The Fear of Exercise
By: Erin Ritterbusch, MS CPT & Marc Zboch
Studies show movement over bed rest is necessary to recover from pain, especially low back pain. Different forms of exercise are generally prescribed to help aid in that rehabilitation, with some being better than others.
In order to achieve the best outcome from exercise, it is best to follow a program that is tailored to your specific issue. But first, one must have a positive outlook on exercise, which can be derailed if there is a fear associated with movement and reigniting the pain. This is what has been deemed as “fear-avoidance beliefs”, which can become a major obstacle in recovery if not addressed.
According to Rainville et al., fear-avoidance beliefs stem from either fear from an emotional standpoint or are information-based on pain and injury. For those of us who suffer with low back pain, that avoidance can “represent cognitions and emotions that underpin concerns and fears about the potential for physical activities to produce pain and further harm to the spine.”
Fear-avoidance beliefs have a strong association with disability and the most significant consequences when it comes to chronic low back pain. When those beliefs are elevated, they have major influence over one’s ability to perform everyday functional physical tasks. When it comes to work disability, fear-based beliefs are strong predictors that it will become long-term. If these beliefs persist, they could hinder the healing process and even any progress made by physical therapy and post-surgery [1].
Fear is often used in order to rationalize, whether it is to explain why the pain has worsened or why one may feel as though they can’t participate in regular movement for fear of more pain. In order to overcome that fear, or to avoid it from occurring to begin with, one must try to have a positive outlook on movement and exercise.
This fear of movement falls under what is called psychosocial factors, along with others such as one’s perceived disability, depression, and catastrophizing [2]. These factors are the characteristics that influence the psychological and/or social aspects of an individual. Specifically, it describes one’s relationship to their social environment and their physical and mental health [3]. Even if an individual may be aware of the benefits of a behavior change such as exercise and movement, a psychosocial factor such as the fear of movement could stand in the way.
So, the big loaded question is, how can one possibly overcome these beliefs in order to improve their lives both physically and mentally and get back on the right track towards recovery and rehabilitation from low back pain? This is where the answer isn’t quite clear, as what may work for one person may not be effective for another. Ultimately, participation in exercise has been shown to be more successful over usual management by a general practitioner to help reduce fear avoidance beliefs [4]. Finding a program, such as 23 Disc, can help build confidence by starting slowly and giving attainable, custom exercises that are going to be effective. This can aid in the restart of the healing process that was once hindered by those beliefs.
[1] Rainville, James, et al. “Fear-avoidance beliefs and pain avoidance in low back pain—translating research into clinical practice.” The Spine Journal, vol. 11, no. 9, 2011, pp. 895-903. doi:10.1016/j.spinee.2011.08.006.
[2] Verbunt, Jeanine A., et al. “Fear of Injury and Physical Deconditioning in Patients With Chronic Low Back Pain.” Arch Phys Med Rehabil., vol. 84, no. 8, 2003, pp. 1227-1232. doi:10.1016/S0003-9993(03)00132-1.
[3] Thomas, Kristin, et al. “Associations of Psychosocial Factors with Multiple Health Behaviors: A Population-Based Study of Middle-Aged Men and Women.” International Journal of Environmental Research and Public Health, vol. 17, no. 4, 2020. doi:10.3390/ijerph17041239.
[4] Moffett, Jennifer A.K, et al. “High Fear-Avoiders of Physical Activity Benefit From an Exercise Program for Patients With Back Pain.” SPINE, vol. 29, no. 11, 2004, pp. 1167–1173. doi:10.1097/00007632-200406010-00002.
