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Breaking the Mental Barriers: Overcoming Fear of Re-Injury

Kinesiophobia is the fear of movement stemming from a belief that physical activity could cause reinjury. Kinesiophobia is actually quite common among athletes recovering from injuries, particularly severe ones like ACL tears, rotator cuff injuries, or fractures. While the physical healing process is closely monitored, kinesiophobia can linger, creating doubt, anxiety, and hesitation.

In fact a 2021 study in Sports Health found that - When controlling for time since surgery, and age - maximal isometric quadriceps strength and kinesiophobia were significantly associated with long-term patient-reported outcomes after ACLR. These results suggest that training to improve quadriceps strength and addressing kinesiophobia in the late stages of recovery from ACLR may improve long-term self-reported function.

LINKS:

ACL Unbroken: https://www.theunbrokenathlete.com/aclunbrokenprogram

Resources: https://www.theunbrokenathlete.com/blog

 

 

TRANSCRIPT

Hi, everyone. 00:02 Welcome to the Unbroken Athlete Podcast. 00:05 I'm Emily Perrin, mental health therapist and former Division I athlete. 00:08 And I'm here with my co-host, Dr. 00:10 Catherine Logan, orthopedic surgeon and nutrition coach. 00:13 Today, we're going to talk about kinesiophobia. 00:16 We are super excited to talk about this topic because many athletes who have specifically torn their ACL really struggle with it. 00:24 Yeah, I totally agree, Emily. 00:27 I think this is a really important topic. 00:29 So, you know, returning to sport after an injury, you know, that's the monumental milestone that everybody is really trying to get to. 00:37 You know, it sort of signifies, okay, I'm getting towards the end. 00:40 I've, you know, worked really, really hard and I really want to reclaim my passion and get back to the things that really fuel them. 00:48 However, you know, sometimes you get through all the physical journey and you still have some issues with like,the physical, mental sort of connection. 00:56 So, you know, I think we want to talk about this word kinesiophobia, you know, which is basically just like fear of movement. 01:03 And it's like stemming from the belief that you internalize of like, okay, what if I get re-injured again? 01:09 So it's not so much fear of re-injury as much as like, it's just like fear of movement, but it's because you believe you're going to get re-injured. 01:17 And this is not just ACL specific, like this happens to,by folks who have like shoulder dislocations. 01:25 But this feeling, you know, can really linger and create some doubt. 01:30 And I did want to bring up, you know, before Emily starts to go into like, why does this occur? 01:35 But there was actually a study in 2021, it was published in Sports Health, which is one of our big academic journals. 01:42 And they had controlled for like,you know, how long it had been from surgery as well as the patient or the individual's age. 01:51 And they looked at like what really impacts outcomes as far as getting back to everything you want to do. 01:56 And the two things that were really, really important after ACL surgery, one was the isometric quad strength. 02:02 So how strong are your quads? 02:04 But the second was kinesiophobia. 02:06 And so I think we really want to spend a lot of time because it's not just a small thing, it's actually really impacting people's ability to get back. 02:16 Yeah, it's so interesting. 02:18 And I, you know, to answer this question, like, why does kinesiophobia occur? 02:22 Well, I in many ways that's kind of like asking, well, like, why does somebody get anxious? 02:27 It's really individual. 02:28 It's, it can be very unique and it's really multifaceted. 02:32 There's a lot of reasons. 02:34 I think the first to acknowledge is, isInjuries for many people can be traumatic, right? 02:42 And so I define and and that word is, I think, really important to break down. 02:47 I define trauma as just an experience that really overwhelms your capacity, right, to kind of navigate it. 02:55 It can be really scary, particularly when we're talking about ACL injuries. 03:01 As someone that has torn their ACL, it is really rattling, it's really jarring, andThat does impact what is called our nervous system, right? 03:11 And our nervous system, our autonomic nervous system is how the mind and the body are connected. 03:16 And trauma really like a traumatic experience occurs within your nervous system. 03:21 And so that isn't as simple as just thinking through that, right? 03:26 It's it's not actually a cognitive experience, it's a somatic 1, which is I think for many people at the heart of this then kinesiophobia experience. 03:36 You know, the reality as well for many athletes and many elite performers is that their performance matters to them and returning to play is a really big deal. 03:45 And there's there can be a lot of pressure and a lot of expectation around that, right? 03:49 And so as they start to work back towards returning to play, they really feel that. 03:55 There, there, there really is, whether it is, you know, whether they're putting that pressure or their that expectation on themselves or it's coming from external factors that's really there. 04:04 You know, I think the other piece is we really have to remember that so much of this return to play journey is not just on the individual athlete. 04:14 There there is, there's a support system that's involved as well, right? 04:17 There is an orthopedic surgeon, there is an athletic trainer or a physical therapist. 04:21 There is family and friends. 04:23 There's oftentimes a. 04:25 Whether it is a mental health professional or a sports psychologist, someone that is helping with the mental and emotional side of things, you know, resilience occurs in community. 04:35 I think, you know, I think we often talk about resilience being just an individual factor or skill, but it's really not. 04:42 And so if an athlete actually lacks a support system or doesn't have. 04:48 the adequate kind of structures in place, then that can certainly lead to probably a little bit more of kinesiophobia. 