The old adage says if you fall off a horse, get right back on. But it isn’t always easy for recovering athletes to return to the game. Fear of movement impacts sports performance more than people may realize. When patients are afraid of re-injury, they compromise their athletic conditioning and rehabilitation. Thus, a person-centered approach considers psychological and physiological factors when treating injured athletes.
What is the Fear of Movement?
The fear of movement (kinesiophobia) is when an athlete is afraid of re-injury. This fear leads to avoidance and escape behaviors which negatively impact sports performance. Kinesiophobia was first defined by Kori et al. in 1990 as “an excessive, irrational, and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or re-injury.”
Two Paths: Avoidance and Confrontation
There are two paths an athlete can take following a painful injury—avoiding pain or confronting pain.
Avoidance
It is natural to want to stay away from pain. Fear-avoidance, however, is a maladaptive response to injury. When the fear outweighs the risk, it negatively impacts recovery and performance. Research published in Clinical Orthopaedics found that “an increase in athletes’ fear-avoidance was associated with a decrease in physical function.” Therefore, the authors suggest that clinical interventions take the impact of fear-avoidance into account when treating injured athletes.
Confrontation
Fear of movement is a barrier to recovery. As clinicians, we need to encourage recovering athletes to get back in the game and be as physically active as their condition allows. Start by educating the patient to explain the cause of the pain. Cognitive Behavioral Therapy (CBT), alongside Physical Therapy, can help them face their fears and return to normal functioning.
Measuring Fear of Movement
Clinicians use various scales to measure athletes’ emotions about returning to sports and identify psychological barriers to recovery.
- Athlete Fear Avoidance Questionnaire (AFAQ) is a 10-question self-assessment that rates thoughts and feelings about injury on a scale from 1 to 5.
- Injury-Psychological Readiness to Return to Sport Questionnaire (I-PRRS) is a self-report on athletes’ confidence on a scale of 0-100
- Re-Injury Anxiety Inventory (RIAI) covers 28 statements about anxiety about returning to sports.
- Emotional Responses of Athletes to Injury Questionnaire (ERAIQ) evaluates fears about returning to sports.
- Return to Sport after Serious Injury Questionnaire (RSSSIQ) measures how fear of re-injury has interfered with sports performance after returning.
- Tampa Scale for Kinesiophobia (TSK) includes statements rated on a 5-point scale (0 to 4) related to fear of injury.
Fear of Movement Impacts Sports Performance
Fear of movement impacts sports performance and rehabilitation outcomes. A person-centered approach to physical therapy recognizes that there is more to healing than physical recovery; athletes need to feel safe as well. At Churchill Orthopedic Rehabilitation, we consider the whole person. We work with patients one-on-one to determine an optimal treatment plan that meets their physical and emotional needs. To refer a patient, call our office at (201)-833-1333.