By Tom Fontana, PT
“I’m scared it will hurt again!” “I’m scared if I move it, it will break!” These are some of the phrases we hear when people first come to us, particularly after a very painful injury, whether it resulted in surgery or not. When it hurts that much, it is perfectly understandable to not want to move it again — pain is an excellent inhibitor of movement and refraining from moving is generally adaptive in the short run. However, whether you’re Gordon Hayward or not, overcoming your fear of moving is part of your rehab.
Your body was built to move and craves movement—lots of good things happen when you move, including benefits to the circulatory and respiratory systems, joints and muscles, and even gastrointestinal function, let alone mood.
In the acute stage after surgery, there are necessary periods of immobilization to allow the repaired structure to heal, and these vary depending on the structure that was repaired. At the end of this stage, sometimes the pain has resolved and in others pain is still an issue. The same is true for injuries that did not require surgery. In either case, people often remember the movement that led to the injury and are motivated not to repeat it.
That’s why in the early stages of PT we take into consideration the amount of pain/fear of movement you have while trying to get you moving as soon as possible. When it is just too painful to get you to move, we do passive things to you (e.g., massage, joint mobilization, heat/ice or other “modalities”) to get your body moving without introducing additional pain. Slowly, we reintroduce motion (again, perhaps passively or actively assisting the movement and teach you to do the same) and strengthening without movement, called isometrics. This may be accompanied by controlled movement of the joint while seated, which will eventually lead to balance or neuromuscular control activities.
Over a period of time, people learn to trust their bodies again and can engage in more active stretching, strengthening with body weight and higher-level balance exercises, eventually returning to more sport-specific or activity-related movements (see James’ article elsewhere in this issue) including the injurious motions. Despite the bad rap that PT stands for “pain and torture,” we recognize that recovery is hard both physically and psychologically and work with you to regain your confidence.