04:56 But again, it's really complicated. 04:58 There's a lot of pieces to it, but those are breaking down just a couple of reasons of why it might occur. 05:04 So I'll put it back to you, Dr. 05:05 Logan, and just like what's, so what's the impact of that? 05:09 Yeah, I would say, you know, the impact can be really, really big. 05:13 And so, you know, it can be that you actually delay your return to sport, even though maybe physically, you know, if you're going through your barrage of testings, like things are, you know, you're meeting all your sort of physical milestones, you still might not be ready and get that delay relative to the kinesiophobia. 05:32 The other thing that's really sort of important is, and I watch for this a lot when I'm like looking at people and how they perform movements. 05:40 There's a lot of quantitative measures that we have. 05:42 Like what's the range of motion? 05:43 You know What's their strength? 05:44 Like the force in Newton's. 05:46 But I'll often sort of comment on the qualitative side because the the patterns of how we move are affected by how we feel. 05:54 You know So if we have altered mechanics because we're fearful of that movement and we're not feeling like prepared or ready for it, that's going to like risk our re-injury rate. 06:07 And not even just like the re-injury rate on that particular side, but sometimes your other side. 06:12 So overall, like you know kinesiophobia affects us physically. 06:18 And you know we really, it's important to really think about like how can we overcome this kinesiophobia? 06:24 'Cause there are strategies and I'm going to let Emily you know kind of lean into like her you know professional expertise more so than... 06:32 This is more outside my scope, but I think the strategies, you know, understanding that there are some ways that you can work on this are important to know. 06:40 Yeah, so umYeah, again, there's, we're gonna, this, this podcast episode in itself could be hours and hours, right? 06:50 We feel like we could talk about this forever. 06:51 But, you know, the first piece is when we are dealing with a phobia, right? 06:57 So I would say the same thing for, you know, if it's arachnophobia, if it's any type of phobia, right? 07:04 You know, and and looking at the impact, it's always a great idea and it can always be a great idea to work with a professional, right? 07:11 Not trying to kind of what I call white knuckle it and navigate this on your own. 07:18 So what I would say is first and foremost, kind of looking for a professional. 07:24 I think it should be someone that's licensed a mental health clinician that can can work with phobias. 07:29 really understands because at the heart of phobia is going to be working with some component of the nervous system, some component of the stress response. 07:37 When there is fear involved, you are working with the stress response, right? 07:42 You are working with the nervous system, which is making a shift into what we call a sympathetic, right? 07:49 Or fight, fight,Response. 07:52 It's often referred to as I just call it the stress response, right? 07:55 And you have to work with that stress response in order to work with the phobia. 08:00 It is not a mental thing. 08:02 You can do as much kind of mental and self-talk as you want. 08:06 That's not going to move the needle on your actual nervous. 08:09 System. 08:09 So what's occurring, you know, in in your nervous system. 08:13 OK, so we have to actually acknowledge that. 08:15 That's the second thing that I'm going to say I have. 08:18 I've had a few athletes that I've worked with that as soon as this fear comes up. 08:23 They're like, push it away, put it on the back burner, right? 08:27 I'm going to avoid, I'm going to distract. 08:28 I'm not going to think about it. 08:30 And we know that the more that you do that, the more it comes back rearing its head. 08:34 So one of the best things we can do, and I think This is why I say find a professional that can help you work with this and really work with phobia, is we really have to kind of. 08:43 Turn towards it, right, and stare it down. 08:46 And there's a lot of tools and techniques that we can do to do that. 08:50 But we have to, it starts first and foremost by really acknowledging that. 08:54 And then the last thing I'll add in is, again, it's not just a mental thing. 08:58 And so a lot of the work that you're probably going to be doing is actually working with the stress response. 09:02 And so this is where, especially in our ACL Unbroken program, right, we're really teaching you a lot of body-based tools and coping skills so that you can work with what's happening in your physiology. 09:13 to kind of slow and soften and soothe that fight or flight response, because you won't actually be able to kind of think or process, right, anything about your sport, or I mean, even really kind of like think more rationally until that stress response calms down a little bit. 09:32 So that's where we're using things like breathing techniques, we're using rhythmic movement, we're using tapping, we're using orienting, we're using more body-based tools and skills to work with that stress response. 09:44 Yeah, I agree. 09:44 I think you know there's other little small ways that you can you know get some gradual exposure, which is also helpful and something that I see with my patients where you know the movement, if there's a particular movement that is fear-inducing for them, you know trying to work really closely with your physical therapist to break it down. 10:05 If it's jumping, that is particularly nerve-wracking, you know how can you break it down into like smaller steps you know fromyou know short hops on the floor to you know maybe double leg hops to single leg hops, and then starting to increase some height. 10:20 You know I think you get the gist of what I'm saying. 10:23 It's just trying to break these down so that you get that gradual exposure. 10:27 So just like to reinforce what Emily said, you're not trying to run away from it. 10:31 Maybe you can't throw it all at you at once, but you know how can you kind of expose yourself to it, start to work into it, but not feel overwhelmed by that. 10:42 And then with those little steps, like feel good about those, celebrate those. 