Fear Not: A Physical Therapist Can Help You Overcome the Fear of Movement

Do you avoid moving (a little or a lot) because you fear it will hurt? Does the fear of reinjury limit your activity? If so, you may be experiencing kinesiophobia. And you're not alone.

As many as 50%-70% of adults — not just athletes — experience this feeling after an injury, accident, or illness. Kinesiophobia can result from personal experience. It also can be learned by watching or mimicking the behaviors of others.

Fear is a natural response to danger or the potential threat of danger. It causes normal physical changes in the body, such as:

• Increased heart rate.

• Rapid breathing.

• Elevated startle "jump" response.

Fear also can cause anxiety — the emotion felt when we think bad things might happen. And anxiety can cause fear, resulting in a continuing feedback loop. Ultimately, when fear and anxiety affect how we move it’s known as fear avoidance.

People who fear moving can have decreased confidence in doing daily activities and may:

• Change their normal movement to feel safe. Moving in ways we are not meant to — and using muscles or joints the wrong way — can lead to new pain.

• Decide that it is just better not to move at all. An inactive lifestyle can increase your risk of developing heart disease, diabetes, and obesity.

While avoidance tactics may seem to help at first, they can lead to long-term problems if continued. Movement and regular physical activity are essential for our hearts, muscles, joints, lungs, mind, spirit, and overall health.

Help Is Available

Physical therapy plays a vital role in addressing the fear of movement. Physical therapists can identify any contributing factors and teach you how to move safely. They, and the physical therapist assistants they work with, can help you get past your fear of movement.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement.

What to Expect From Physical Therapy

Physical therapy aims to restore function so you can do the activities you need and love to do.

During your initial visit, your physical therapist may:

• Measure your fear of movement or reinjury. The Tampa Scale of Kinesiophobia or a questionnaire can help identify the reasons for your fear. There are a variety of possible causes.

• Evaluate your overall strength, endurance, and balance.

• Ask about your personal goals.

Your physical therapist will use this information to design a personalized treatment plan that may include:

• Gradual exposure to activities that do not cause harm.

• A strength, balance, and endurance exercise program paced for your specific needs.

• Virtual reality activity exposure.

• Adapted yoga.

• Aquatic exercises.

• Patient education. Your physical therapist can help you better understand how your body should move.

• Guiding you through activities so you can focus less on your fear and improve your ability to move.

• Assistance and guidance to help you set quality-of-life goals.

Your physical therapist also may recommend cognitive behavioral therapy. This treatment can help you address fear or anxiety.

Physical therapists use the latest evidence to address each person's needs, challenges, and goals to:

• Improve mobility.

• Manage pain and other conditions.

• Recover from and prevent injury and chronic disease.

Physical therapists and physical therapist assistants empower you to take part in your recovery. They work with each other, other health care providers, and community partners to ensure you receive the best care.

Let a physical therapist help restore your movement so you can regain your physical, mental, and social health. Choose more movement for better health.

What can physical therapy help with?

What Can Physical Therapy Help With?

Physical therapists can provide supplementary treatment to a wide variety of medical conditions, depending on their specialty.

Physical therapists treat musculoskeletal conditions and work to optimize recovery or educate a person on how to optimize their movement patterns.

Some conditions that our physical therapists specializein include:

• Post- op Rehab, including total knee replacements, labrum repairs, menisectomy, spinal fusion.

• Conditions that affect the hand, such as carpal tunnel syndrome, and trigger finger.

• Musculoskeletal dysfunction, including back pain, rotator cuss tears, and knee pain.

• Sports-related injuries, such as tennis elbow, achilles tendonitis, ACL tears.

• Chronic pain.

• Hypermobility, leading to joint instability and pain.

How Long Should We Stretch?

How Long Should We Stretch?

When stretching our muscles, the general consensus is that we should stretch up to 60 seconds per muscle. Whether it is 20 seconds 3 times or 30 seconds 2 times as long as the muscle is stretched for 60 seconds.

There are others however who advocate a different stretch duration and repetition. Thirty years ago a man by the name of Aaron Mattes developed the 2 seconds, 10 times stretch. The premise of this technique is holding a stretch for only 2 seconds inhibits the protective stretch reflex (myotatic reflex).

