Unlearning Fear of Movement

Kinesiophobia, or fear of movement, is an issue that affects far too many of us. Often
times, people with chronic pain or a history of injury to a particular body area will develop a fear of movement. Kinesiophobia can exist on a macro or micro level, affecting both overall physical activity levels, as well as movement of specific joints and patterns of muscular activation. Kinesiophobia is often outside of our conscious control, as the fear circuits of our brain (e.g. the amygdala) are involuntary and affect our movement without us necessarily being aware.

How does this happen? Individuals with kinesiophobia may associate certain activities with pain, as this activity may have caused pain in the past. An activity that is a common trigger is bending down towards the ground, perhaps because this movement may have led to an injury in the past. The internalized association between movement and pain will contribute to fear-avoidant behavior, and the individual will continue to avoid this activity due to fear of pain or re-injury. Over time, even after the original injury heals, the individual will still have this same fear embedded in them and will avoid bending down. Now the motor pathways, muscles, and joints responsible for bending down will atrophy, and it will be far more likely to cause injury if the individual were to bend down in the future! The irony is that the fear is what contributes more so to the dysfunction, rather than an issue in the physical tissues of the body.

What can we do about this?

Because fear is a learned behavior, we must "unlearn" the fear, as well as create new neural pathways that teach us that movement can be safe, easy, and pleasurable. Your physical therapist at the Wellness Station will quickly identify what is contributing to your kinesiophobia. Along with providing education about anatomy, biomechanics, and pain neuroscience, your therapist will teach you how to gradually engage in safe movement patterns that will help you gently progress towards your functional goals. It is important that this process is done slowly and gently, as our brains will not be receptive to learning if fear is still present. The tissues of your body will slowly adapt, and your nervous system will gradually learn that previously feared movement patterns can be safe and even easy.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

What's the Deal with Stretching?

We have all heard a lot about stretching. Some people swear by it as a practice that will prevent injury, restore flexibility and range of motion, and improve performance. Others consider it to be a superfluous practice that lacks therapeutic benefits and could actually lead to harm. The truth likely lies somewhere in between. To determine whether stretching would be a beneficial practice in one's life, it is necessary to clarify a few important points.

First of all, what even is stretching?

Stretching is an umbrella term that can be divided into several categories.

Passive stretching:
The use of an external force, such as the weight of one’s own body, an object, or a force from another person to deliberately lengthen a muscle. This type of stretching is targeted at a very specific muscle, such as the hamstring, and the stretch may be held for any length of time, such as 30 seconds.

Active stretching:
The use of the strength of one’s own opposing muscle groups to lengthen a muscle and hold for a set duration. This looks similar to a passive stretch but requires more muscular work. Active stretches are common in yoga, and may include postures such as a lunge, an active pigeon pose, or a downward dog.

Dynamic stretching:
A form of active stretching in which one uses their own strength to move muscles through a range of motion. Dynamic stretching involves taking an active stretch as a foundation and adding movement rather than statically holding a posture. This is a good practice for warming up the full body prior to athletic activity, and may include movements such as arm circles, bringing knees to the chest, lunge variations, trunk rotation, etc.

PNF stretching:
PNF stands for proprioceptive neuromuscular facilitation. PNF stretching involves alternating cycles of contracting and releasing specific muscle groups with varying levels of force throughout the range of motion of a particular joint.  This form of stretching is often utilized in physical therapy, but it can be done alone as well. For example, if the intention is to stretch one’s chest muscles by placing the right hand on a doorway and then turning the body to the left, this stretch can incorporate PNF techniques by alternating between gently pressing the hand into the doorway, and then relaxing. Or, the hand can be lifted away from the doorway to engage the antagonist muscles (mid-back, scapular, and posterior deltoid muscles). These techniques can be combined with the breath to allow the nervous system to reset levels of neuromuscular tone, as well as build awareness of how to engage various muscle groups.

