Skip to main content
SpringerLink
Log in

Association of pain-related threat beliefs and disability with postural control and trunk motion in individuals with low back pain: a systematic review and meta-analysis

  • Review Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Low back pain (LBP) individuals with high levels of fear of pain might display changes in motor behavior, which leads to disability. This study aimed to systematically review the influence of pain-related threat beliefs or disability on trunk kinematic or postural control in LBP.

Method

Eight electronic databases were searched from January 1990 to July 1, 2020. Meta-analysis using random-effect model was performed for 18 studies on the association between pain-related threat beliefs or disability and lumbar range of motion. Pearson r correlations were used as the effect size.

Result

Negative correlations were observed between lumbar range of motion (ROM) and pain-related threat beliefs (r = − 0.31, p < 0.01, 95% CI: − 0.39, − 0.24) and disability (r =  − 0.24, p < 0.01, 95% CI: − 0.40, − 0.21). Nonsignificant correlations were reported between pain-related threat beliefs and center of pressure parameters during static standing in 75% of the studies. In 33% of the studies, moderate negative correlations between disability and postural control were observed.

Conclusion

Motor behaviors are influenced by several factors, and therefore, the relatively weak associations observed between reduced lumbar ROM with higher pain-related threat beliefs and perceived disability, and postural control with disability are to be expected. This could aid clinicians in the assessment and planning rehabilitation interventions.

Level of Evidence I

Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Katz JNJJ (2006) Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. JBJS 88:21–24

    Google Scholar 

  2. Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, Castel LD, Kalsbeek Carey WDTS (2009) The rising prevalence of chronic low back pain. Arch Intern Med 169:251–258

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hong J, Reed C, Novick D, Happich MJS (2013) Costs associated with treatment of chronic low back pain: an analysis of the UK general practice research database. Spine 38:75–82

    Article  PubMed  Google Scholar 

  4. Vlaeyen JW, Linton SJ (2000) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85:317–332

    Article  PubMed  Google Scholar 

  5. Karos K, Meulders A, Gatzounis R, Seelen HA, Geers RP, Vlaeyen JW (2017) Fear of pain changes movement: motor behaviour following the acquisition of pain-related fear. Eur J Pain 21:1432–1442

    Article  CAS  PubMed  Google Scholar 

  6. Vlaeyen JW, Linton SJ (2012) Fear-avoidance model of chronic musculoskeletal pain 12 years on. Plain 153:1144–1147

    Google Scholar 

  7. MacDonald D, Moseley GL, Hodges PW (2009) Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain. Pain 142(3):183–188

    Article  PubMed  Google Scholar 

  8. Hodges PW (2011) Pain and motor control: from the laboratory to rehabilitation. J Electromyogr Kinesiol 21:220–228

    Article  PubMed  Google Scholar 

  9. Meulders AJ (2019) From fear of movement-related pain and avoidance to chronic pain disability: a state-of-the-art review. Curr Opin Behev Sci 26:130–136

    Article  Google Scholar 

  10. Tang NK, Salkovskis PM, Poplavskaya E, Wright KJ, Hanna M, Hester J (2007) Increased use of safety-seeking behaviors in chronic back pain patients with high health anxiety. J Behav Res Ther 45:2821–2835

    Article  Google Scholar 

  11. Nishi Y, Osumi M, Nobusako S, Takeda K, Morioka S (2019) Avoidance behavioral difference in acquisition and extinction of pain-related Fear. J Front Behav Neurosci 13:236

    Article  Google Scholar 

  12. Vlaeyen JW, Kole-Snijders AM, Boeren RG, Van Eek H (1995) Fear of movement/(re) injury in chronic low back pain and its relation to behavioral performance. J Pain Res 62:363–372

    Google Scholar 

  13. Palmieri RM, Ingersoll CD, Stone MB, Krause BA (2002) Center-of-pressure parameters used in the assessment of postural control. J Sport Rehabil 11:51–66