10:46 And you'll hear us talk about celebrating small wins all the time, because as you're going through a recovery, sometimes something like simple as, okay, I was able to, you know, get myself in and out of my car without anybody helping me seems like a really big deal. 11:02 And you know, you should celebrate that and understand that these... 11:06 achievements are going to reinforce your confidence. 11:10 And that's just going to help you continue to establish even larger goals. 11:14 Yeah, I love that because so many of us skip over the the wins, right? 11:19 And we want to jump right back in to full fledge, like, you know, box jump ofyou know, 30 feet or whatever it's called, 30 inches. 11:29 So I think that's super important. 11:30 We have to break it down. 11:31 We have to, in many ways, work with the new normal, right, as we're returning. 11:36 And another thing that can be helpful with that is a mindfulness practice, right? 11:40 I mean, that in many ways, both mindfulness and visualization can be really helpful in terms of really starting to create somepositive and healthy neural pathways in terms of training attention, kind of again, calming and soothing that stress response in the body, also helping you start to really take yourself through um whatever activity, right? 12:03 Whether you're a skier, whether you're a climber or a hiker, or you're returning to sport, right? 12:08 Basketball, lacrosse, doesn't matter, right? 12:10 You're really kind of starting to see yourself take yourself throughyou know, being back in whatever activity you're going to be back in. 12:19 I think those two things in particular can also, again, really help strengthen some of the more mental aspects, but it's not just mental, right? 12:28 It's It's both it's mind and body. 12:30 And then the last piece is just, I would say, really leaning on your support system, right? 12:37 I mean, we talked earlier or I mentioned earlier, this piece around support and building resilience, andyou have to remember that even though you're the one that's turned your ACL, you're not in it alone. 12:49 And there's been so many athletes that have come before you, and there's going to be so many athletes that come after you, right? 12:55 You're not alone in this. 12:56 And you have to, you know, one of the things we talk about in our ACL Unbroken um program is develop your support team early and lean on them, talk to them, tell them aboutthe fears that you have. 13:11 You know, I really think there's something incredibly profound about getting some of our fears out of us, right? 13:17 Whether it's down on paper, whether it's talking it out, really communicating with your team of people. 13:23 Yeah, I agree. 13:24 And, you know, I think for those who are listening, who are more like coaches or the therapists or the trainers who are working with the athletes or the athletes yourself, like things to really think about is, you know, make sure thatYou know, you're focusing on like setting realistic goals early on, like breaking down those return to sport process into the more manageable phases is always going to be a lot more digestible and more beneficial in the long run. 13:51 You know, look at, you know, as far as when you're working with an athlete, like focus on the functionality of it all, like emphasize what the athlete can do rather than like what they can't do yet. 14:02 You know, like I said, that feeds into breaking it down into smaller steps. 14:06 just like remind them that you know they are making progressions and that you know the capabilities are still continuing to grow. 14:15 Like in my clinic, I always see all the time where you know I won't see somebody for you know a period of maybe six weeks or three months, you know so I'm seeing bigger increments. 14:23 So I see all this really growth andand progression, and sometimes they'll come in and be like, I haven't gotten any better. 14:29 Like, and you know, you see like, or, you know, I see it from stepping back, so much growth. 14:34 And so making sure you're reminding them of that, 'cause when you're like living in it every day, sometimes that's very hard for the individual to appreciate. 14:42 Yeah. 14:43 So as we start to wrap up here, let's just kind of summarize really this kind of holistic approach that we've talked about in terms of navigating kinesiophobia. 14:53 SoI'll put it to you, Catherine, just kind of giving us in terms of the things that you talked about, a couple bullet points here. 15:00 Yeah, I would say, you know, first of all, kinesiophobia is something that, you know, should be addressed. 15:07 So it's, you know, that fear of movement is going to impact the physical outcome. 15:12 So making sure that we're not ignoring that, that we're taking that seriously. 15:16 whether you're the athlete yourself or you're working with this athlete. 15:20 And it should be like a multimodal approach. 15:23 You know, don't be afraid to work with a professional. 15:27 If you don't have access to that, you know, work closely with your coaches or your physical therapist, make sure you're communicating these thoughts and fears. 15:35 And do that gradual exposure, you know, work into these movements in a controlled, but like progressive manner and make sure you're celebrating. 15:42 Every time you're making those little gains, you know, they might seem small to you, but celebrate them. 15:48 They will build your confidence and that is, you know, going to feed into everything on and off the field. 15:55 But we will, you know, as always sort of put resources within our website and our blogs, you know, having more information and you know check out the ACL Unbroken where like you can really do a deep dive into all these processes, but we also will have some resources on our website so check them out. 16:18 Thank you for listening to the Unbroken Athlete Podcast. 16:21 You can find our show notes and more on our website, www.theunbrokenathlete.com. 16:27 Don't forget to check out our Unbroken Athlete app, now available on iOS in the App Store for links to the show, resources, and our Unbroken Athlete programs.