The stretch reflex inhibits the muscle from lengthening for the stretch after 2 seconds. If the target muscles is indeed being inhibited then true lengthening without soreness will not occur.

The stretch is performed using Active Isolated Stretching. Using the muscle opposite in action to the target muscle to be stretched and only holding for 2 seconds, performing up to 10 repetitions with progressive increase in range of motion will allow progressive lengthening and eliminate overloading the stretched muscle which could cause potential microtears. An example would be contracting your quadriceps muscle to stretch the hamstring. By activating the quadriceps the brain then tells the hamstring to relax thus allowing the stretch.

So does it work? I put AIS to the test with myself and several patients. The muscle to be stretched was the left Middle Scalene which bends the neck to the side and is often a source of neck pain and tightness. I did not experience any rebound tightness later in the day or the following day. The increased ROM persisted for several days. One of my patients did not feel any difference between the 2 second x 10 reps stretch and the traditional 30 seconds x 2 reps stretch. The remaining 3 patients felt less soreness and improved ROM with AIS.

I then tried stretching my painful L Iliopsoas muscle. I had been doing 30 seconds x 2 reps with temporary relief (a few hours). The next day I tried the 2 seconds x 10 reps. I noticed a slight ache post stretch which resolved quickly. The pain and tightness remained improved for at least 2 days. Next, I tried stretching my non painful Hamstrings. I did not notice much of a difference between traditional stretching and AIS for reduction in tightness and duration.

My study is small and limited but it is possible the 2 second stretch works well for a painful muscle which is not responding to traditional stretching and other patient populations which have to be careful with stretching.

So which stretch to use? Check with your physical therapist if you are in rehab or other wellness provider who may be aware of both techniques. Most importantly, stretching should not make you feel worse than when you started and NEVER stretch a cold muscle.

To your health and wellness!

Joann Tippett, PT, MSPT, CKTP, CCI

30 minute exercise routine (moderate level)

Level 2: Moderate Strengthening Exercises

Moderate Single-leg Bridge for Hip Extensors

1. Lie on your back with one knee bent and that foot on the floor, and one leg straight out, with your hands palm down at your side (Photo A).

2. Press into the floor from your hips through your foot on your bent leg, and lift your buttocks and your outstretched leg while counting 1-2 until your thighs are evenly lined up to obtain this bridge position (Photo B).

3. Hold this position for five seconds, then slowly return to start to the count of 1-2-3-4. It should take you longer to return to start. Control is important.

4. Repeat as many times as you feel matches your fitness level.

5. Repeat with your other leg.

Note: To make this exercise more challenging, bend your elbows, or reach up to the ceiling with your hands and arms while doing the bridge exercise.

Sidelying clam shell

1. Lie on your side with your hips and knees bent (Photo A).

2. Keeping your hips perpendicular to the floor, lift your upper leg to the count of "1-2" (Photo B).

3. Return to your starting position slowly as you count "1-2-3-4" aloud. Control is important.

4. Repeat as many times as you feel matches your fitness level.

5. Repeat with on the other side.

Note: To make this exercise more challenging, tie an elastic exercise band or bungee cord around your legs, just above the knee to add resistance (Photo C).

OR Seated clam shell

1. Sit in a chair with good posture. Put your knees together and your feet flat on the floor.

2. Loop an elastic exercise band or bungee cord from below and cross the ends over your legs just above your knees, and hold the band in this position (Photo A).

3. Keeping your feet together, spread your knees apart as you count 1-2 (Photo B).

4. Return to your starting position even more slowly while counting 1-2-3-4. Control is important.

5. Repeat as many times as you feel matches your fitness level.

Moderate Stair Step for Quad Strength

Stand on the ground in front of a step/set of stairs. Use the handrail for balance as needed. Place your left (leading) foot on the first step (Photo A).

1. Step up one step with your right leg, so that both feet are on the first step (Photo B). Do these two movements to a count of 1-2.

2. Keeping your left foot on the step, step down backward with your right leg to return to your starting position to the count of 1-2-3-4.

3. Repeat as many times as you feel matches your fitness level.

4. Repeat with the opposite leg as the leading leg.

Moderate Heel Raise for Calf Strength

1. Stand on the bottom step with both feet and let your heels extend over the edge of the step (Photo A). Use the handrail for balance as needed.

