“Fear of movement has repeatedly been shown to be a strong predictor of chronic disability in patients suffering from pain, and also a major barrier to exercise and activity.” 

Canadian Physiotherapy Association

\http://physiotherapy.ca/Practice-Resources/Professional-Development/Webinars/Interpretation-des-indicateurs-de-resultats/Translating-Outcome-Measures-Outlines/Archived-Outlines/Tampa-Scale-for-Kinesiophobia-%28TSK%29

Have you ever felt yourself “paralyzed” by fear? It could be mental, physical, or both. Do you think horses experience similar behaviors to our own when confronted with fear-based memories and trauma?

http://www.thehorse.com/articles/29270/effect-of-stressful-situations-on-horses-working-memory

In the wild, the fear of movement (kinesiophobia) is overridden by the horse’s prey-animal response. Even if injured, a horse will run away if he feels threatened. The sub-cortical processes that developed for survival take over, and there is no way to soothe the frightened animal until the threat and fear of threat is removed. The horse naturally reacts much in the way the zebra is described in the article below (quotes in italics):

http://www.healthcentral.com/chronic-pain/c/23153/147406/movement/

“If a zebra in the safari injures his leg, he keeps moving as much as possible because he needs to survive. If a human injures his leg, he may stop moving because he is too scared to move. This fear of movement (kinesiophobia) is rooted in the belief that pain is harmful and threatening.”

The zebra, like the wild horse, will alter his gait, avoid the pain as much as possible, and find a way to cope. He won’t stay still and think about it, knowing he won’t survive too long if he doesn’t keep moving.

With humans, avoidance behaviors impact mental and physical health moreso than directly affecting survival skills.

“On the other hand, humans can get all wrapped up in worry; worry about not being able to go to work, worry about not being able to keep up with the house, worry about the unknown, and worry about future. These threats to basic livelihood promote anxiety, pain and the fear of movement.”

It would appear that in mammals with a more evolved cortex and reasoning skills, the body-mind connection is so acute that when we are in fear, both our physical and mental aspects are profoundly affected. In other words, physical pain can have a detrimental effect on our psyche, and mental pain, such as depression, can ultimately manifest as a reflection in our physical state.

“Physical health declines from lack of movement as the body becomes deconditioned. Mental health declines from lack of movement as the person becomes more depressed. As the overall health declines while the fear of movement grows, the pain will become worse and the cycle will perpetuate itself. If you are stuck in this fear of movement cycle, you need a way to stop it.”

For the horse that has been adapted to all factors involved with domestication, including time spent in a stall, on an artificial feeding schedule, trained to carry a rider and participate in activities not conducive to the feral state, it may be possible for him to develop the depression, physical deterioration, and a fear of movement that his wild cousins would not exhibit at all. What do we do about this human-created and human-like condition in the domesticated horse, who might have become so traumatized he is afraid to move or undertake an activity? What does that look like in the horse when we are confronted with a sudden change in his behavior that could be trauma and pain related?

Here are some examples and comparisons of horses and humans, based on actual scenarios:

Fear of movement in the horse:

– Physical example: A young thoroughbred filly was enjoying her first free-jumping session. The beautiful chestnut was by one of the top racing stallions in the U.S. at the time. Her conformation was almost perfect, and she was declared sound upon arriving in the hands of the trainer I worked for. She was successfully jumped through the chute several times, and was willing each time, until, for some reason, she wasn’t.

The handler led her into the chute for another jump-through, but this time the filly’s head shot up, her body tightened, and she didn’t want to go. The trainer stepped in with stronger encouragement, and she jumped through, but without the same level of confidence as she previously exhibited.

They stopped the session after that, and put her back in her stall.

Following that day, the talented young horse refused to so much as step over a pole on the ground. She was subsequently given to me as a “project” to try to unravel what had happened and how to restore her confidence over an obstacle. I had not been present at the free-jumping session and nobody could explain why this horse’s demeanor had changed so drastically in the blink of an eye.

– Mental example: Fortunately the chestnut filly’s free-jumping schooling had been video recorded, and I was able to watch the session in which she went from confidently flying over every jump, to balking at even stepping over a pole on the ground in the days and weeks that followed.

Physically, it appeared that absolutely nothing had happened to cause any pain or injury. She hadn’t hit anything, stumbled, or refused. She remained sound afterward; at least insofar as standard veterinary soundness protocol was concerned. I watched the video over and over again, trying to see what could have caused the extreme reaction.

