If a movement or activity causes pain, you should avoid it – right?

Yes, and then no.

Following an injury, your damaged tissues will tell you to avoid certain things. They tell you by causing you to feel pain. If you are a normal person, you will likely avoid what is causing the pain. This approach makes sense initially following the injury. However, it is easy to get trapped into continuing with that approach indefinitely, and there lies the problem. This exaggerated, prolonged fear of pain actually has a name: “Fear Avoidance Belief.” Fear Avoidance Belief (FAB) has been studied extensively and this is what we know…

Avoidant behavior is healthy when the individual is trying to avoid further stressing injured tissues and allowing them to heal. However, it is harmful for the individual to continue avoiding activity after the injury has healed; the resulting exaggerated sensitivity and disability restricts normal use of the tissue and deteriorates the individual physically AND mentally.

Evidence suggests that fear avoidance belief is a warning sign for a poor outcome in subacute (one to three months) LBP, and that early treatment, including interventions to reduce FAB, may help avoid delayed recovery and chronic pain. A strong relationship exists between elevated FAB and chronic disability secondary to low back pain.

Fear of pain, the fear avoidance model.

Chronic pain is another example of what can result from the misinterpretation of pain as a catastrophe. Because of this misinterpretation, the individual repeatedly avoids the pain-inducing activity and will likely overestimate any future pain from such activity. The excessive sensitivity to pain discourages the individual from exercise and weakens his or her body.

Early recognition and intervention is key to preventing individuals with high fear avoidance beliefs to go on to develop chronic pain, disability, and depression. Suggested interventions include de-emphasizing anatomic findings, encouraging the patient to become an active participant in their recovery, and educating the patient to view their back pain as a common condition, not a serious disease.

Graded exercise has also been endorsed as a treatment for those with FAB. At Results Neck & Back Therapy, we have Central Oregon’s only medical grade exercise equipment. MedX medical spinal strengthening equipment is adjustable in very small increments of resistance and range of motion. With a sensible and gradual progression of strengthening exercise, those patients with a high FAB find that they can use their body and not hurt themselves. Once they discover this, their potential to resume normal activities increases significantly.