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This strange brain reaction to pain is called ‘muscle guarding’ (The Washington Post)

Posted: May 09, 2024 in In the News

This article originally appeared in The Washington Post on May 9, 2024.


This strange brain reaction to pain is called ‘muscle guarding’

By Rebecca Theim

Stephen Clark, an Atlanta-area physical therapist, sees many patients who suffer from muscle guarding after a traumatic surgery or injury. Muscle guarding, which emanates from the brain, is a physical response to pain. For some, though, protracted muscle guarding can prolong pain and inhibit recovery.


He mentioned helping a female patient recovering from a broken ankle who experienced muscle guarding. “If I went to touch her ankle, she would tense up, even though I hadn’t touched her yet,” said Clark, director of clinical innovations at Confluent Health. The patient’s brain made a decision that even the idea of Clark touching her ankle equaled danger.


In muscle guarding, the brain seeks to protect an injured area by subconsciously directing the surrounding muscles to not function, or to lock, ostensibly to defend the body against additional pain or injury.

“Most patients who are in pain have some level of protective muscle guarding,” said John Shipley, a board-certified physical therapist with the Johns Hopkins Musculoskeletal Center in Columbia, Md.

Muscle guarding manifests in many ways, including leg muscles that resist movement during physical therapy for a knee replacement, a shoulder that inexplicably “freezes” after surgery or injury, or low back pain that persists long after doctors conclude an injury is healed. Muscle guarding even plays a role in endometriosis, and pain during pregnancy and postpartum.

“It’s absolutely built into us after an injury or major surgery that you need to heal, you need to be careful,” said Amanda C. de C. Williams, a professor of clinical, educational and health psychology at the University College London, who has studied muscle guarding for eight years. “But the questions we grapple with is for how long, and how much pain should you encounter as you recover?”


Williams and other experts say that anxiety may play a role in chronic muscle guarding, and treatments that help alleviate anxiety may also help lessen pain.


Nick DiNubile, a Philadelphia-area orthopedic surgeon and chief medical adviser of the American Council on Exercise, acknowledged that not taking a proactive approach to rehabilitation is common in surgical medicine. “A lot of doctors take the position: Scar looks good, stitches are out, everything’s okay,” DiNubile said. “They abdicate the role of ensuring that strength and conditioning are restored.”

...Read the full article here.

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