There was a single, brief moment in which the horse’s expression and body language changed. One of the jumps had been raised slightly, and she had approached too quickly, causing her to twist her shoulders and land awkwardly while regaining her balance. It was immediately following that jump when everything seemed to go downhill. It was apparent that this young thoroughbred was extremely sensitive and her loss of confidence translated instantly to a kinesiophobic type of response the next time she was asked to hop over a jump, or even a pole. The fear in her mind was likely related to a fear of falling, as the horse instinctively knows that falling can mean “death by predator.”

– How it affects the body: The beautiful conformation of the filly was almost lost to the fact that she completely tightened up after the traumatic incident. No amount of slow, calming, work from the ground or under saddle seemed to relieve her of her stress. I spent countless hours on the ground, eventually getting her to walk over a pole again without panicking. When I began working with her, she seemed to have a perpetual “deer caught in the headlights” expression, her neck held upright and rigid, no matter what setting she was placed in, or how long or briefly she was worked, or whether she was turned out or not. It was sad to see such a gorgeous horse struggling with her deeply rooted fear.

We eventually discovered through her previous owner that she had flipped over in the starting gate when on the racetrack. To me, this validated her difficulty in overcoming what seemed like a relatively minor incident at the time. She might have been injured when she fell over backwards, as well as frightened, and her seemingly minor loss of balance through the jumping chute was enough to trigger those memories.

The story seems to illustrate just how dramatically unresolved fear might affect the lives of our domesticated horses in ways similar to how it affects human beings.

Fear of movement in the human:

– Physical example: An adult enthusiastically takes up the sport of running, and embarks on a training program with the goal of racing in mind. Overzealously adding too much mileage too soon causes a lower leg muscle to tear, and the pain is intense. The runner doesn’t want to give up though, and returns to activity before the muscle is fully healed, causing the injury to recur, except worse than it was before, making every step an excruciating experience. The time for healing is now doubled, and scar tissue is inevitable at the injury site.

– Mental example: Even once healed, the formerly exuberant runner might now be afraid to run. As with the equine version of kinesiophobia, the response to the memory of pain that occurred while running is now causing the person to fear returning to the activity they were undertaking when the injury took place.

– How it affects the body: As with horses, an injury on one side of the body can have a domino effect on other physical structures in the way of compensatory issues. Humans can explain using words as to where something hurts and how much, whereas the horse cannot. Oftentimes, however, we experience the outbursts and moodiness of a human who may be in pain, but we are personally unaware of the pain they are feeling. This is not unlike a horse in pain, and how we might experience the aftermath of unresolved trauma in the animal in the way of extreme or uncharacteristic behavior.

Gait anomalies may develop over time, as the stronger leg is favored while the injured leg is still healing. There may also be residual pain and discomfort, as nerves that are in the process of healing can fire spontaneously and make you wonder if the injury is in danger of recurring. The same thing likely happens for horses, and a bout of pain, even if temporary, causes a stress-response including an elevated heart rate and the release of stress-related hormones into the bloodstream such as cortisol and adrenaline.

One of the key issues to resolving kinesiophobia is in understanding that not all pain is “bad.” It is the body’s way of protecting itself and doesn’t always mean that harm is being done. Sometimes it is also part of the healing process, or under normal load-increasing exercise protocols, it can be a part of the building up of muscle tissue.

Overcoming the fear involves exploring where it is coming from and challenging your belief system about your pain. You may need to begin very gently, both with yourself and with your traumatized horse, and lay down a new neural pathway by beginning very slowly and mindfully so as to reduce the threat value of pain. The correlation between the activity and bodily discomfort will remain until enough progress has been made to work through the fear and the brain is retrained to accept the movement without painful consequences. This is known as graded exposure: (http://www.ncbi.nlm.nih.gov/pubmed/17716819)

http://www.thehorseagilityclub.com/your-club/netherlands/

Honoring where we are at:

Imagine punishing a horse like the chestnut filly in the example above, or being yelled at by your coach because you didn’t perform your best. Maybe you were a child and a parent made you feel guilty for spilling grape juice on the rug, or not getting high enough marks in school. These childhood incidents, which may not seem as traumatic as something like the young filly’s terrifying flip-over in the starting gate, can remain locked inside and ready to surface at the next level of provocation. Chronic, unresolved feelings of guilt and shame can become just as painful as an incident involving physical trauma.

When you see someone who appears to be depressed and “curled up” into themselves—perhaps with rounded shoulders, gaze dropped, and lackluster step—they could be experiencing the paralyzing effects of long-held traumas and are literally in fear of moving forward with their lives, in both a mental and physical sense.

The horse’s body language could be similar, if not outright lame, due to residual tightness and subsequent weakness in one or more areas of the body. Mentally, it can manifest as “stubbornness,” a “bad attitude,” spookiness, or a flat-out refusal to move when under saddle, even when all possibilities for pain such as ill-fitting tack, bad shoeing, and other soundness issues have been addressed.

