The relationship between pain-related fear and lumbar flexion during natural recovery from low back pain

Abstract

Pain-related fear has been associated with avoidance behavior and increased risk for chronic low back pain; however, few studies have examined how pain-related fear relates specifically to motion of the spine following an acute episode of back pain. Thirty-six participants with a recent episode of low back pain were recruited from the general population using a combination of fliers and radio advertisements. To explore the natural recovery from low back pain we recruited individuals who were not seeking medical care. Participants performed a forward bending task at 3, 6, and 12 weeks following onset of low back pain. Three-dimensional joint motions of the spine and hip were recorded using an electromagnetic tracking device. Initial assessments of low back pain and pain-related fear were then correlated with joint excursions observed during each forward bending. Lumbar motion was inversely related to pain-related fear, but not low back pain, at all three testing sessions. In contrast, hip motion was inversely related to pain at all three testing sessions but was not related to fear. These findings suggest that pain-related fear results in avoidance behavior that specifically limits or restricts motion of the lumbar spine.

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

“…Degenerative changes of end-stage arthritis in the hip and spine can significantly alter body kinematics and therefore lumbar-pelvic-femoral alignment [24,36,42]. There is evidence that lumbar-pelvic-femoral mobility affects the risk of dislocation after THA, with a case report of late posterior hip dislocation after lumbar spinopelvic fusion [33].…”

The efficacy of surface electromyographic biofeedback assisted stretching for the treatment of chronic low back pain: A case-series

“…A large variety of factors, other than objective pathology and the musculoskeletal system may be involved in non-specific back pain. It is consistently reported in the literature that psychological and social factors influence the experience and course of back pain (Linton, Buer, Vlaeyen, & Hellsing, 2000;Thomas & France, 2008;Vlaeyen, Kole-Snijders, Boeren, & van Eek, 1995;Waddell et al, 1993). In some patients, psychosocial factors, fear, and catastrophising play central roles in their pain presentation (Saner, Kool, De Bie, Sieben, & Luomajoki, 2011).…”

“…The fear-avoidance model of chronic pain suggests the development of a cycle of decreased physical activity and an increase in pain perception (Slade et al, 1983). According to this model, those who perceive pain as a potential sign of tissue damage, are more inclined to avoid movements or behaviours, thus prolonging return to normal activities and delaying recovery (Linton et al, 2000;Thomas & France, 2008;Trost, France, Sullivan, & Thomas, 2012).…”

“…Strong evidence indicates that chronic LBP is associated with a reduction in range of motion (ROM) (Hansen et al, 1955;Thomas & France, 2008;. Impaired range of motion (ROM) is associated with high fear of pain and is potentially due to heightened resting potentials of the paraspinal muscles and neuromuscular spasm (Arena, Sherman, Bruno, & Young, 1991;Geisser et al, 2005).…”

“…Reduced lumbar ROM therefore does not fully explain absent FR, as even individuals with chronic LBP have been shown to flex past the angle at which FR commonly occurs in asymptomatic individuals Thomas & France, 2008). Although some authors report that FR will typically occur at a point after 70 degrees of trunk flexion Wolf, Basmajian, Russe, & Kutner, 1979), more recent studies indicate that the required angle is more likely based on individual flexibility than a mechanically pre-determined angle (Shin, Shu, Li, Jiang, & Mirka, 2004).…”