Understanding Hurt vs. Harm: How Physiotherapy Helps You Move Safely
Introduction:
Pain is a natural response that signals something in the body, but not all pain means damage. Understanding the difference between "hurt" and "harm" is essential in physiotherapy and pain management. Many people avoid movement due to fear of pain, which can lead to worse outcomes over time. Learning how to move safely with guidance from a physiotherapist can improve function and reduce long-term disability.
Hurt vs. Harm: The Key Distinction
Feeling pain during movement doesn’t always mean that harm is occurring. "Hurt" refers to discomfort that might arise from using sore or stiff muscles, while "harm" indicates actual tissue damage. Many people experiencing pain after an injury or surgery avoid movement entirely due to fear of making things worse. However, this avoidance can actually delay recovery and lead to chronic pain.
The Role of Fear-Avoidance in Pain
Fear-avoidance occurs when a person becomes so afraid of pain that they avoid physical activities altogether. This can lead to:
● Deconditioning (loss of strength and mobility)
● Increased stiffness and pain
● Psychological distress (anxiety and depression)
● A reduced quality of life
To measure this, physiotherapists use the Fear-Avoidance Beliefs Questionnaire (FABQ) and other outcome measures to assess how fear impacts movement and recovery. Recognizing these patterns early helps create a structured and safe approach to exercise.
Symptoms of Fear-Avoidance Behaviours
● Avoiding movements that were previously painful
● Believing that any pain means more damage is happening
● Anxiety about worsening the injury
● Increased stiffness and difficulty returning to activities
How Physiotherapy Can Help
A physiotherapist can guide you in distinguishing between hurt and harm by:
● Educating you on safe movement and pain science
● Using graded exposure therapy (gradually reintroducing movement to rebuild confidence)
● Implementing tailored strength and mobility exercises
● Monitoring progress with functional outcome measures
● Reassuring you that movement, when done correctly, promotes healing rather than causing harm
Patient Education and Self-Management
It’s important to stay active in a controlled and safe way. Here are some strategies:
● Gentle movement exercises: Start with low-impact activities like walking or stretching.
● Gradual progression: Increase intensity slowly rather than avoiding movement altogether.
● Mindfulness and relaxation techniques: Managing stress can help reduce pain perception.
● Regular physiotherapy check-ins: A therapist can guide you in recognizing good vs. bad pain.
Conclusion
Pain does not always mean damage, and avoiding movement can lead to worse outcomes. With a guided physiotherapy approach, you can safely regain strength and function without fear. Early intervention is key, so if pain is stopping you from doing what you love, seek professional support.
By: Preya Ramdass, Registered Physiotherapist
References:
1. Vlaeyen, J. W., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85(3), 317-332.
2. Sullivan, M. J., Bishop, S. R., & Pivik, J. (1995). The pain catastrophizing scale: development and validation. Psychological Assessment, 7(4), 524-532.
3. Hodges, P. W., & Tucker, K. (2011). Moving differently in pain: A new theory to explain the adaptation to pain. Pain, 152(3), S90-S98.