Whatever happened to us, or to the horse, we have to begin the healing process by accepting where we are now. We cannot rush the restorative work, because it is unique to each individual, and we cannot presume to know everything that led to the consequential mental and physical responses following the traumatic event or events.

We, as humans, are easily caught in long-term fear, as avoidance mechanisms become finely tuned. We get good at it. Even for physiotherapists, treating patients with the condition is difficult and hard to adequately assess, even though research has shown it is present in a significant proportion of their clientele. Horses are likely subject to similar losses of safety and when kept in a confined, domestic situation, chronic fear and kinesiophobia may be retained, as their instinct to keep moving has been restrained by their unnatural environment and training. Their mental and physical rehabilitation process is not unlike that for humans as well.

As Tara Brach writes in Radical Acceptance, Embracing Your Life With the Heart of a Buddha, “We are caught in the trance of fear when the emotion of fear becomes the core of our identity and constricts our capacity to live fully.” (p.168)

“…if experiences of fear are continuous over the years, chronic tightening happens. Our shoulders may become permanently knotted and raised, our head thrust forward, our back hunched, our chest sunken. Rather than a temporary reaction to danger, we develop a permanent suit of armor. We become, as Chogyam Trungpa puts it, ‘a bundle of tense muscles defending our existence.’ We often don’t even recognize this armor because it feels like such a familiar part of who we are. But we can see it in others. And when we are meditating, we can feel it in ourselves—the tightness, the area where we feel nothing.” (p. 169)

“Because the trance of fear arises from feeling cut off in relationships, we continue to feel fundamentally unsafe until we begin to experience with others some of the love and understanding we needed as children. The first step in finding a basic sense of safety is to discover our connectedness with others. As we begin to trust the reality of belonging, the stranglehold of fear loosens its grip.” (p. 171)

As we know all too well with horses, if they feel unsafe and do not trust us as a rider or handler, their fear remains, but may also be exacerbated if not re-schooled with great care and skill.

What works—making the move:

Improving proprioception…the body experience. What is happening in your body when you feel the emotions relating to the trauma. Thinking about moving is not the same as actually moving, so it has to be undertaken one tiny step at a time.

The common denominator is in slowing things down—and consciously creating a new neural pathway based in mindful movement.

Backing off the training and intensity, finding a baseline tolerance that will not trigger the kinesiophobia, and planning a careful course for progression, are the steps to gaining trust and beginning to feel safe once again. This applies to horses and humans, and addresses both mental and physical aspects of the fear.

With a process of graded exposure, it is possible to re-establish the desired activity with a joyful approach and fresh enthusiasm. The brain literally rebalances, reducing the anxiety, fear and pain, and instead sends out more positive messages relating to the chosen activity. This is a form of coping strategy that can help horses and humans move forward in their lives, literally, by overcoming their fear of movement and releasing the fear that initially shut them down.

More research is needed to help us understand how much of a horse’s resistance might be related to fear of pain versus how much resistance is related to actual pain. Studies that involve heart-rate variability in real-time could potentially provide us with better answers than we have now, by providing data that conveys obvious levels of stress in a being that is unable to verbalize his feelings. We hope this will be a positive step in the direction of improved equine welfare and lead to more compassionate training methods in the future. In effect, the research will likely help us understand how to cope with our own fear of pain, both mental and physical, and become more compassionate toward other humans too.

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The Compassionate Equestrian blog is written by TCE coauthor Susan Gordon unless otherwise noted. Dr. Schoen’s personal blog and website may be found at http://www.drschoen.com

About the blogger:

Susan Gordon is 55 years old and lives on Salt Spring Island, B.C., Canada. She turned professional as a rider in 1983, upon the invitation of Maclay champion (1973), the late Michael Patrick. Susan trained eventing, hunter, jumper and dressage horses, apprenticing with other top trainers in her chosen disciplines. She taught freelance from 2002 until retiring in 2010, bringing elements of meditation practice, music, dance, art, and an interest in non-invasive, holistic therapies to her work with students and their horses. She has since completed courses in sustainability (University of British Columbia and University of Guelph), and documentary filmmaking (Pull Focus Film School, Vancouver). She is a nationally ranked competitive masters and age-group runner in the 5K to ½ Marathon Road Race distances. The Compassionate Equestrian is her first book. Coming soon will be Iridescent Silence of the Pacific Shores (Gordon/D. Wahlsten 2015), a book of abstract water photography with a strong environmental statement, and DVD featuring original Orca calls and music composed by Ron Gordon, Ph.D.