Functional Neurological Disorder (FND) is a neurological condition that can affect movement, sensation and other functions of the nervous system.
Despite growing awareness of FND, it is still commonly misunderstood. People living with FND may hear that their symptoms are “all in their head”, that nothing is wrong because their scans are normal, or that stress must be the cause.
These misconceptions can make an already challenging condition even more difficult to navigate.
In this article, we break down five common myths about Functional Neurological Disorder and explain how neurological physiotherapy can help people with movement-related symptoms.
Myth 1: “Is FND All in Your Head?”
The short answer: No.
This is one of the most common misconceptions about FND.
While symptoms arise from the brain and nervous system, FND is not imagined, fabricated or “made up”.
Research using brain imaging has identified differences in how certain brain networks function in people with FND. The symptoms are genuine and occur outside of a person’s conscious control.
A useful way to understand FND is that there is a problem with how the nervous system is functioning, rather than structural damage to the nervous system.
Bottom line: The symptoms are real, involuntary and deserve proper care and support.
Myth 2: “If Scans and Tests Are Normal, Nothing Is Wrong.”
False.
Many neurological conditions can have normal structural scans, and FND is one of them.
MRI scans and other investigations are often used to look for structural damage or disease. In FND, the issue relates to how the nervous system is functioning rather than damage that can necessarily be seen on a structural scan.
Importantly, healthcare professionals diagnose FND using positive clinical signs and characteristic patterns of symptoms – not simply because tests or scans are normal.
Bottom line: Normal test results do not mean symptoms are imaginary or unimportant.
Myth 3: “Stress Causes FND.”
Not always.
Stress can sometimes be a contributing factor, but it is not the cause for everyone.
Some people develop FND following:
- Injury or illness
- Surgery
- A neurological event
- A period of significant stress
- No clearly identifiable trigger at all
Every person’s experience is different.
While stress, anxiety or emotional health may influence symptoms in some people, psychological stress is not required for a diagnosis of FND.
Bottom line: FND is a complex condition with multiple potential contributing factors, and stress is only one possible piece of the puzzle.
Myth 4: “There Is Nothing That Can Be Done for FND.”
Fortunately, this is not true.
Many people with FND can improve with the right support and treatment approach.
Management may involve:
- Education about FND
- Physiotherapy
- Occupational therapy
- Psychological support when appropriate
- Fatigue management
- Strategies to improve movement and confidence
The appropriate treatment will depend on the person’s symptoms and individual needs.
Recovery looks different for everyone, but meaningful improvements are possible.
Bottom line: FND is treatable, and many people benefit from an individualised, multidisciplinary approach.
Myth 5: “If My Symptoms Improve One Day and Return the Next, I Must Be Imagining Them.”
No.
Fluctuating symptoms are common in FND.
Many people notice their symptoms change depending on factors such as:
- Fatigue levels
- Attention and concentration
- Stress
- Pain
- Sleep quality
- The environment they’re in
This variability is something clinicians may see when assessing and treating FND.
Bottom line: Good days and bad days can occur with FND and do not mean your symptoms aren’t real.
How Can Physiotherapy Help My FND?
Physiotherapy can be an important part of treatment for people experiencing movement-related symptoms of FND.
Importantly, physiotherapy for FND can look different from rehabilitation for an injury or structural neurological damage.
Rather than simply strengthening a weak muscle or practising a movement repeatedly, FND physiotherapy may focus on helping the nervous system relearn more automatic and efficient movement patterns.
Here are five things you may experience when working with a neurological physiotherapist.
1. Helping You Understand Your Symptoms
Education is an important part of FND treatment.
Your physiotherapist can help you:
- Understand how FND can affect movement
- Recognise factors that may influence your symptoms
- Learn why symptoms can fluctuate
- Develop confidence in your body’s ability to move
For many people, developing a better understanding of what is happening can reduce fear and uncertainty and support their rehabilitation.
2. Retraining Movement
Movement-related symptoms of FND may include:
- Changes in walking
- Balance difficulties
- Limb weakness
- Tremor
- Freezing or difficulty initiating movement
Physiotherapists may use strategies that encourage more automatic, natural movement.
This might include:
- Attention-shifting techniques
- Functional task practice
- Rhythm or cueing strategies
- Movement retraining exercises
For some people, movement can become easier when attention is shifted away from consciously controlling the affected body part and towards the task or another external focus.
Movement retraining draws on the nervous system’s ability to adapt and learn. This is closely related to neuroplasticity – the brain’s ability to change and reorganise in response to experience and practice.
3. Building Confidence in Movement
People with FND may become concerned that movement will worsen their symptoms or cause harm. This can sometimes lead to gradually reducing activity.
Physiotherapy can aim to:
- Reduce fear or apprehension around movement
- Improve confidence
- Encourage appropriate activity participation
- Support a return to meaningful daily activities
Building confidence in movement can be an important part of rehabilitation.
4. Managing Fatigue and Activity Levels
Fatigue is common in FND and can have a significant impact on everyday life.
A physiotherapist can help you:
- Pace activities effectively
- Recognise and manage “boom and bust” activity patterns
- Gradually increase activity levels where appropriate
- Develop achievable exercise and activity goals
The focus is on sustainable progress rather than repeatedly pushing through exhaustion and experiencing setbacks.
5. Supporting Long-Term Self-Management
Living with FND often involves learning how to recognise and respond to symptoms over time.
A physiotherapist can help you develop practical strategies to:
- Manage symptom flare-ups
- Remain active during setbacks where appropriate
- Monitor progress
- Maintain gains achieved during rehabilitation
Recovery isn’t always a straight line. Having strategies to manage changes in symptoms can be an important part of longer-term rehabilitation.
Where Can I Get Help for FND in the Illawarra?
If you live in the Illawarra and have been diagnosed with Functional Neurological Disorder, P4 Movement in Wollongong provides neurological physiotherapy and allied health support.
Our team provides physiotherapy, neurological rehabilitation, exercise physiology and other allied health services, with individualised programs based on your symptoms, abilities and goals.
Depending on your needs and location, home-based services may also be available across the Illawarra.
Ready to Take the Next Step?
If you have FND and would like support with movement, mobility, balance or physical function, our neurological rehabilitation team can help.
Call P4 Movement on 1300 306 939 or book an appointment to discuss FND physiotherapy and neurological rehabilitation.
References
- Espay, A. J., Aybek, S., Carson, A., et al. (2018). Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders. JAMA Neurology, 75(9), 1132–1141. doi:10.1001/jamaneurol.2018.1264.
- Hallett, M., Aybek, S., Dworetzky, B. A., et al. (2022). Functional Neurological Disorder: New Phenotypes, Common Mechanisms. The Lancet Neurology, 21(6), 537–550. doi:10.1016/S1474-4422(21)00422-1.
- Nielsen, G., Stone, J., Matthews, A., et al. (2015). Physiotherapy for Functional Motor Disorders: A Consensus Recommendation. Journal of Neurology, Neurosurgery & Psychiatry, 86(10), 1113–1119. doi:10.1136/jnnp-2014-309255.
- Bennett, K., Diamond, C., Hoeritzauer, I., et al. (2021). A Practical Review of Functional Neurological Disorder (FND) for the General Physician. Clinical Medicine, 21(1), 28–36. doi:10.7861/clinmed.2020-0987.
Disclaimer: This article is intended for general educational purposes only and does not replace personalised medical or healthcare advice. FND symptoms and treatment needs vary between individuals. If you have concerns about your symptoms or treatment, speak with your treating healthcare professional.
