This post was written by Jithmie Jayawickrema, PT, DPT, OCS, physical therapist, Parkview Therapy Services.
Have you ever been injured, gone through rehab and then received the green light to resume all prior activities, only to have your brain say, “Stop! Remember what happened the last time you did this?” This protective mechanism by the brain can actually change the way you move and create a cycle of fear avoidance that can affect your daily activities.
Fear of reinjury and pain can change the way you move as your body gets accustomed to new motor patterns. Physical therapists can often tell if someone has had a knee or ankle injury by the way they navigate stairs or walk on uneven surfaces. A previous shoulder injury may present in the way a patient lifts their arm to reach for something. These learned movement patterns can be hard to break, leading to compensations that can cause other injuries.
The following are mechanisms that your body uses to protect itself from potential reinjury:
Muscle guarding or bracing yourself
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Tendency to brace yourself by tightening muscles or stiffening your joints, not allowing your muscles to have a healthy balance of contracting and relaxing.
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Example: stiffening knee when landing from a jump post op ACL surgery, which does not allow for proper force absorption
Compensatory patterns causing asymmetry
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If you have an injury in your left knee, you might tend to put more weight through the right leg and cause overloading injuries on the right side.
Hyper-vigilance
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You might think about the injured body part every time you move, which can cause you to fixate on it and remain constantly aware of the injury despite the lack of pain.
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Any joint noise (pop, crack) or mild discomfort in that region can be perceived as a major injury or reinjury as your nervous system is now in constant fight-or-flight mode.
How can physical therapy help overcome the fear of reinjury?
Graded exposure to movement safely reintroduces motions in a safe and controlled setting. Physical therapists may suggest tactics such as:
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Breaking up movements to prepare you for the final movement that you might be fearful of, like working on single-leg balance or hopping before jogging.
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Specific strength training to build resiliency and confidence in your movement.
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Redirection strategies to overcome fear, such as deep breathing techniques or exercises or stretches to transition to if pain comes on. This can offer you a sense of control of your pain.
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External cues redirecting your attention from the body allow your automatic movement patterns to take over. Instead of giving cues to bend your knees when you land for proper force absorption, an external focus of attention will cue you to land softly.
Reprogramming your mindset is important to beat the fear of reinjury. Consult your physical therapist to rebuild your confidence in your movement!
To schedule an appointment with Parkview Therapy Services, visit us here.
