It Hurts!!! I should rest? A Clinician Explains Fear Avoidance
Fear Avoidance

Ever heard the term Fear Avoidance?

Have you ever had an injury and thought you should avoid all movement?

Or even been fearful of movement?


What is Fear Avoidance?


The fear avoidance model describes how individuals develop and maintain chronic pain as a result of avoidant behavior based on pain related fear. Research shows that primary tissue healing occurs approx 4-6 weeks after injury, so why are you still experiencing pain months later?

While initially, you do want to allow the tissue/tendon/ligament/etc to heal, you should not avoid movement all together. Hypervigilance of pain with movement can restrict normal use of tissue and lead to deterioration and muscle atrophy. I have observed over the last two years as a clinician that patients with shoulder pain typically present with more fear avoidance behaviors and anxiety with movement when compared to other diagnosis’.

As a result, their pain threshold lowers and their self perception of their disability increases as they develop more chronic pain. Research shows that higher fear of movement and emotional distress scores at baseline were significantly associated with higher disability over one year in patients with shoulder pain [1].


Fear Avoidance & Shoulder Pain


Shoulder pain is a more common, long-lasting musculoskeletal disorder with 40-50% of patients reporting continued pain 6+ months after seeing a clinician based on a study published by BMC Musculoskeletal Disorders [1]. This article discusses how a patient perceives their pain and how it can affect their overall recovery. If pain is perceived as non-threatening, then a patient will typically continue to participate in activities of daily living, which in turn promotes functional recovery.

While on the other hand, avoidance can also lead to withdrawal from valued activities and might cause emotional distress, which is known to be associated with decreased pain tolerance. The study concludes that in patients with shoulder pain referred to secondary care it was found that both higher fear of movement and emotional distress scores at baseline were associated with higher self-reported disability over the follow-up year. 


So, should you rest after your injury?


The answer is yes and no. During the acute/healing phase you should move within a pain free range of motion, but not restrict movement all together. Motion is lotion for your joint, and it is true “if you don’t move it, you lose it”. Therefore, after an injury, it is encouraged that you seek assistance from a clinician to assist you in preserving your joint integrity and tissue elasticity (full motion without restriction) while you heal and then progress you to more functional movement.

If you are experiencing pain and need help recovering functional movement patterns, please seek help by visiting your local physical or occupational therapy clinics. And if you are in the Augusta area, and want to schedule an evaluation, we would be happy to have you. You can book an appointment online here

Brooke attended the physical therapy assistant program at Orangeburg-Calhoun Technical College after studying exercise science at the University of South Carolina, Aiken. She has been practicing as a Physical Therapy Assistant since 2021 and serves patients and clients both in ProActive’s aquatic therapy programs and at the clinic.



[1] Major, D.H., Røe, Y., Småstuen, M.C. et al. Fear of movement and emotional distress as prognostic factors for disability in patients with shoulder pain: a prospective cohort study. BMC Musculoskelet Disord 23, 183 (2022). https://doi.org/10.1186/s12891-022-05139-6

Are you dealing with pain?

We understand that struggling with the stress and strain of pain can be tough…Whether it’s waking up feeling stiff or severe tension after walking, running, or playing, no one wants to spend each day dealing with the soreness that pain brings. While many people choose surgery or injections for pain relief, at ProActive Rehabilitation & Wellness, we offer non-surgical therapies which prevents patients from going under the knife.


If you’d like to book a pain consultation now, with one of our top clinicians, click the button bellow or have your provider fax over a referral. We only book a limited amount of these consultations each month, so act quickly before they’re gone.

Rafi Salazar OT

Rafael E. Salazar II, MHS, OTR/L (Rafi) is the CEO & President of Proactive Rehabilitation & Wellness, as well as the Principal Owner of Rehab U Practice Solutions and the host of The Better Outcomes Show. Rafi’s career trajectory includes 10+ years of experience in healthcare management, clinical operations, programmatic development, marketing & business development. He even spent some time as an Assistant Professor in a Graduate Program of Occupational Therapy and has served on numerous boards and regulatory committees. Today, Rafi helps innovative healthcare companies humanize healthcare through his consulting workHe also leverages his experience as a professor and academic to speak and train on the topics around humanizing the healthcare experience.

Rafi also authored the book Better Outcomes: A Guide to Humanizing Healthcare