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Eur Spine J. 2019 May 21. doi: 10.1007/s00586-019-06010-4. [Epub ahead of print]

Kinesiophobia modulates lumbar movements in people with chronic low back pain: a kinematic analysis of lumbar bending and returning movement.

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Graduate School of Health Science, Kio University, 4-2-2 Umaminaka, Koryo-cho, Kitakatsuragi-gun, Nara, 635-0832, Japan.
Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Department of Nursing and Physical Therapy, Konan Woman's University, Kobe, Hyogo, Japan.
Graduate School of Health Science, Kio University, 4-2-2 Umaminaka, Koryo-cho, Kitakatsuragi-gun, Nara, 635-0832, Japan.



We aimed to kinematically analyze lumbar bending and returning movements and clarify the relationship between fear of movement and kinematic output.


We recruited 45 participants with CLBP (i.e., > 6 months) and 20 healthy control (HC) participants with no history of CLBP. We used the numerical rating pain scale (NRS), Tampa Scale for Kinesiophobia (TSK-11), and Pain Self-Efficacy Questionnaire (PSEQ-2) as qualitative outcome measurements. CLBP participants were divided into two subgroups (high- and low-fear groups) based on the median split of the total TSK-11 score. In the kinematic recording session, a starting-cue beep signaled participants to bend forward using the lumbar region of their spine and then return to an upright posture, and we used a flexible twin-axis electrogoniometer to record the lumbar movements. The time series of lumbar movements was divided into four phases according to lumbar movement velocity, and we calculated the length (sec) of each phase.


Phase 1 (duration prior to cue-induced movement initiation) and phase 3 (switch in the direction of lumbar movement from forward to backward) were significantly longer in the CLBP high-fear group compared with those in the CLBP low-fear group and HC group (p < 0.05). The increased lengths of these two phases were positively correlated with not only pain intensity but also TSK-11 scores (p < 0.05).


These results represent evidence of a particular lumbar movement pattern associated with kinesiophobia. These results might help to identify psychological factors that impact lumbar movement patterns in individuals with CLBP. These slides can be retrieved under Electronic Supplementary Material.


Fear of movement; Kinematic analysis; Kinesiophobia; Low back pain


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