discomfort and pain. Performing yoga and pilates with chronic back pain, may feel uncomfortable. But can be a large contributing factor to feeling better in the long term. If you develop kinesiophobia, and avoid stretching and exercises because you perceive that discomfort as pain, and therefore damaging- you are literally causing damage to your recovery.

In conclusion, in most cases, movement is essential to your physical and mental well being. It is important to be aware of and avoid falling into the kinesiophobia trap. If you have been prescribed rehabilitation exercises- please do them. If you have any questions about exercises and stretches or require further advice. Please don't hesitate to contact me. I hope you found this useful.

- Phil