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Effects of Motor Imagery on Movement-Based Fear in Musculoskeletal Conditions: A Critically Appraised Topic
Megan E Pearcy1, Gemma E Leonard1, Megan E Palfrey1
1Shenandoah University, Leesburg, VA, USA.
Journal of Sport Rehabilitation
|January 22, 2026
Summary
Graded motor imagery (GMI) combined with physical therapy (PT) significantly reduces movement-based fear in patients with musculoskeletal injuries. This approach also improves range of motion and functional outcomes, offering a promising adjunct to traditional PT.
Area of Science:
- Rehabilitation Medicine
- Pain Management
- Motor Control
Background:
- Movement-based fear negatively impacts injury recovery and function.
- Graded motor imagery (GMI) is effective for specific conditions like CRPS and neck pain.
- Its efficacy in extremity musculoskeletal injuries undergoing physical therapy (PT) is less clear.
Purpose of the Study:
- To determine if GMI integrated with traditional PT decreases movement-based fear compared to PT alone.
- To evaluate the impact of GMI on individuals with extremity-related musculoskeletal conditions.
Main Methods:
- A systematic literature search of randomized controlled trials was conducted in April 2025.
- Databases included Cochrane, CINAHL, PubMed, PEDro, and SPORTDiscus.
- Articles were quality-assessed using the PEDro scale (minimum score of 6/10).
Main Results:
- GMI plus PT showed greater improvements in fear outcomes for adhesive capsulitis, posttraumatic elbow stiffness, and post-Total Knee Arthroplasty.
- Significant reductions in movement-based fear were observed (P < .01 to P = .014).
- Improvements were also noted in non-movement-based outcomes like range of motion and pain scales.
Conclusions:
- GMI combined with traditional PT is effective in reducing movement-based fear.
- This combined approach enhances range of motion, strength, and functional outcomes.
- Recommended with a Grade A based on evidence quality, suggesting further research on optimal parameters.
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