    Article  Google Scholar 

  14. Davis DS, Mancinelli CA, Petronis JJ, Bensenhaver C, McClintic T, Nelson G (2013) Variables associated with level of disability in working individuals with nonacute low back pain: a cross-sectional investigation. J Orthop Sports Phys Ther 43:97–104. https://doi.org/10.2519/jospt.2013.4382

    Article  PubMed  Google Scholar 

  15. Brech GC, Andrusaitis SF, Vitale GF, Greve JM (2012) Correlation of disability and pain with postural balance among women with chronic low back pain. Clinics 67:959–962

    Article  PubMed  PubMed Central  Google Scholar 

  16. Trost Z, France CR, Sullivan MJ, Thomas JS (2012) Pain-related fear predicts reduced spinal motion following experimental back injury. J Pain® 153:1015–1021

    Article  Google Scholar 

  17. van der Hulst M, Vollenbroek-Hutten MM, Rietman JS, Schaake L, Groothuis-Oudshoorn KG, Hermens H (2010) Back muscle activation patterns in chronic low back pain during walking: a “guarding” hypothesis. Clin J Pain 26:30–37

    Article  PubMed  Google Scholar 

  18. Mazaheri M, Heidari E, Mostamand J, Negahban H, van Dieen JH (2014) Competing effects of pain and fear of pain on postural control in low back pain? Spine 39:E1518-1523. https://doi.org/10.1097/brs.0000000000000605

    Article  PubMed  Google Scholar 

  19. Al-Obaidi SM, Nelson RM, Al-Awadhi S, Al-Shuwaie N (2000) The role of anticipation and fear of pain in the persistence of avoidance behavior in patients with chronic low back pain. Spine 25:1126–1131

    Article  CAS  PubMed  Google Scholar 

  20. Geisser ME, Haig AJ, Wallbom AS, Wiggert EA (2004) Pain-related fear, lumbar flexion, and dynamic EMG among persons with chronic musculoskeletal low back pain. Clin J Pain 20:61–69

    Article  PubMed  Google Scholar 

  21. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. https://doi.org/10.1136/bmj.b2700

    Article  PubMed  PubMed Central  Google Scholar 

  22. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283:2008–2012. https://doi.org/10.1001/jama.283.15.2008

    Article  CAS  PubMed  Google Scholar 

  23. Nicholas M, Vlaeyen JW, Rief W, Barke A, Aziz Q, Benoliel R, Cohen M, Evers S, Giamberardino MA, Goebel A (2019) The IASP classification of chronic pain for ICD-11: chronic primary pain. J Pain Res 160:28–37

    Google Scholar 

  24. Hootman JM, Driban JB, Sitler MR, Harris KP, Cattano NM (2011) Reliability and validity of three quality rating instruments for systematic reviews of observational studies. Res Synth Methods 2:110–118. https://doi.org/10.1002/jrsm.41

    Article  PubMed  Google Scholar 

  25. Katrak P, Bialocerkowski AE, Massy-Westropp N, Kumar VS, Grimmer KA (2004) A systematic review of the content of critical appraisal tools. BMC Med Res Methodol 4:1–11

    Article  Google Scholar 

  26. Rosenthal R, Rosnow RL (2000) Rubin DB Contrasts and effect sizes in behavioral research: a correlational approach. Cambridge University Press

    Google Scholar 

  27. Higgins JP, Thompson SG, Deeks JJ, Altman DGJB (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  28. Cohen J (2013) Statistical power analysis for the behavioral sciences. Routledge

    Book  Google Scholar 

  29. Thomas JS, France CR (2007) Pain-related fear is associated with avoidance of spinal motion during recovery from low back pain. Spine 32:E460-466. https://doi.org/10.1097/BRS.0b013e3180bc1f7

    Article  PubMed  Google Scholar 

  30. Thomas JS, France CR (2008) The relationship between pain-related fear and lumbar flexion during natural recovery from low back pain. Eur Spine J 17:97–103. https://doi.org/10.1007/s00586-007-0532-6

    Article  PubMed  Google Scholar 

  31. Thomas JS, France CR, Lavender SA, Johnson MR (2008) Effects of fear of movement on spine velocity and acceleration after recovery from low back pain. Spine 33:564–570. https://doi.org/10.1097/BRS.0b013e3181657f1a