In addition to what type of stretching one is performing, the benefits or detriments of the stretching routine also depend on various other factors. This includes the intention of the stretcher, the efficiency of movement, the state of the nervous system, injuries and pathologies present, and the comprehensiveness of the stretching program (e.g. only stretching one muscle group while neglecting all other muscles is not a well-balanced practice). Clearly, stretching is not good or bad, harmful or helpful. It depends on all of the above factors and more.

The type of stretching that tends to be the least beneficial and the most detrimental is passive stretching. This type of stretching involves statically pulling on an isolated muscle group with the hopes of becoming more flexible. The benefits of this practice depend on the intention as well as the technique. If one's goal is to yank and pull on their muscle until it gets longer, good luck! Our nervous system has a mechanism that will actually tighten muscles more if it senses overstretching.

On the other hand, those of us who are already hyperflexible or may have a connective tissue disorder such as Ehler's Danlos syndrome, overstretching can actually damage the muscle and joint over time, as the tissues may stretch past the point of no return and become unable to support the body in a functional way. Passive stretching is not necessarily a bad thing- if performed gently with careful attention to sensation and the breath, this practice can be helpful for calming the nervous system, deepening mind-body connection, and improving flexibility over time. However, there are more effective ways to achieve these goals.

The other three types of stretching (active, dynamic, PNF) are more useful tools for improving functional movement. If one’s stretching practice is primarily passive, try to incorporate active, dynamic, and PNF techniques into the routine. These practices improve injury resistance by priming us for movement, and deepen our kinesthetic awareness by teaching us more about our unique neuromuscular patterns of tension and weakness.

Check out this article for more information about PNF stretching and how to begin incorporating this technique

To learn how to apply these techniques through a holistic lens to relieve pain or discomfort in any area of the body, consult your Wellness Station physical therapist.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

You Can Break the Cycle of Chronic Pain!

It’s All In Your Head: Your Brain & Pain

Many of us who experience pain might feel very offended if we were told that this pain was all in our head. However, all pain, as well as any other sensation, is created by the brain. This is because pain is a perceptual process- the experience of the pain is not actually happening in the part of your body that hurts, but rather it is happening in your brain. Sometimes this perception of pain can be a very useful process (Ouch, I just touched a hot stove, let me move my hand away as quick as possible!), but when it comes to chronic pain, this process can severely impact our quality of life.

In cases of chronic pain, the brain tends to get hypersensitized to the pain until we are in a constant state of high alert. A learning process occurs in which neural pathways involved in pain perception of a certain area (the low back, for example) become strengthened. The neural pathways responsible for chronic pain experience go far deeper than our acute pain pathways, such as in the stove top example. This is because over time, the neural pathways related to the chronic pain will be embedded into the memory and emotional centers of our brain, making chronic pain far more complex than pain from acute injuries.

As with any learning process, we form associations, such as... sitting = pain, long car rides = pain, exercise = pain. These associations can contribute to a self-perpetuating cycle in which we avoid certain activities because of the fear of pain, which decreases our quality of life, thereby contributing to depression, inactivity, limited social participation, and other factors that will actually make our pain worse over time.

How do we break this vicious cycle?!?

Pain is our brain's opinion of how much danger we are in, and we have to change that opinion. Our brain was capable of establishing these detrimental neural pathways that contributed to the chronic pain, and it is just as capable of creating new pathways that will help us get out of this situation. This is because our brain remains plastic for our entire lives, meaning we are always capable of learning. We must learn that we are safe, and that movement of the affected body part is safe and beneficial.

At The Wellness Station, we help those in chronic pain learn that they are safe.

By creating individualized movement programs, we help our clients learn ways of moving and relating to the body in a manner that will drive neuroplasticity. We will help to teach the little person in the control room (aka your brain) that movement can be associated with calm, pleasure, and ease, rather than movement = pain. The movements lessons are designed to help our clients move with greater efficiency to make movement easier and to decrease tension and tissue strain. We will also help with self-care tools necessary to calm down the nervous system to decrease pain sensitivity, and provide guidance regarding management of the psychosocial aspects of living chronic pain.

Do not let pain stop you from living life to the fullest. It is never too late to learn!

Written by Jacob Tyson, DPT - Physical Therapist, RYT-200- Yoga Instructor and The Wellness Station Team