Fear-avoidance beliefs are associated with reduced lumbar spine flexion during object lifting in pain-free adults

Knechtle, Deborah; Schmid, Stefan; Suter, Magdalena; Riner, Fabienne; Moschini, Greta; Senteler, Marco; Schweinhardt, Petra; Meier, Michael L.

doi:10.1097/j.pain.0000000000002170

Cited by 28 publications

(36 citation statements)

References 72 publications

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“…= 0.0496; p = 0.242). This finding for TSK-total is consistent with some studies [22,28] but not with others [18,31], which is most likely due to a variety of different methodological approaches as well as different population characteristics. In addition, a conditioning process due to task-specific pain experiences might elicit an altered behavioral or muscular reaction.…”

Section: Discussionsupporting

confidence: 91%

“…To avoid lumbar flexion and remain an upright position of the back, muscular activation of trunk muscles, especially of the erector spinae is required [21,24,27]. This goes along with the results from Knechtle et al [22], which showed a reduced flexion of the lumbar spine (particularly in the L4/L5 region) in healthy individuals with high task-specific fear during object lifting. This again supports the assumption of movement adaption through a change of muscular activity in the lower lumbar back driven by fear avoidance beliefs.…”

Section: Discussionmentioning

confidence: 99%

“…For the current study, the score of the item three “lifting a pot with a bent back” (PHODA-lift) was used as measure of task-specific pain-related fear. Lifting a pot represents a typical lifting task and previous studies reported a significant relationship of this item with lumbar spine motion in healthy pain-free individuals as well as patients suffering from LBP [22,28].…”

Section: Methodsmentioning

confidence: 99%

“…In support of an association between pain-related fear and lumbar flexion, LBP patients showed a significant relationship between reduced lumbar flexion during object lifting and higher task-specific (round back beliefs) but not general pain-related fear [28]. In addition, a recent study revealed that these associations seemed not only to be present in LBP patients but also in healthy pain-free individuals with no history of chronic LBP [22], indicating that pain-related fear might play a role in lifting behavior in the absence of pain.…”

Section: Introductionmentioning

confidence: 99%

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Spatial distribution of erector spinae activity is related to task-specific pain-related fear during a repetitive object lifting task

Liechti

Eichelberger

et al. 2021

Preprint

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Fear-avoidance beliefs, particularly the fear of lifting an object with a flexed spine, were shown to be associated with reduced spinal motion during object lifting in both individuals with and without low back pain (LBP). LBP patients thereby also showed potentially clinically relevant changes in the spatial distribution of back muscle activity, but it remains unknown whether such associations are also present in pain-free individuals. The aim of this study was therefore to investigate the relationship between fear-avoidance beliefs and the change in spatial distribution of lumbar paraspinal muscle activity in pain-free individuals during a repetitive object lifting task. Thirty participants completed two pain-related fear questionnaires and performed 25 repetitions of lifting a 5kg-box from a lower to an upper shelf and back, while multi-channel electromyographic signals were recorded bilaterally from the lumbar erector spinae muscles. Changes in spatial distribution were determined by calculating the differences in vertical position of the weighted centroids of muscle activity (centroid shift) between the first and last few repetitions. Multiple linear regression analyses were performed to examine the relationship between the centroid shift and fear-avoidance belief scores. The analyses showed that the fear of lifting an object with a flexed spine was negatively associated with erector spinae activity centroid shift (R2 adj. = 0.1832; p = 0.045), which might be an expression of behavioral alterations in order to prevent the back from possible harm.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Spatial distribution of erector spinae activity is related to task-specific pain-related fear during a repetitive object lifting task

Liechti

Eichelberger

et al. 2021

Preprint

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“…Interestingly, this lifting technique is advocated in manual handling training to reduce the risk of LBP [9]. Although this cross-sectional study cannot determine the cause-effect relationship of LBP related to lifting, or the reason for the differences seen in lifting technique, previous research has demonstrated that people both with LBP [42,43] and without LBP [44], who have higher levels of pain-related fear, lift with less lumbar flexion. There is also evidence that as people with chronic LBP improve, how they perform activities such as bending and lifting becomes faster with greater lumbar ROM in most cases [45].…”

Section: Aim 1 -Comparison Of Lifting Technique Between Lbp and Nolbp Groupsmentioning

confidence: 90%

Exploring lumbar and lower limb kinematics and kinetics for evidence that lifting technique is associated with LBP

