MSK Myth Busting:
Fear Avoidance Behaviour
As Musculoskeletal (MSK) clinicians, here at PAM Physio Solutions we adhere to the Biopsychosocial model, which emphasizes understanding the person as a whole and identifying potential barriers to recovery. One of the most pervasive myths we encounter is the belief that rest is the best remedy following an injury.
This myth is rooted in the idea that if an activity exacerbates pain, it should be avoided, as pain is often equated with damage and harm.
The Traditional View
Traditionally, people have been advised to rest for back pain. This approach stems from the belief that immobilisation would prevent further injury and facilitate healing. However, updated research and evidence-based practice have debunked this notion, revealing that prolonged rest and avoidance of activity can actually lead to higher levels of pain, greater disability, poorer recovery, and longer absences from work.
The Reality: Pain Without Damage
One of the key insights from recent research is that pain does not always indicate damage or injury. Pain is a complex experience influenced by various factors, including psychological and social elements. It is possible to experience pain without any physical damage, and often, a combination of factors contributes to the sensation of pain.
The Importance of Movement
The cornerstone of effective MSK rehabilitation is movement. A holistic approach, as practiced by Occupational Health (OH) MSK specialists, helps dispel the myths surrounding rest and movement. Encouraging patients to stay active and gradually resume normal activities is crucial for recovery. This approach not only helps in physical rehabilitation but also addresses psychological barriers, reducing fear and anxiety associated with movement.
The Role of Language in Recovery
As health professionals, the language we use can significantly impact a patient’s recovery. Terms like “degeneration,” “crumbling spine,” or “slipped discs” can be detrimental, creating fear and potential catastrophizing. It is essential to avoid over-medicalizing conditions and suggesting unnecessary investigations, which can reinforce fear avoidance behaviours.
Stress Healing and Adaptive Loading
An important concept in MSK rehabilitation is adaptive loading. Tissues in the body are remarkably good at adapting to load, which is why a graded introduction to activity and work is vital. This process, known as adaptive loading, is a fundamental part of the rehabilitation process. By gradually increasing the load and activity levels, tissues can strengthen and adapt, leading to better outcomes and reduced pain.
Practical Tips for Patients
- Stay Active: Engage in regular, gentle activities that do not exacerbate pain. Walking, swimming, and cycling are excellent options, and it’s a good idea to find something you enjoy doing.
- Gradual Progression: Increase activity levels gradually. Start with low-impact exercises and slowly build up intensity and duration.
- Positive Language: Use positive and reassuring language when discussing your condition. Avoid terms that may induce fear or anxiety.
- Holistic Approach: Consider psychological and social factors that may be contributing to your pain. Techniques such as mindfulness and cognitive-behavioural therapy can be beneficial.
- Consult Professionals: Work with MSK specialists who understand the importance of a holistic approach and can guide you through a tailored rehabilitation program.
Dispelling the myths surrounding rest and movement is crucial for effective MSK rehabilitation. By understanding that pain does not always equate to damage and embracing a holistic, movement-based approach, patients can achieve better outcomes and a quicker return to normal activities. As MSK clinicians, it is our responsibility to educate and support our patients, helping them overcome fear avoidance behaviours and promoting a healthier, more active lifestyle.
