Fear. It’s a strange thing. It almost always motivates us to change behaviour. At times it pushes us to run. At times it paralyses us.

As humans we all experience fear at different points in our lives over different things. What is it for you? Is it failing your client? Is it making your pain worse? Is it heights? Is it small spaces? Maybe the unknown. Maybe the uncertainty of quitting your job and pursuing your passion. I don’t think any of us are entirely free from the grips of fear at some point in our lives.

For me, there are lots of fears. I fear inadequacy as a physiotherapist. I fear letting people down, but I also fear missing out on life because I have been trying to please others. I fear small spaces. I fear judgement. I fear life passing by while I’m not looking.

As part of Antony Lo’s Peak Simplicity Masterclass, I videoed a session with a client with the aim of watching it back. The idea behind it was to identify my beliefs, my biases, the language I use, what works and what does not work. I strongly believe the learning I would have gotten from it would have been invaluable. I say “would have” because I was not able to bring myself to watch it. But what it actually did, was highlight to me more than one of my fears.

But why could I not bring myself to watch it? Because I really don’t like watching myself on video! Or at least that’s what I told myself at the time. But what was the real reason? Why was it any different to watching myself on exercise demonstration videos or on short talk videos I do for the clinic. Why was this time different?

Unable to watch the session back, instead I had a peer view it for me and give me feedback. What I did well, what I could change, an outside perspective.  

I was so wound up about the whole experience of watching the session, or even discussing it with someone else who had watched it- discussing my ways, the things I do in session, my quirks and nuances, the things I did well, but to the forefront of my mind was what he was going to say I did poorly. My fear of judgement and inadequacy.

I tried to justify every single thing I did. I was wound up, stressed, I was uncomfortable about the conversation, and I was uncomfortable having someone from the outside looking in on how I work. Was it adequate? Was I adequate? But was that all?

I also feared making this client worse. She had previously been very eager to progress quicker, always wanting more strenuous exercises, always wanting to push harder; “no pain no gain”. And so I provided more strenuous exercises, I increased the intensity. Initially we saw improvement but after a 6 weeks her symptoms worsened to a point of unbearable pain. Unable to find positions of ease, unable to get adequate pain relief and led to the client needing a steroid injection.

And so here we were, post injection, treating her again for the same condition. But all I could wonder was “Why?” Why did she come back to me? I had failed her once. I had made her worse. Am I not only going to make her worse again?

Throughout this session her fear of pain was palpable- or that’s how I saw it at the time. We spoke about the need to lean on the fence, and to expose the limits of the system to expand them. But her fear of movement was hindering her progress. Or was it mine? Who exactly was fearful? Maybe both of us? Potentially. But did I ask, question, and explore? “Are you happy to continue?”, “How manageable is the pain?” “Are you happy to keep pushing, trying, and testing? Pushing your limits? Lean on the fence some more?”. Or did I merely assume? Who was actually limiting her? Hindsight is 20/20 vision but how can I know the answer to these questions without asking

Why was I so fear avoidant? Do I hold an element of guilt for her pain worsening? Wasn’t I supposed to “fix” her? I had failed her once, and I feared I would fail her again. I feared if I pushed her too much, she would fall back into that dark place of no comfort, constant pain, and very poor function.

When we got to the fence to lean on it, it was not her retracting, it was me. Guided by my fear, I changed behaviour. Fear avoidant.

Fear is conditioned. A learned behaviour. A child inheriting their mothers fear of spiders. What happens if I portray my fears to my client? Can they also “learn” fear from me? Maybe a client inheriting a fear of movement from their physiotherapist?

Am I projecting my fear onto this woman? Am I not leaning on the fence for fear of regression? Am I feeding into that sense of guilt and allowing it to command what I do? Am I now, and possibly my client, being dictated and puppeteered by these fears?

So where had I gone wrong with this lady? What did I need to change? I should have empowered this lady to move comfortably and confidently. As her physiotherapist, I should be encouraging her to not be fear avoidant and not to be fearful of movement, and yet here I am fuelling her with my fear. 

We know that fear has a huge impact on a person’s pain. Is my fear of making her regress, my fear of not being able to fix her hindering her progress?

This brings me back to why I was unable to watch the video in the first place. I was fearful of all the things I might have done wrong, of what I said, of the language that may not have been perfect. Fearful of the potential negative impact I may have had on this individual’s life.

While discussing all of this with my peer, we touched on the topic of confidence. Not on the confidence the client has in their body, nor of the confidence the client has in me, but the confidence I have in myself. It has always been an area that I feel I have been lacking in. Why? Because of the pressure I placed upon myself to fix rather than to guide and facilitate.

Fear is not always a bad thing but when it becomes a puppeteer in our lives, it is time for change.

How can I expect to help people if I, myself am not confident that I can help people? If I am not confident in my own abilities as a physiotherapist, am I always leaving room for fear and hence guilt? Maybe fear isn’t always a bad thing but when it becomes a driving force in what we do and why we do it, I think it’s an issue. 

And so, as I reflected on this- me, my fear of inadequacy or doing something wrong, my confidence or lack thereof- I noticed somewhat of a viscous circle. It dawned on me; isn’t this exactly what our clients go through? They hurt their back while lifting something, they’re told by someone or maybe themselves “well the way that you did it was probably wrong” and so they lack confidence to try it again, becoming fearful. They act upon their fears, likely by becoming avoidant of that specific activity. No longer comfortable even approaching the fence, not to mention leaning on it. Fear is not always a bad thing but when it becomes a puppeteer in our lives, it is time for change.

So as physiotherapists, are we much different from the person standing in front of us?  Don’t we all have biases, beliefs, motivations, and fears? Using these beliefs and biases to find the answer to a problem. Trying to banish a puppeteer who is no longer helpful to our goal.

“Avoiding danger is no safer than outright exposure. The fearful are caught as often as the bold”

Is our job to hammer a muscle, needle a trigger point, manipulate a joint? Or is it our job to find out what the fear is- yours and theirs? Who is the puppeteer and why? Help them work through a solution- regain their autonomy and independence. Help to promote their own self confidence and regain control. Work with them to formulate an action plan, exercise program and a path to their solution. Work with them to address their concerns. Allow them to do the things they want to do maybe albeit in a modified version for now, and not allow fear to take the driving seat. And finally, cut both them and ourselves some slack if things don’t go the way you expected.

Our bodies are individual, complex systems. Affected by numerous different factors. My role is as a facilitator and not a fixer. And so should I blame myself for things not following the path I expected? Should I leave that fear control how I move forward? Or should I acknowledge it, change tactic, and reset?

There are things we have control over as therapists. And there are things we don’t. Knowing the difference is imperative. And as I sit here and reflect, I now realise, I should not fear pushing my client “too much”. I should be giving them the power to push or not.

A fixer can take blame for not fixing. But a facilitator cannot. Fears are things that will come and go. Dancing on the line of fear is exciting, uncomfortable, and thrilling all at once. It is something that we as physiotherapists will have to do, to make a difference to our client’s lives. As Helen Keller beautifully puts it “Avoiding danger is no safer than outright exposure. The fearful are caught as often as the bold”.

So, what’s your biggest fear and how do you plan on conquering it?

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