Fear-avoidance behaviour is a theory that evolved in the 1980’s that continues to both gain momentum and create debate about the nature of musculoskeletal pain.

We all experience acute pain at some stage or other. Yet whilst most will recover from a painful episode once the initial symptoms settle, some will spiral into a chronic pain pattern that negatively influences not just their physical health but also eventually their emotional, psychological and even their economic well being.

The fear-avoidance behaviour model states it is overly fearful people who go on to develop chronic pain. It is thought that these fears arise from an initial injury or painful episode involving actual soft tissue damage, yet once the injury has healed the person continue to associate those movements with the pain. This can lead to disengagement with a range of meaningful activities from sport, hobbies, social contact and work, leading to disability and depression. And more pain. A vicious cycle indeed.

Opponents of the model have long decried it’s simplicity, yet new evidence appears to be emerging that places this model in a more modern setting. Professor Lorimer Mosely from The University of South Australia is leading the charge. Most notably he hypothesised recently that those who perceive expected musculoskeletal pain to be uncontrollable are most likely to develop chronic pain, such as people with fibromylagia. And those who perceive it to be controllable yet still avoid the behaviour are likely to develop avoidance behaviours that are specific to that particular task or movement only.

This provides some interesting cues to practitioners on how to both identify at risk people at an early stage of injury and treat those who are suffering from chronic pain. It underlines the need for early intervention for spinal pain and injuries from science based practitioners, and the restoration and reinforcement of normal movement patterns to avoid the chronic pain spiral. And for those already suffering from chronic pain, reducing painful stimulus with hands-on therapy is very important. Yet it must be interlinked with exercise that reinforces normal movement patterns and the awareness of normal movement. Physiotherapists are well placed to deal with these issues, and many utilise Clinical Pilates for this very reason. There are many ways  for people to engage in restorative movement and they should seek their health practitioners advice on how to go about this rather than put up with chronic musculoskeletal pain.

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