Fear avoidance beliefs limit lumbar spine flexion during object lifting in pain-free adults

AbstractThere is a long-held belief that physical activities such as lifting with a flexed spine is generally harmful for the back and can cause low back pain (LBP), potentially nurturing fear avoidance beliefs underlying pain-related fear. In chronic LBP patients, pain-related fear has been shown to be associated with reduced lumbar range of motion during lifting, indicating distinct and probably protective psychomotor responses to pain. However, despite short term beneficial effects for tissue health, recent evidence suggests that maintaining a protective trunk movement strategy may also pose a risk for (persistent) LBP due to possible pro-nociceptive consequences of altered spinal kinematics, reflected by increased loading on lumbar tissues and persistent muscle tension. Yet, it is unknown if similar psychomotor interactions already exist in pain-free individuals which would yield potential insights into how a person might react when they experience LBP. Therefore, the aim of this study is to test the impact of pain-related fear on spinal kinematics in a healthy cohort of pain-free adults without a history of chronic pain. The study subjects (N=57) filled out several pain-related fear questionnaires and were asked to perform a lifting task (5kg-box). High-resolution spinal kinematics were assessed using an optical motion capturing system. Time-sensitive analyses were performed based on statistical parametric mapping. The results demonstrated time-specific and negative relationships between self-report measures of pain-related fear and lumbar spine flexion angles during lifting, yielding important implications regarding unfavorable psychomotor interactions that might become relevant in a future LBP incident.

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Using Massage to Combat Fear-Avoidance and the Pain Tension Cycle

International Journal of Athletic Therapy & Training ◽

10.1123/ijatt.2018-0097 ◽

2019 ◽

Vol 24 (5) ◽

pp. 198-201

Author(s):

Emily R. Hunt ◽

Shelby E. Baez ◽

Anne D. Olson ◽

Timothy A. Butterfield ◽

Esther Dupont-Versteegden

Keyword(s):

Inflammatory Process ◽

Muscle Tension ◽

Cellular Level ◽

Therapeutic Modality ◽

Muscle Dysfunction ◽

Clinical Settings ◽

Fear Avoidance ◽

Fear Avoidance Beliefs ◽

Beneficial Effects ◽

Fear Avoidance Model

Massage is a common therapeutic modality utilized by clinicians in a variety of settings to help treat injuries, reduce pain, and return function to patients. Massage benefits the patients both psychologically and physiologically, as patients report less pain and anxiety along with better mood and even decreased blood pressure following massage. Additionally, on the cellular level, massage has the ability to modulate the damaging inflammatory process and, in some cases, influence protein synthesis. Although massage has not been linked to a rehabilitation theory to date, this paper will propose how massage may influence fear-avoidance beliefs, or the patient’s inability to cope with pain that then leads to a pain tension cycle. Pain will often result in use avoidance, which creates muscle tension that further exacerbates the pain. Massage can affect the Fear-Avoidance Model because the beneficial effects of massage can break the cycle by either relieving the patient’s pain or eliminating the muscle tension. A modified Fear-Avoidance Model is presented that conceptualizes how pain and fear-avoidance lead to tension and muscle dysfunction. Massage has been incorporated into the model to demonstrate its potential for breaking the pain tension cycle. This model has the potential to be applied in clinical settings and provides an alternate treatment to patients with chronic pain who present with increased levels of fear-avoidance beliefs.

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Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2011.3534 ◽

2011 ◽

Vol 41 (5) ◽

pp. 336-345 ◽

Cited By ~ 22

Author(s):

Dennis L. Hart ◽

Mark W. Werneke ◽

Daniel Deutscher ◽

Steven Z. George ◽

Paul W. Stratford

Keyword(s):

Lumbar Spine ◽

Functional Status ◽

Physical Activities ◽

Fear Avoidance ◽

Fear Avoidance Beliefs

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Accept Anxiety to Improve Sleep: The Impact of the COVID-19 Lockdown on the Relationships between Mindfulness, Distress and Sleep Quality

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182413149 ◽

2021 ◽

Vol 18 (24) ◽

pp. 13149

Author(s):

Marco Mirolli ◽

Luca Simione ◽

Monica Martoni ◽

Marco Fabbri

Keyword(s):

Sleep Quality ◽

Sleep Problems ◽

Self Report ◽

Dispositional Mindfulness ◽

Beneficial Effects ◽

Mediating Role ◽

Leading Role ◽

Improve Sleep Quality ◽

The Impact

It has been recently proposed that mindfulness can improve sleep quality through the mediating role on psychological distress and that acceptance may play a pivotal role in mindfulness beneficial effects. The aim of the present work was to understand the effects of the COVID-19 lockdown on dispositional mindfulness, sleep, and distress, and on their relationships. In particular, we wanted to test the hypothesis that the detrimental effects of lockdown on sleep depended on mindfulness and distress (including anxiety and depression) and that the acceptance facet of mindfulness played the leading role. A longitudinal study based on self-report questionnaires was conducted on 39 Italian adults (M age = 35.03, SD = 14.02; 21 men) assessing mindfulness, distress, and sleep quality before (23 December 2019–8 March 2020) and during (27 April 2020–10 May 2020) the first Italian COVID-19 lockdown. Lockdown decreased mindfulness while increasing distress and sleep problems. Path analysis showed that the effects of lockdown on sleep were fully mediated by mindfulness and distress. Furthermore, a more detailed analysis showed that these effects were mainly dependent on the acceptance component of mindfulness working through anxiety. The present study confirms, in the context of the COVID-19 lockdown, a model according to which mindfulness, and specifically acceptance, influences sleep through the mediating role of distress.

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