2. Slowly lower your heels below the level of the step and then rise onto your toes, so your heels are as high as possible (Photo B). Do this to the count of 1-2.

3. Slowly return to your starting position to the count of 1-2-3-4. Control is important.

4. Repeat as many times as you feel matches your fitness level.

Moderate Half Sit-ups for Abdominal Strength

1. Lie on your back with your hips and knees bent, feet flat on the floor, and one hand on top of each thigh (Photo A).

2. Tuck your chin to your chest and sit up enough so that your hands reach the top of your knees. You do not need to sit up farther. Only your shoulders need to come off the floor.

3. Hold this position for a count of 10. Make sure that you count out loud, so you do not hold your breath.

4. Repeat as many times as you feel matches your fitness level.

Note: To make this exercise more challenging, cross your arms over your chest while lifting your shoulders off the floor and hold for a count of 10.

Moderate Counter-Facing Press for Pecs/Triceps

1. Stand a little more than an arm's length away from a counter or heavy piece of furniture (Photo A).

2. Keeping your whole body in line, lower your body toward the counter to the count of 1-2 (Photo B).

3. Press away from the counter to return to your starting position with a count of 1-2-3-4. Repeat as many times as you feel matches your fitness level.

Moderate Standing Row for Rotator Cuff/Scapula

Note: This exercise requires an elastic exercise band or bungee cord.

1. Open a closet door or other stable door. Wrap the band around the inside door handle and close the door so you are outside the closed door. With your arms out in front of you, hold the ends of the band (Photo A).

2. Stand upright with good posture. Keeping your shoulders down, squeeze your shoulder blades together while pulling back with your arms to the count of 1-2, until your elbows come to your sides (Photo B).

3. Slowly return to your starting position to the count of 1-2-3-4. It should take you longer to return to your start. Control is important.

4. Repeat as many times as you feel matches your fitness level.

Moderate Biceps Curl with Overhead Press

Note: This exercise requires the use of small hand weights (5-8 pounds) or other objects that you can easily grasp with your hands and lift overhead. If you do not have weights, 16- or 20-ounce water bottles, canned goods, or quart-sized milk or juice containers will work. Add more repetitions to challenge your muscles if you cannot increase the weight.

1. Stand upright with good posture, holding your weights in each hand with your arms at your sides (Photo A).

2. Slowly bend your elbows and curl your weights up to a 1-2 count until your elbows are at 90 degrees (Photo B).

3. Then, slowly press your weights overhead to a 1-2 count (Photo C).

4. Slowly return to your starting position using a count of 1-2-3-4. Control is important.

5. Repeat as many times as you feel matches your fitness level.

Fewer Opioids. More Movement. Better Health.

Fewer Opioids. More Movement. Better Health.

Every year, millions of Americans use opioids to manage pain.

Pain can be unrelenting, overwhelming, and all-consuming. So why do so many of us try to manage pain only from the palm of our hand?

Doctor-prescribed opioids are appropriate in some cases, but they just mask the pain—and reliance on opioids has led to the worst drug crisis in American history.

That’s why the CDC recommends safer alternatives like physical therapy to manage pain. Physical therapists treat pain through movement, hands-on care, and patient education—no warning labels required. By increasing physical activity you can also reduce your risk of other chronic diseases.

Fewer Opioids.
More Movement.
Better Health.
Pain is personal, but treating pain takes teamwork.
When it comes to your health, you have a choice.
Choose more movement and better health.
Choose physical therapy.

Call our office today to get started! (925) 977-9300 or email gobeyond@gobeyondphysicaltherapy.com

Physical Therapy Guide to Low Back Pain

Physical Therapy Guide to Low Back Pain

If you have low back pain, you are not alone. At any given time, about 25% of people in the United States report having low back pain within the past 3 months. In most cases, low back pain is mild and disappears on its own. For some people, back pain can return or hang on, leading to a decrease in quality of life or even to disability. Physical therapists help people with low back pain improve or restore mobility and reduce their pain.

Physical therapists are movement experts. We can improve quality of life through hands-on care, patient education, and prescribed movement. Don’t wait to get your treatment started. Call asap to get an evaluation so we can start working together to GET you better!