The Hidden Impact of Chronic Musculoskeletal Pain
Chronic musculoskeletal pain is more than a persistent ache. For many people, it disrupts the way they move, altering fundamental patterns like walking. Over time, this pain doesn’t just limit activity levels – it can rewire how the brain and body interact. Two key consequences often seen in individuals with long-standing pain are movement apprehension and reduced neuromuscular drive, both of which profoundly affect gait quality and efficiency.
What is Movement Apprehension?
Movement apprehension refers to a conscious or subconscious fear of pain during activity. When someone has experienced repeated discomfort with certain movements, such as stepping forward or pushing off the ground, their brain begins to anticipate pain before it even occurs. This “protective mindset” can lead to guarded movements, stiff postures, and hesitation (Caneiro et al., 2017).
In walking, movement apprehension may show up as shortened stride length, slower walking speed, or reduced arm swing. Rather than being fluid and rhythmic, gait becomes cautious and mechanical. While this may feel safer in the short term, it often perpetuates abnormal loading patterns and reinforces the cycle of pain.
Neuromuscular Drive and Chronic Pain
Neuromuscular drive refers to the brain’s ability to activate muscles efficiently through motor unit recruitment. In healthy movement, the nervous system sends strong, coordinated signals to muscles to produce smooth, powerful motion. Chronic pain, however, interferes with this process.
Pain alters motor control at both cortical (brain) and spinal cord levels. Protective inhibition reduces the amplitude of signals sent to muscles, resulting in lower force output and slower recruitment (Hodges & Tucker, 2011). This can feel like “weakness” or lack of trust in the limb, even when muscle strength is not significantly diminished on testing. For example, someone with chronic knee or lower back pain may struggle to generate normal hip extension or ankle push-off during walking, not because the muscles are incapable, but because the nervous system is dampening the drive (Rice & McNair, 2010).
How These Factors Affect Walking Gait
When movement apprehension and reduced neuromuscular drive coexist, gait efficiency is markedly impaired. Common adaptations include:
Shorter steps to minimise joint excursion and perceived risk.
Reduced ground reaction force due to weaker push-off.
Asymmetrical loading, with the painful side often contributing less propulsion.
Increased co-contraction of muscles around joints, as the body attempts to stabilise through stiffness rather than controlled mobility (Arendt-Nielsen et al., 2010).
These adaptations increase energy cost, reduce walking speed, and over time may lead to secondary issues such as deconditioning, balance deficits, or pain in previously unaffected areas - and greatly increasing all cause mortality!
Breaking the Cycle
The encouraging news is that these changes are reversible with targeted rehabilitation. Strategies include:
Graded exposure to movement, helping individuals rebuild trust in their body by progressively increasing walking challenges.
Neuromuscular retraining, such as task-specific exercises, biofeedback, or gait retraining drills, to restore efficient muscle activation.
Strength and conditioning to improve capacity of key gait muscles like the gluteals, quadriceps, and calves.
Cognitive approaches, including education and reassurance, to address fear-avoidance beliefs.
Final Thoughts
Walking is one of the most fundamental human activities, yet chronic musculoskeletal pain can distort this simple movement through apprehension and altered neuromuscular control. Recognising these subtle changes is essential for clinicians and individuals alike. By addressing both the physical and psychological contributors through evidence-based exercise physiology, it is possible to restore a more confident, efficient gait and ultimately improve quality of life.
References
Arendt-Nielsen, L., Graven-Nielsen, T., Svarrer, H., & Svensson, P. (2010). The influence of muscle pain on motor control and coordination. Scandinavian Journal of Medicine & Science in Sports, 10(4), 221–227. https://doi.org/10.1111/j.1600-0838.2009.01067.x
Caneiro, J. P., O’Sullivan, P., Lipp, O. V., Mitchinson, L., Oeveraas, N., Bhalvani, P., & Smith, A. (2017). Evaluation of implicit associations between back posture and safety of bending and lifting in people without pain. Scandinavian Journal of Pain, 17, 77–82. https://doi.org/10.1016/j.sjpain.2017.07.014
Hodges, P. W., & Tucker, K. (2011). Moving differently in pain: A new theory to explain the adaptation to pain. Pain, 152(3), S90–S98. https://doi.org/10.1016/j.pain.2010.10.020
Rice, D. A., & McNair, P. J. (2010). Quadriceps arthrogenic muscle inhibition: Neural mechanisms and treatment perspectives. Seminars in Arthritis and Rheumatism, 40(3), 250–266. https://doi.org/10.1016/j.semarthrit.2009.09.003
Related Services
At SOS Exercise Physiology, we specialise in helping people with chronic pain restore confidence in their movement. Our services include:
Exercise physiology for pain management
Strength and conditioning
Book a consultation today and take the first step toward moving freely again.
