Overcoming Kinesiophobia in Injured Worker Rehabilitation: Understanding the Role of Pain

In the world of workers’ compensation, there is always so much to learn about injury and treatment. Many claims examiners may assume they understand medicine, but it took me four decades within the system before I learned about Kinesiophobia. Once introduced to this concept, I was amazed at how well it explained some of the barriers that injured workers face during their journey to recovery from work- related injuries. It also sheds light on why some injured workers do not recover as well as others. Understanding Kinesiophobia offers workers’ compensation professionals a key to helping challenged injured workers optimize their recovery.

Numerous factors can cause delayed recovery, leading to chronic pain syndromes and resulting disability and dysfunction. The path to recovery and return to work for injured workers is fraught with challenges, and one significant obstacle is kinesiophobia—the fear of movement and physical activity due to the anticipation of pain and, particularly, the fear of reinjury. In addition to Kinesiophobia, there are several other barriers to recovery, including adverse childhood experiences (ACEs), an inability to cope, catastrophic thinking, a history of substance abuse, psychosocial factors, and the encouragement by family members and friends to rest and avoid activity rather than rehabilitate. Compounding these challenges are system-wide misplaced financial incentives in the workers’ compensation system that may also drive increased disability.

Kinesiophobia is not only a significant barrier to optimum recovery, but it’s also one of the major obstacles preventing injured workers from returning to their jobs. Although not within the classic medical definition of kinesiophobia, the fear of reinjury can also manifest when employers are fearful of reinjury and therefore do not provide light or modified duties.

Understanding Kinesiophobia:

It is crucial to identify when Kinesiophobia is impacting recovery and return to work and to take the necessary steps to overcome these barriers. Here are some important facts about kinesiophobia:

Embracing Necessary Discomfort in Rehabilitation:

Discomfort (also known as pain) plays a crucial role in learning and recovery. For instance, sticking one’s finger in a pot of scalding hot oil quickly teaches the importance of avoiding such actions. However, in the context of physical therapy and rehabilitation, a certain degree of discomfort may be necessary to stretch and strengthen tissue and regain an optimum range of motion. Acknowledging the distinction between harmful pain and therapeutic discomfort is vital in addressing kinesiophobia and achieving successful recovery and return to work.

Subjectivity of Pain:

Pain is a subjective experience. What one individual perceives as excruciating and unmanageable, another may consider uncomfortable but manageable. After an intense workout in the gym, some may find muscle discomfort to be a positive experience (proof of exercising) rather than a negative one. Personal perception of pain can significantly impact treatment and recovery. Recognizing that pain tolerance varies among individuals, it’s essential to tailor rehabilitation approaches to consider each worker’s pain threshold when developing treatment programs. Physicians and therapists who are not aware of these issues may find that surgery, other treatments, and physical therapy fail when not acknowledging and understanding issues like Kinesiophobia.

Anticipation of Pain:

Sometimes, the anticipation of pain can be more daunting for injured workers than the actual pain they will experience. Each of us brings our unique life experiences and beliefs to the experience of pain. Part of a Physical Therapist’s job is to manage the anticipatory fears of patients and have them perform required movements at a controlled intensity. Once the patient experiences this minor pain, the fear diminishes.

Memory and Pain Perception:

Human memory has a fascinating way of moderating our perception of pain. I have little accurate memory of how severe the pain was after my shoulder surgery. I remember that I was “uncomfortable” but do not really remember the severity of the pain in the immediate days following the surgery. You may also reflect on not remembering the severity of the pain after a broken bone or even a stubbed toe. The phrase “Time heals all wounds” can be applied to most people who have had severe pain. Their perception of the pain severity fades over time. Repeated instances of minor pain during home exercises will aid the change in perception from daunting pain to mere discomfort.

Digital health, such as Plethy’s Recupe app, are excellent at encouraging exercise adherence, thus creating these memories of minor discomfort.

Recognizing and Treating Kinesiophobia:

Kinesiophobia is best treated by first recognizing its existence. One of the most common tools for diagnosing and evaluating the level of kinesiophobia is the Tampa Scale of Kinesiophobia (TSK), consisting of 17 self-reporting questions that assess levels of fear, pain catastrophizing, and disability.

It is important to note that despite the fear of physical activity, physical activity can also be a form of treatment (and often is the best treatment that will facilitate full recovery). There are specific strategies or techniques to help individuals manage the anticipation of pain effectively.

Kinesiophobia can be treated through a multidisciplinary approach, involving a rehabilitation physician, a psychologist, and a physical therapist.

The focus of most treatment includes counseling, reassurance, education, relaxation training, mirror therapy, and small incremental steps in treatment. Proven treatment includes mindfulness exercises, cognitive-behavioral techniques, medication for anxiety and limited low-dose analgesics. Active care activities, such as exercises in the home and clinic, are also key to reducing this fear through exposure. Here, adherence is key, especially with home exercises as the patient will spend far more time at home than in the clinic. Thus, Recupe and other digital health show great promise towards the treatment of kinesiophobia.

Conclusion:

Kinesiophobia can be a significant barrier to recovery and return to work. It presents a significant challenge in the rehabilitation of injured workers, impacting their ability to engage in essential physical therapy and return to work. Recognizing the role of pain in rehabilitation, understanding the subjectivity of pain perception, and acknowledging the impact of short-term memory on pain experiences are crucial steps in addressing kinesiophobia effectively. As professionals in the workers’ compensation and risk management industry, it is imperative to adopt a holistic approach that combines empathy, education, and tailored rehabilitation strategies to help injured workers overcome kinesiophobia and achieve a successful recovery.

It is essential for claims professionals to engage in identifying potential cases and intervene to overcome the barriers. If an injured worker refuses to return to light or modified duties, determining the underlying reasons, such as the fear of reinjury, is crucial. Providing this information to the doctor and supporting the appropriate clinic and home treatment can facilitate a more comprehensive approach to rehabilitation and recovery.