What Is Your Movement Perspective? Part 2

PERSPECTIVE 1: Physical ACTIVITY is risky and often a cause of injury; therefore, it is safer to be physically INACTIVE.
PERSPECTIVE 2: Physical INACTIVITY is risky and often a cause of injury while physical ACTIVITY is a way of making the body more resilient.

    These two perspectives speak to an individual's understanding of risk. Does one believe that he/she is reducing risk of injury by not partaking in activities that may be complex and therefore challenging to master, or does one believe that putting forth the effort to become proficient in these movements will decrease his/her risk of injury by making him/her more resilient to activities encountered daily? It is an important concept to consider, as an individual's mindset towards risk of injury will often dictate his/her willingness to take the time to learn proper execution of complex functional movements. In my experience as a physical therapist, more musculoskeletal injuries are developed gradually overtime from routinely moving or positioning oneself inefficiently, than from being acutely injured from a specific movement. Moreover, individuals with views aligned with perspective 2 tend to have a better prognosis for recovery when injured versus those that adopt perspective 1. I believe this to be true for two important reasons:

1. Individuals with perspective 2 tend to have an improved understanding of how to use their bodies efficiently, and therefore are better able to safely stay active around the injury. This allows for less deconditioning and improved full body circulation; therefore, quicker healing/recovery.
 2. Individuals with perspective 2 tend to view pain/symptoms as the result of moving inefficiently as opposed to the result of performing a dangerous movement. In this way, the pain acts as feedback for them to make adjustments to their technique or programming. This is important, because it gives individuals a sense of control over what causes symptoms/injury, and therefore, decreases fear of injury.

Current research1,2,3 seems to support my clinical observations in regards to the power of fear-avoidance in determining an individual's response to intervention in the face of injury. Wertli et al, concluded in their systematic review that  “evidence suggests that Fear-Avoidance Beliefs (FABs) are associated with poor treatment outcome in patients with low back pain (LBP)”, and therefore recommended early treatment, including interventions to reduce FABs, as to avoid delayed recovery and chronicity. The authors further stated that “patients with high FABs are more likely to improve when FABs are addressed in treatments than when these beliefs are ignored”.  One can easily see how adopting perspective 2 falls in line with the above scientific conclusions.

1.Wertli MM, Rasmussen-barr E, Held U, Weiser S, Bachmann LM, Brunner F. Fear-avoidance beliefs-a moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J. 2014.
2. Rainville J, Smeets RJ, Bendix T, Tveito TH, Poiraudeau S, Indahl AJ. Fear-avoidance beliefs and pain avoidance in low back pain--translating research into clinical practice. Spine J. 2011;11(9):895-903.
3. Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85(3):317-32.