Fear of Re-Injury Makes Injury Last Longer, Delays Return to Work


When people experience a musculoskeletal injury, one that involves muscles or bone, recovery depends on many things ranging from the obvious (treatment) to the not-so-obvious (fear of movement causing pain). While most people who are injured at work are able to return to their position within a reasonable amount of time, up to 20 percent do not recover quickly and live with prolonged pain and disability, resulting in a delayed return to work.

Fear avoidance includes catastrophizing (fearing the worst) and fear of movement. Many studies have been done to understand who develops fear avoidance and why. By finding a fear-avoidance model, researchers hope to be able to identify those who may fall into this group and intervene before the situation deteriorates.

The authors of this study analyzed the relationships identified by the fear-avoidance model by measuring levels of catastrophizing, fear of movement, depression and pain severity. Researchers identified 401 people who were unable to work because of injury and they were attending a community-based disability reduction program. The researchers chose the people with the highest measures of pain catastrophizing and fear of movement, leaving them with 121 people (82 men, 32 women) for the study.

The injured workers had been off work for at least six weeks and had sustained a soft tissue injury, most frequently back pain. Their average age was 41.9 years. The 10-week program was run by psychologists and they worked with the workers on strategies and targeting risk factors, such as fear of movement. The workers did not have to complete the full 10 weeks if they were ready to return to work earlier and this happened with many who had begun the program not long after their injury.

The workers’ pain was measured using the McGill Pain Questionnaire, pain catastrophizing was measured through a self-reporting questionnaire called the Pain Catastrophizing Scale, as was the fear of movement using the Tampa Scale for Kinesiophobia. Depression was also measured, using the Back Depression Inventory.

The researchers compared questionnaire scores from before and after treatment, and how quickly the patients returned to work to come up with their findings. The results showed that although neither the sex of the patient nor the length of time affected how quickly they returned to work, higher scores on fear of movement and pain severity at the start of the study did mean it would likely take longer. This finding was not all that different from what previous studies have found as well. The study also showed that when it took a long time to adjust catastrophizing, there were higher levels of depression.

The authors concluded that research should be done on finding ways to lower catastrophizing levels among patients with this type of injury. By lowering the level, the workers could usually return to work more quickly.