01 Mar Fear Avoidance & Graded Exposure

Fear Avoidance & Graded Exposure

It is possible to link these theories and management normally reserved for ‘phobic’ behaviors e.g. fear of heights or water to people with pain and loss of movement. If a person’s range limitations relate to fear of pain or doing damage the same ‘approach’ can apply. Find a starting point whereby the person can do the movement with confidence. Start easy and move to more difficult and challenging tasks. The options are endless. The key is how you set it up with the person and continue it to the simple and gradual return of normal movement and function.

Vita ingredients of phobia and musculoskeletal fear avoidance and graded exposure:

• The person sees they have a problem and that it is impacting their life, stopping them doing normal things, function and is quite constant or consuming
• They are prepared and motivated to have a go at confronting it and trying to overcome it
• They need and are open to some kind of assistance or expert help and more importantly are willing to trust the professional
• They need to be gradually exposed to the thing they fear, starting easy and moving to more difficult and challenging tasks
• The therapist may need to be inventive to find ways of bringing or transitioning the sufferer from one level to the next

Start Easy Build Slowly

An easy starting point can always be found and from there all movements or exercises are on a graded hierarchy. Most people don’t have anything like true phobias but simply a reluctance to do certain movements in ‘case it hurts’ or ‘makes the situation worse’ or ‘causes more damage’. This they key area where they require adequate guidance.

Return Of Physical Confidence

Whether the issue is acute or chronic, the fundamental thing is gradual physical progress. Start with safe, achievable movements and gradually increase the quality, quantity and difficulty of movement in a progressive but safe manner. The persons goals are also central to this as they may have concerns and fears about movement, exercise and activity. Beliefs about what is wrong, their strength or weaknesses, movement, where the pain is from, damage, pain and further harm concerns. Structure and pain related beliefs lead to fear avoidance behaviour e.g. wisely you twist your ankle and rest from training the next day versus you have chronic low back pain and avoid walking or any gentle movement.

To be continued.