Kinesiophobia in chronic low back pain
Patients with chronic low back pain (LBP) may fear re-injury enough to avoid movement. This concept is called kinesiophobia (fear of movement). A constant cycle of pain, fear, disuse, and depression can be the result of kinesiophobia.
In this study, psychologists and Physical Therapists got together to test chronic LBP patients for kinesiophobia. Patients with chronic LBP filled out four separate surveys of questions about function, pain, perceived disability, and fear of movement/reinjury. Then they performed four tests of reaching high and low targets at slow and fast speeds.
Right before each movement test, the patients rated the pain as they expected it to be. Then after the test, they re-rated the experience. The expected and experienced (actual) harm were analyzed and compared for two groups. Group one had low levels of kinesiophobia. Group two had high levels of kinesiophobia.
The results showed that high kinesiophobia patients had lower function in daily activities because of back pain. They were more likely to report higher pain levels than patients with low kinesiophobia. Women with high kinesiophobia were more likely to predict catastrophic results of movement activities than men with equally high levels of kinesiophobia.
The high kinesiophobia group was more likely to overpredict pain ratings with activities. In other words, the predicted pain level was much higher than the actual experience. That was true for the first time they tried an activity. The second time they performed the same movement, their pain ratings were the same as the low level kinesiophobia.
And although their fear was less the second time doing the same activity, their fear went right back up when starting any new (even slightly different) activities. They were unable to apply what they learned about specific movements to general movement.
These findings provide Physical Therapists useful information when working with fearful LBP patients. A slow, graded, and progressive rehab program aimed at practicing movements and reducing fear can help overcome kinesiophobia.
Zina Trost, et al. Exposure To Movement in Chronic Back Pain: Evidence of Successful Generalization Across a Reaching Task. In Pain. June 2008. Vol. 137. No. 1. Pp. 26-33.