Kinesiophobia – the fear of movement. Useful, beneficial and necessary in cases of acute pain where minimising movement to protect an injury is beneficial to the system. When that fear of movement extends beyond the duration of healing processes, however, we begin to have a problem. The problem arises as your body omits certain relative movements from its repertoire and begins to access others instead. This form of adaptation is known as compensation. If I can’t move my foot, I’ll move my hip more instead…
One case this week is of a guy who broke his neck in an RTA 30 years ago. He was placed in traction for two weeks, wore a halo brace for 6 weeks, a moulded neck collar for 3 months and a soft collar for a further 3 months. In essence he was not able to move his neck for 15 months due to external restrictions – when it’s highly possible that his break would have healed during some time in the first three months.
30 years later he is still wearing a metaphorical collar. It’s as if he never actually took it off. Neck range fully compromised in the frontal plane, 5 degrees of leftward rotation and 10 degrees of right rotation with accompanying poor sagittal plane spinal mechanics; neck flexion and extension compromised along with thoracic spine and pelvic tilts too. Naturally frontal plane spine motions and rotations have also been compromised. His whole upper body does not move. He leads with his eyes and hopefully his head and body follows.
When I held his head still in his upright stance and asked him to rotate his spine, however, I immediately saw that his spinal rotation improved and his relative neck rotation dramatically increased.
I said “It’s not that you CANNOT move your neck. It’s that you DO NOT move your neck”
When the neck does not move in this way it is possible to track backwards down to the feet and map the limitations and compensations in my Flow Motion Model to see the joints that are over working and under working. The only dominance in the neck was that of right rotation which occurs in left suspension and right shift phase making it very difficult for him to bear weight in his right leg.. Consequently he has a very heavy left leg limp. Using simple AiM movement protocol to get this guy back into his body, breathing correctly with good (better) spinal motion and accessing gait phases to get him back into his right leg again and critically giving the brain confidence to let go of the fear of moving his neck, we were able to take steps in the right direction.
By the end of the session he could turn his head 45 degrees to the left and 45 degrees to the right. With full flexion and extension and a much improved frontal plane. The pain he came to see me for – low back pain, dropped away once the brain understood that it no longer needs to operate for a stable, immobile, long forgotten neck.
The hardest part will be overriding 30years of pattern orientated behaviour of turning his whole body to talk to someone instead of just turning the neck… More work to be done
PS he has been having regular treatments to get his back cracked for the past fifteen years… When something doesn’t work repeatedly. It’s time to look elsewhere….
Interestingly, we are often able to track a person’s movement limitations back to a previous injury and are treating the adaptations potentially founded in their initial kinesiophobia.