Kinesiophobia in Low Back Pain: Overcoming the Fear of Movement
Something that I have noticed in the clinic recently is patients with history of low back pain who become fearful of movement. This fear, known as kinesiophobia, can persist even after inflammation has subsided and the body has healed.
Why Does Kinesiophobia Occur?
Interestingly, even when pain and inflammation have reduced, and the body is moving well with improved range of motion, the brain can hold onto memories of the postures and movements that originally caused pain. As a result, even though these movements are no longer causing damage, the brain interprets them as pain-inducing. This can lead to a fear of movement and exercise, reinforcing a cycle of avoidance and stiffness.
The body thrives on movementou – our joints and muscles are designed for it! Research indicates that there is little correlation between kinesiophobia and pain intensity (John et al., 2023). This means that avoiding movement is not an effective strategy to reduce pain or prevent injury. Instead, larger predictors of kinesiophobia include gender, self-efficacy, and disability levels (John et al., 2023). Setting low exectations of what movements you can do or should avoid, can increase your likelihood of kinesiophobia.
How to Overcome Kinesophobia
I always encourage movement, but the question is – where should you start? The typical physiotherapy answer: it depends!
The key to reintroducing exercise and previously painful movements is graded exposure. This means gradually increasing activity levels instead of jumping straight into a high-intensity workout or hour-long strength session with exercises you haven’t done in months. A physiotherapist can help you create a graded exercise program tailored to your needs and guide you through safe progressions over time (John et al., 2023).
Practical Tips for Moving Again
- Love walking? Keep walking! Walking is an excellent low-impact cardiovascular exercise that promotes gentle spinal rotation, which can be beneficial for lower back pain.
- Modify as needed. If back pain starts after 30 minutes of walking, try walking for 20 minutes instead and gradually build up your endurance.
- Weight lifting and strength training. The hip flexion position of squatting can be triggering for those who have had lower back pain. This can be a scary movement to get back to. However, strength training is one of the most beneficial treatments for both the recovery and prevention of lower back pain. A good starting point is reducing the range of motion and using body weight to get familiar with the movement again, such as bodyweight squats and lunges. Avoid deep bends initially—just focus on moving and feeling comfortable with the motion. As confidence and comfort improve, gradually progress to deeper ranges of motion and adding weights. It is best to consult your physiotherapist to he;p guide your re-introduction into strength training.
- Start with core strengthening. You can begin with McGill’s Big Three exercises to help strengthen the core, the Bird Dog, Core Sit and Side Plank. For more details, check out Andrew’s great blog explaining this approach: What You Need to Know About Lower Back Pain – Part 4.
- Deep breathing exercises and relaxation. Pain catastrophizing and stress can
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both play into low back pain. There is some evidence that deep breathing exercises and relaxation can help in reducing lower back pain (Tedeschi, 2024). A study found that combining deep breathing with physiotherapy led to better outcomes, so why not add it in? Breathing exercises are free, simple, and a great way to introduce calm into our busy lives. A great place to start is box breathing:
- Visualize a box and let your breaths in and out trace the edges.
- Breathe in for 4 seconds (tracing up one side of the box).
- Hold for 4 seconds (tracing along the top of the box).
- Exhale for 4 seconds (tracing down the other side of the box).
- Hold for 4 seconds (tracing along the bottom of the box).
- Repeat for a few cycles to feel more relaxed.
- If you’re not a visual person, simply follow the 4-4-4-4 pattern: inhale, hold, exhale, hold.
- Another option is belly breathing – allow your belly to expand like a balloon as you breathe in, and relax as you slowly exhale.
- The specific breathing technique doesn’t matter as much as simply being mindful of your breath – this is an excellent relaxation technique to incorporate into daily life.
- Seek professional guidance. If you’re unsure why certain movements still trigger discomfort, book in with your physiotherapist to assess and guide you through a personalized recovery plan.
By incorporating movement into your routine in a controlled and progressive way, you can help rewire your brain’s response to movement, reduce fear, and regain confidence in your body’s ability to move freely.
Reference:
John, J. N., Ugwu, E. C., Okezue, O. C., Ekechukwu, E. N. D., Mgbeojedo, U. G., John, D. O., & Ezeukwu, A. O. (2023). Kinesiophobia and associated factors among patients with chronic non-specific low back pain. Disability and Rehabilitation, 45(16), 2651–2659. https://doi.org/10.1080/09638288.2022.2103747
Shi, J., Liu, Z., Zhou, X., Jin, F., Chen, X., Wang, X., & Lv, L. (2023). Effects of breathing exercises on low back pain in clinical: A systematic review and meta-analysis. Complementary Therapies in Medicine, 79, 102993–102993. https://doi.org/10.1016/j.ctim.2023.102993
Tedeschi, R. (2024). Mindful Breathing as an Adjunctive Approach to Chronic Low Back Pain Management: A Scoping Review. Pain Management Nursing, 25(5), 436–441. https://doi.org/10.1016/j.pmn.2024.04.011
