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Helping a Patient in Pain who fears Movement

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April 11, 2016
Edward Smith

Helping a Patient in Pain who Fears Movement

Psychological Injuries Without Physical Injuries

Helping a Patient in Pain who Fears Movement

Things like energy level, function, mood, sleep quality, and many other quality of life measurements are changed in the presence of pain and the resulting lack of movement.  When a patient is suffering from pain and is afraid of movement, there is a great barrier to achieving quality health.  Among all therapeutic interventions, exercise is perhaps the least invasive and most effective way to manage a person in pain.

How can I help a patient in pain who is afraid of movement?

Kinesiophobia is the fear of movement.  Movement is a necessary part of healing.  If a person fears movement and it dominates their life, then suffering and disability will increase.  When patients are afraid of movement, they have likely seen many different providers and have had many attempted interventions, including physical therapy, injections, drugs, and the health of the kinetic chain.

If a patient suffers from knee, back, or shoulder pain, the person must have their entire kinetic chain addressed.  This needs an evaluation of energy transfer and compensation from heel strike to arm swing.  Each joint must compensate in a predictable way to balance the talus, femur, tibia, pelvis, humerus, scapula, and ribs.  The site of the actual pain is only one detail in the patient’s health.  The Integrity of each aspect along the kinetic chain tells the whole story of the health of the entire system.  Medicine needs to treat the body as a single unit.

What is a movement diagnosis?

There are three categories of diagnosis in medicine.  There is the chief complaint, the structural component, and the movement.  For example, if the patient is suffering from knee pain, the chief complaint would be “left knee pain”.  There may also be a diagnosis of left knee osteoarthritis.  A common movement diagnosis associated with this chief complaint would be right kinetic chain restriction with anterior rotation of the right pelvis and limited hip mobility. The movement diagnosis is part of the complexity of health to help guide treatment.

If the right kinetic chain is restricted, then the left kinetic chain needs to compensate for this. It is probable that the left shoe has a characteristic pattern of wear as the person with a right kinetic chain abnormality will favor the right side of their body and will place an inordinate amount of pressure on the left side of the body. If this patient has poor mechanics and a muscular imbalance that affects the left side of the body, and the increased pressure will lead to osteoarthritis of the left knee. If the physical therapist only focuses on the left knee pain, the problem will not be fixed. As a result, the patient will come to fear movement and may become hopeless. For hope to overcome fear, medicine must address the patterns of movement.

In summary, kinesiophobia is well understood in pain management and may be addressed by integrating the personalized medicine with the scientific aspects of movement.  It is only with this integration, that the patient’s fear of movement can be conquered.

I’m Ed Smith, a Chronic Pain Lawyer in Sacramento and Northern California. Call me anytime at 916-921-6400 or 800-404-5400 for free, friendly advice.

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