I hurt my back in a horse back riding accident. Even though they say you should get right back on the horse, I ended up in the emergency room and never had a chance to do it. Now, I can hardly bend or twist without pain — there’s no way I can get back on my horse. Will this eventually get better? I hope so (and sooner than later before I lose my courage all together).

Fear of movement and fear of re-injury are common after traumatic injuries and especially in people with low back pain. The knowledge and fear that certain movements will cause pain result in avoiding movement. Eventually, this fear-avoidance behavior can lead to loss of function and disability.

Studies show that pain-related fear affects how patients respond to their pain. Pain catastrophizing is a part of the problem. People who catastrophize tend to do three things. They think about their pain and can’t stop thinking about how much it hurts. They blow their pain out of proportion and are afraid that there might be something really serious wrong. And they feel helpless to change their pain, believing that there is nothing they can do to reduce their pain.

You may be experiencing some of these responses when you reach the limits of your pain free motion and become aware (and possibly fearful) that if you go any further, something is going to hurt. It is possible to work through this response. It takes time and may require the supervision of a health care professional such as a physical therapist.

The therapist will help you learn how to do graded exercise. Together, you would find out how much exercise you can do before your pain stops you. This is referred to as exercising to pain tolerance. You start at that level of exercise or activity. The therapist guides you in building tolerance by slowly increasing duration, intensity, and frequency of the exercise or activity.

Another approach called graded exposure starts by looking at which activities you are fearful of (e.g., lifting, carrying, twisting, bending). Each of those activities is then practiced with supervision or guidance from your therapist. You should start at a level that feels safe to you. Rate your fear before and after each activity. As the fear goes down, the frequency, intensity, and duration of the activity is increased. Then you can start doing the same things at home on your own.

The final step is to start including activities and movements that you’ll need for horseback riding. If you let your therapist know your goal of getting back in the saddle, he or she can help tailor your exercise and home program to reach that goal.