By Trude Stjernen, Physiotherapist:

A few years ago I had a conversation with a woman with a long history of pain in her lower back. She was convinced to protect her back from more pain (and injury) she had to avoid all kinds of movements to her back. She actually compared the spine to an onion: each time she bent forward one layer would peel off and eventually it will lead to the degeneration of her spine.

The fear of moving, aka kinesiophobia, is not uncommon amongst people. For years we have been told to straighten up, keep our core activated, avoid lifting like this and sitting like that, where we’ve been told that this can potentially harm our bodies. No wonder people develop a fear of moving. For this woman, she blamed all her pain on moving her body incorrectly; and she looked at movement as something dangerous. Perhaps someone told her that bending is dangerous for your back? Perhaps the first time she ever experienced pain in her back was with a forward bend?

Pain is, after all, the body’s way of protecting us from danger, but how much pain you feel does not always relate to the distress or damage of the tissue. One cannot deny anyone’s experience or perception of pain, this should by all means be considered as real. The important question is: is this pain signalling a threat worth signalling, or is the brain overreacting to residue signals from the previously damaged tissue?

Learning about, and understanding pain helps you deal with it more effectively, and it is a good way to start your rehab. Very rarely will pain from our muscles and joints be dangerous, and it will almost always be healed over time. Actually, placing too much emphasis on physical abnormalities can induce a negative self-perception of health and lead to fear avoidance and pain catastrophizing behaviours, a situation that may predispose individuals to chronic pain. Once one understand ones pain one can better implement strategies aimed toward recovery.

After clearing my patient of any serious spinal pathology, I encouraged her to challenge her limits and her pain through education, and asking her to put herself into a safe environment where she could move in patterns she previously associated with discomfort and pain. Feeding successful, pain free movement into the system can be a very effective way of recovering from movement ailments and provide a large psychological boost.

Moving forwards I plan on elaborating more on pain and how to identify the various types of pain; and make suggestions on how to deal with it. Please feel free to share some of your stories with us.


  1. Greg Lehman (2014). Pain Fundamentals: A pain science education workbook for patients and therapists.
  2. David S. Butler and G. Lorimer Moseley (2003, 2010). Explain Pain.
  3. Guillaume Le’onard, Yannick Tousignant-Laflamme and Catherine Mercier (2012). Simple things matter! How reassurance and pain management strategies can improve outcomes in physiotherapy: a case report. Published in International Journal of Rehabilitation Research 2013, Vol 36 No 1.

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