Saraceni

Campbell

et al. 2021

PLoS ONE

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Purpose To investigate if lumbar and lower limb kinematics or kinetics are different between groups with and without a history of LBP during lifting. Secondly, to investigate relationships between biomechanical variables and pain ramp during repeated lifting. Methods 21 LBP and 20 noLBP participants completed a 100-lift task, where lumbar and lower limb kinematics and kinetics were measured during lifting, with a simultaneous report of LBP intensity every 10 lifts. Lifts were performed in a laboratory setting, limiting ecological validity. Results The LBP group used a different lifting technique to the noLBP group at the beginning of the task (slower and more squat-like). Kinetic differences at the beginning included less peak lumbar external anterior shear force and greater peak knee power demonstrated by the LBP group. However, at the end of the task, both groups lifted with a much more similar technique that could be classified as more stoop-like and faster. Peak knee power remained greater in the LBP group throughout and was the only kinetic difference between groups at the end of the lifting task. While both groups lifted using a more comparable technique at the end, the LBP group still demonstrated a tendency to perform a slower and more squat-like lift throughout the task. Only one of 21 variables (pelvic tilt at box lift-off), was associated with pain ramp in the LBP group. Conclusions: Workers with a history of LBP, lift with a style that is slower and more squat-like than workers without any history of LBP. Common assumptions that LBP is associated with lumbar kinematics or kinetics such as greater lumbar flexion or greater forces were not observed in this study, raising questions about the current paradigm around ‘safe lifting’.

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From protection to non‐protection: A mixed methods study investigating movement, posture and recovery from disabling low back pain

Wernli

Smith

Coll

et al. 2022

European Journal of Pain

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Background Movement and posture are commonly believed to relate to low back pain (LBP). Yet, we know little about how people make sense of the relationship between their LBP, movement and posture, particularly after recovery. We aimed to qualitatively explore this understanding, how it changes and how it relates to quantitative changes. Methods A mixed method study in the context of an existing single‐case design involving 12 people with disabling non‐specific LBP. Interviews were conducted before and after a 12‐week physiotherapy‐led Cognitive Functional Therapy intervention, and qualitative findings from these were integrated with individualized, quantitative measures of movement, posture, psychological factors, pain and activity limitation. Results Strong beliefs about movement and posture were identified during the baseline interviews. Lived experiences of tension and stiffness characterized the embodiment of ‘nonconscious protection’, while healthcare and societal messages prompted pain‐related fear and ‘conscious protection’. Through varied journeys, most participants reported improvements over time with less protective movement and postural strategies. For some, being less protective required focused attention (‘conscious non‐protection’), but most returned to automatic, normal and fearless patterns (‘nonconscious non‐protection’), forgetting about their LBP. One participant reported no meaningful shift, remaining protective. Greater spinal range, faster movement, more relaxed postures and less back muscle EMG accompanied positive changes in self‐report factors. Conclusion The findings offer a framework for understanding how people make sense of movement and posture during the process of recovery from persistent, disabling non‐specific LBP. This involved a re‐conceptualisation of movement and posture, from threatening, to therapeutic. Significance Findings from qualitative interviews before and after a Cognitive Functional Therapy intervention in 12 people with disabling low back pain highlighted an individualized recovery journey from conscious and nonconscious protection to conscious non‐protection for some, and nonconscious non‐protection for many. Pre and post‐quantitative measures of movement, posture, psychological factors, pain and activity limitation integrated well with the qualitative findings. The findings suggest movement and posture may form part of a multidimensional pain schema.

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Fear-avoidance beliefs are associated with reduced lumbar spine flexion during object lifting in pain-free adults

Abstract: Pain-related fear is associated with less lumbar flexion during lifting in pain-free adults, indicating a protective movement strategy in the absence of low back pain.

Cited by 28 publications

References 72 publications

Spatial distribution of erector spinae activity is related to task-specific pain-related fear during a repetitive object lifting task

Spatial distribution of erector spinae activity is related to task-specific pain-related fear during a repetitive object lifting task

Exploring lumbar and lower limb kinematics and kinetics for evidence that lifting technique is associated with LBP

From protection to non‐protection: A mixed methods study investigating movement, posture and recovery from disabling low back pain

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