Tuesday 15 August 2017

Pain Psychology - Avoidance Habits

I've been clear on my stance that the sooner someone seeks rehab for their pain, whether it's an acute injury or an overuse condition, the quicker and easier the recovery will be. There are a multitude of reasons for this, one of which is avoidance habits. 

Consider the scenario where an individual suffers a low-back strain while working. Instead of doing something about it right away, he continues to work through it. As it becomes worse during the week, he begins to modify his work mechanics. After a while, the pain becomes such that he drops to light-duty tasks to try and allow himself to rest. Still not seeking help, he starts avoiding any heavy lifting at home as well. This entire time, his body becomes more and more deconditioned due to lack of use, propelling the amount of pain he's experiencing. Soon enough, the individual no longer feels comfortable attempting any work, now expecting pain should he try. 

These types of cases are extremely common, with essentially every person experiencing long-term pain developing habits to help them avoid that pain that they live in fear of. As the extremity of these habits progresses with the severity of issue, not only does the affected (and protected) area become weaker, but also does the individual become more unwilling to confront that pain in order to finally take action on it.

My knee hurts. I'm gonna stop adulting from now on.

Furthermore, it's likely that this conscious guarding of the body against pain has even more psychological implications that propagate pain. For instance, hyper-awareness of information regarding their pain is likely to exacerbate an individual's perception of it.

This ties in closely with the pain-identity occurrence that I wrote on before, in that avoidance habits quickly lead to development of that chronic state if being unable or even unwilling to return to a healthier state.

Like before, careful imagery and visualization of an improved quality of life is important, as it helps to reestablish the belief that recovery is attainable. Goal-setting, as usual, provides the framework to create a realistic view on the process. 

Clients should also be encouraged to gradually - and controllably - return to movements and activities. Exposure to "acceptable" levels of pain in this way will assist in helping those people in moving past their fear it and more willing to confront it to recover without damaging them more in the interim.

Protection methods are often necessary in early stages of injury, but preventing them from turning into avoidance habits is something that therapists need to be attentive toward. Individuals need to be encouraged to return to their activities after they heal, not to completely fear those activities and allow it to stonewall their recovery. 

This topic was written with consult and collaboration with Alison Quinlan, a Sports Behavioural Consultant in Victoria, BC who is also pursuing continued education in dietetics. Follow her on Twitter and visit her website and blog to see some of her own authored articles. 

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