A clinical program of Energize Occupational Therapy Services
Movement Habits, Avoidance
and Chronic Pain
Repeated experiences of pain, injury or symptom flare-ups can understandably change how a person moves. An activity that was once automatic may begin to feel uncertain, risky or unsafe. A person may brace, move stiffly, avoid particular positions, rely heavily on one side of the body or stop activities they believe could cause pain, reinjury or loss of control.
These changes are not always conscious. A protective movement pattern may become habitual even when the person is no longer actively thinking about pain or danger. Over time, it can become their usual way of moving.
Fear of movement is sometimes called kinesiophobia. It may involve concern that movement will cause pain, worsen a condition, create a new injury or lead to loss of control. The term does not mean that pain is imagined or that fear is the sole cause of the person’s difficulties. Fear is only one reason protective movement habits can develop.
Avoidance Can Begin as Protection
Avoiding or changing movement is not automatically unreasonable. Following an injury, surgery or significant symptom flare, reducing or modifying an activity may be appropriate. Painful experiences can also teach the nervous system that a particular movement or situation may be threatening.
Avoidance may provide short-term relief or reassurance. However, when the pattern continues after circumstances have changed, the person may have fewer opportunities to learn what their body can currently tolerate.
Habitual bracing or stiffness may increase muscular effort, alter how other parts of the body participate and make everyday activities less efficient. Over time, these patterns may contribute to reduced strength, endurance, movement confidence and participation. Someone may be physically capable of a movement but no longer include it naturally during daily activity.
Not all avoidance or movement modification needs to be challenged. Medical restrictions, tissue healing, instability, falls risk and other health conditions may require an activity to remain limited or adapted. The question is whether the current pattern remains necessary and helpful.
Understanding the Pattern
I help clients examine how they approach activities, which parts of the body participate, where unnecessary effort or guarding may be occurring, and what they expect will happen.
Before changing a movement pattern, we consider:
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relevant diagnoses and medical precautions;
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the person’s current abilities and actual risks;
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whether the pattern is conscious or habitual;
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what the person predicts will happen;
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how the movement affects other areas of the body; and
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what the person needs or wants to do in everyday life.
The goal is not to impose one “correct” way of moving. It is to understand the person’s current options and determine whether additional movement choices could make an activity easier, more efficient or more sustainable.
Comparing What Is Expected With What Happens
When appropriate, an activity can be attempted or modified in a safe and manageable way. The person can then compare what they expected with what they actually experienced.
They may discover that a movement feels different than anticipated, symptoms settle sooner than expected, or changing speed, position, physical support or muscular effort makes the task more manageable. A planned working-recovery period may also change what happens afterward.
The goal is not to prove that an activity will be painless. It is to gather useful information, help the nervous system update its expectations and give the person more choices.
Rebuilding Movement Confidence and Flexibility
Movement work should connect to real life. Depending on the person, this might involve reaching, carrying, walking, completing household tasks, working or returning to a valued leisure activity.
We may change one part of an activity at a time and decide what to repeat, adapt or progress. The process is collaborative. The client is not expected to ignore symptoms, surrender control or push through regardless of the consequences.
Progress does not require eliminating every sensation or concern. It may mean moving with less guarding, allowing more of the body to participate, using less effort, recovering more predictably or returning to something that matters.
The goal is to distinguish necessary protection from habits that are no longer helping—and rebuild movement confidence, flexibility and choice through safe, meaningful activity.
References
National Institute of Neurological Disorders and Stroke. (2026, March 13). Pain. https://www.ninds.nih.gov/health-information/disorders/pain
Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85(3), 317–332. https://doi.org/10.1016/S0304-3959(99)00242-0
Woods, M. P., & Asmundson, G. J. G. (2008). Evaluating the efficacy of graded in vivo exposure for the treatment of fear in patients with chronic back pain: A randomized controlled clinical trial. Pain, 136(3), 271–280. https://doi.org/10.1016/j.pain.2007.06.037