There are many factors that create alarm among injured workers, but the final concern may create the greatest psychological disability: a. there is no future employability b. disappointing to, and thereby being abandoned by, the family c. the incapacity to cope with the role of chronic residual pain d. fear of re-injury.
Patient’s dread of re-injury creates a cycle of avoiding rehabilitation and home exercise, and withholding full effort in physical therapy. A patient’s avoidance of pain thwarts, confounds, and may invalidate the results of a functional capacity exam (FCE). If the FCE is invalid for failure to put forth full effort, is it invalid due to conscious distortion, or to the self-limiting behavior that arises from fear of re-injury and greater pain?
If the patient is able to set aside concern with re-injury and put forth full effort, what is the cost of this cooperation? Three days of being bedbound? Confirmation that “holding back” is the better course of protection from pain?
Patient who had an acute, or even minor injury has experienced the “favoring” of the limb (etc.) to avoid further damage and pain. When we look at a patient’s failure to put forth effort, avoidance of involvement, lack of participation or simply disuse of the injured body part, we are, in fact, often talking about the disabling impact of fear..
Pain-related fear of movement was the strongest single contributor to disability in this group of patients
(Lentz TA, Sutton Z, Greenberg S, Bishop MD. Arch Phys Med Rehabil. Pain-related fear contributes to self-reported disability in patients with foot and ankle pathology. 2010 Apr;91(4):557-61.)