This morning, while walking my dog, the cloth leash slipped out of my hand and dragged there beside her for a few steps as we walked happily side-by-side down the street. A few moments later I sensed her absence, turned around, and there she was standing still, looking at me, her back foot on the end of the leash. She was stuck! She had no strategy, no training, and no skill to get herself out of this “mess”.
In the clinic I encounter this same situation quite frequently. It goes like this: A patient has an injury of some sort, and due to the pain caused with certain activities, they simply stop using their body in a natural way. We call this an avoidance strategy.
Now, there’s nothing wrong with avoidance strategies. They work. But they are supposed to be used temporarily. An example of an appropriately used avoidance strategy is the use of crutches or a brace for the ankle after an ankle sprain. By avoiding weight-bearing or further twisting of the ankle for a few days, we enable the early phase of healing to proceed uninterrupted. It’s easy to see that if one continued to use crutches and a brace on the ankle for a few months, this long term use of an avoidance strategy would lead to all kinds of issues: stiffness, weakness, loss of body awareness, and incoordination. A long-term avoidance strategy that I see almost daily in my office is the avoidance of bending after having a lower back pain episode. Most folks realize very quickly in a back pain episode that bending increases their pain, so they find a way to limit this activity. This is actually a great strategy. But if they never resume bending, their back gets weak and stays stiff and sore.
Let’s go back to my dog for a moment. When she stepped on her leash, she felt a sudden pull on her collar that probably felt unfamiliar to her, created a confused state, and she just stopped. Perhaps she was afraid.
It turns out that fear of pain is the number one reason we’re hesitant to give up our avoidance strategies. When we experience significant pain, it scares us. The pain signal feels dangerous, and we try to heed this signal. But in most cases the dangerous pain subsides, and as time passes, healing naturally occurs. This is when fear can limit our progress. If we continue to manage our problem during the late phases of healing the same way we managed the early phase of healing, then we’re standing on our own leash.
When we learn the difference between “dangerous” pain and “safe” pain we can make much better decisions about how much we should move.
Think of a scab on your knuckle. If the scab is well-formed, bending the knuckle may cause a temporary pain from stretching the tight scab. But once you straighten the finger back up, the pain eases rapidly. This indicates that the finger is safe to move. Now, imagine you bent your finger before the scab was fully formed. You’d split the new scab, and likely start bleeding again, and likely cause a lingering pain due to aggravating the healing process. Unfortunately, you’ve now increased the time it’s going to take to heal this injured tissue.
This principle can be applied to any part of the body after almost any type of injury or painful episode. A good therapist can help guide you through this, but it can also be done on your own.
Remember, movement is healing. And all pain is not dangerous. If you are having difficulty recovering from an injury, be sure to ask yourself if fear of pain is keeping you from getting better. Freedom from pain may come as easily as lifting your foot off the leash!
