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Fear Avoidance and the Pain Cycle

Fear Avoidance and the Pain Cycle

Have you ever been in pain and were fearful to move because the pain would worsen? Or that you would cause more damage? Did you ever think that not moving could be bad? This fear avoidance behavior can actually cause more pain.  In fact, avoidance of movement can also increase one’s stress and alter one’s central nervous system leading to decreased healing.

Fear Avoidance Behavior

For anyone with a painful experience it is important that something must be done. The experience is worth paying attention to and focusing on. The experience teaches us how to prevent the experience in the future.  This is a natural occurrence due to our natural instinct for survival, however until it becomes fear avoidance behavior and one begins to imprint this behavior into their brain and daily life.  This behavior can then cause more harm than good.

For Example:

Someone with a sprained ankle will limp to reduce pain because it is natural for us to do so to not further injure the ankle.  However, if one continues to limp due to fear of spraining the ankle again this can lead to knee, hip, and low back pain leading to a vicious cycle of never ending pain.  This can affect one’s social life, independence, and overall quality of life.

Pain Alters Central Nervous System & Brain Output

When the body senses pain, our “fight or flight” (sympathetic) nervous system kicks in.

  • The increased activation of the sympathetic system leads to decreased immune response and increased emotional state and stress.
  • There is an increase of stress hormone levels leading to increased inflammation, decreased tissue recovery, and increased pain sensitivity.

The Pain Cycle

Pain leads to fear avoidance behavior.  Fear avoidance behavior leads to decreased quality of life.  Decreased quality of life leads to stress.  Stress leads to more pain.  More pain leads to increased pain sensitivity via sympathetic nervous system…and the cycle continues.

How Can a Physical Therapist Help?

  • A physical therapist can educate patients about their pain. Allowing them to grab hold and understand their pain rather than having their pain grabbing ahold of them first.
  • A physical therapist will help patients focus on meaningful and purposeful movement.  They can help give patients control and empower them to alter CNS/brain processing systems that are detrimental to their healing.
  • American Physical Therapy Association’s vision statement for the physical therapy profession: “Transforming society by optimizing movement to improve the human experience”

Consult with a Physical Therapist!

If you have pain, want to avoid fear avoidance behavior, and want to return to regular activity consult a physical therapist today!


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References: Gifford, L (1998). Pain, the Tissues and the Nervous System: A conceptual model, Physiotherapy, 84, 27-36.

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Christy Loo, PT, DPT
Christy enjoys spending time with family and friends and being physically active playing a variety of sports. She is frequently outside hiking, fishing, and camping – enjoying nature’s beauty and the fresh open air.