Imagine living with pain that never quite goes away. At first, you make small adjustments; you skip a run here, avoid lifting something heavy there. But over time, the list of things you don’t do starts to grow. You stop playing sports, you avoid gardening, even everyday movements like bending down or walking for too long start to feel risky. The pain isn’t just in your body anymore. It’s in your mind, shaping your choices and shrinking your world.
When working with clients recovering from a musculoskeletal injury, this is not uncommon. The biggest obstacle is no longer the injury itself, but the fear of making things worse. This fear of movement, known as kinesiophobia, can trap clients in a cycle of avoidance, deconditioning, and ongoing pain.
For those of us working in occupational rehabilitation, understanding this fear-avoidance pattern (and knowing how to break it!) is critical to helping clients return to work and life.
What is fear-avoidance and why does it matter?
Fear-avoidance happens when a client begins to associate certain movements with pain, injury, or harm, even if those movements are now physically safe. Over time, this can cause them to withdraw from normal activities, both at work and in daily life. The less they move, the more strength and mobility they lose. Their nervous system can become increasingly “on guard,” heightening pain sensitivity. As their physical capacity declines, so does their confidence in their own body.
It becomes a self-perpetuating loop: fear leads to avoidance, avoidance leads to weakness and stiffness, which leads to more pain — and that pain only reinforces the fear.
How exercise physiology can help break the cycle
Exercise physiology plays a key role in chronic pain rehab by helping clients rebuild trust in their bodies through carefully guided, progressive movement. At Specialised Health, our approach is to:
- Start where the client is: If bending forward is a trigger, we begin with small, safe ranges of movement that the client can tolerate without a flare-up.
- Gradual exposure: We introduce movements in manageable steps, progressing only when the client demonstrates readiness.
- Layer in success experiences: Every time a client completes a movement they feared without negative consequences, it chips away at that fear. Over time, they start to see movement as safe again.
- Provide positive reinforcement: Celebrating small wins helps to boost motivation and confidence.
- Integrate real-life relevance: We design exercise programs that mimic work and daily life demands, so the confidence built in the clinic translates directly to their job and home environment.
Education is just as important as exercise
Alongside exercise, one of the most powerful tools we have is conversation. We help them to understand that pain does not always indicate tissue damage – instead it can be due to a hypersensitive nervous system triggering pain signals without injury.
For many, this is completely new information, and can be difficult to accept. Understandably, their beliefs about pain have been shaped by past experiences, well-meaning advice or even fear-driven medical messaging. That’s why education can’t be a one-off conversation – it’s something we weave into every session.
By introducing concepts little and often, we gradually build trust and help clients reframe what pain means in their body. Over time, they begin to see discomfort not as a warning to stop, but as a signal they can safely work with. This shift in understanding is what allows them to approach movement with greater confidence and less fear.
Guiding movement without reinforcing pain
The art is in striking the right balance: encouraging movement without pushing so hard that the client experiences a major flare-up, but also not backing off completely at the first sign of discomfort.
For us, this means monitoring our own language and cues. Avoiding terms like “don’t do that” or “be careful”, as these can reinforce fear around movement. We take care to adapt exercises and daily tasks to suit, rather than eliminating them all together. And we invite an open curiosity towards movement, where the client is encouraged to gently nudge at their perceived limits while still maintaining autonomy in their rehab.
Objective tracking such as using measurements for range of motion, endurance and strength can also help to show progress in black-and-white, allowing clients to realise that change is possible.
Final thoughts for our referrers
When kinesiophobia is addressed effectively, clients not only recover physically but also rebuild their resilience for everyday life. They move with more confidence, engage more in life and are less likely to relapse into the pain-avoidance cycle. For insurers and referrers, this means faster, more sustainable return-to-work outcomes.
If you’re working with a client who’s “stuck” despite the injury having healed, fear-avoidance may be the missing piece. Partnering with an Exercise Physiologist experienced in chronic pain and graded exposure can help break that cycle: safely, strategically, and with the client’s long-term independence in mind.