    Article  PubMed  Google Scholar 

  32. Jette NG, Lim YL, Lim HL, Mokhtar SA, Gan KB, Singh DK (2016) Lumbar kinematics, functional disability and fear avoidance beliefs among adults with nonspecific chronic low back pain. Sultan Qaboos Univ Med J 16:e430–e436. https://doi.org/10.18295/squmj.2016.16.04.005

    Article  PubMed  PubMed Central  Google Scholar 

  33. Matheve T, De Baets L, Bogaerts K, Timmermans A (2019) Lumbar range of motion in chronic low back pain is predicted by task-specific, but not by general measures of pain-related fear. Eur J Pain. https://doi.org/10.1002/ejp.1384

    Article  PubMed  Google Scholar 

  34. La Touche R, Grande-Alonso M, Arnes-Prieto P, Paris-Alemany A (2019) How does self-efficacy influence pain perception, postural stability and range of motion in individuals with chronic low back pain? Pain Phys 22:E1-e13

    Article  Google Scholar 

  35. Nordstoga AL, Meisingset I, Vasseljen O, Nilsen TIL, Unsgaard-Tondel M (2019) Longitudinal associations of kinematics and fear-avoidance beliefs with disability, work ability and pain intensity in persons with low back pain. Musculoskelet Sci Pract 41:49–54. https://doi.org/10.1016/j.msksp.2019.03.008

    Article  PubMed  Google Scholar 

  36. La Touche R, Perez-Fernandez M, Barrera-Marchessi I, Lopez-de-Uralde-Villanueva I, Villafane JH, Prieto-Aldana M, Suso-Marti L, Paris-Alemany A (2018) Psychological and physical factors related to disability in chronic low back pain. J Back Musculoskelet Rehabil. https://doi.org/10.3233/bmr-181269

    Article  Google Scholar 

  37. Waddell G, Somerville D, Henderson I, Newton M (1992) Objective clinical evaluation of physical impairment in chronic low back pain. Spine 17:617–628

    Article  CAS  PubMed  Google Scholar 

  38. Rainville J, Sobel JB, Hartigan C (1994) Comparison of total lumbosacral flexion and true lumbar flexion measured by a dual inclinometer technique. Spine 19:2698–2701

    Article  CAS  PubMed  Google Scholar 

  39. Kang SW, Lee WN, Moon JH, Chun SI (1995) Correlation of spinal mobility with the severity of chronic lower back pain. Yonsei Med J 36:37–44. https://doi.org/10.3349/ymj.1995.36.1.37

    Article  CAS  PubMed  Google Scholar 

  40. Nattrass CL, Nitschke JE, Disler PB, Chou MJ, Ooi KT (1999) Lumbar spine range of motion as a measure of physical and functional impairment: an investigation of validity. Clin Rehabil 13:211–218. https://doi.org/10.1177/026921559901300305

    Article  CAS  PubMed  Google Scholar 

  41. Parks KA, Crichton KS, Goldford RJ, McGill SM (2003) A comparison of lumbar range of motion and functional ability scores in patients with low back pain: assessment for range of motion validity. Spine 28:380–384. https://doi.org/10.1097/01.brs.0000048466.78077.a6

    Article  CAS  PubMed  Google Scholar 

  42. Atya AM (2013) The validity of spinal mobility for prediction of functional disability in male patients with low back pain. J Adv Res 4:43–49. https://doi.org/10.1016/j.jare.2012.01.002

    Article  PubMed  Google Scholar 

  43. Pranata A, Perraton L, El-Ansary D, Clark R, Mentiplay B, Fortin K, Long B, Brandham R, Bryant AL (2018) Trunk and lower limb coordination during lifting in people with and without chronic low back pain. J Biomech 71:257–263. https://doi.org/10.1016/j.jbiomech.2018.02.016

    Article  CAS  PubMed  Google Scholar 

  44. Sung PS (2013) A compensation of angular displacements of the hip joints and lumbosacral spine between subjects with and without idiopathic low back pain during squatting. J Electromyogr Kinesiol 23:741–745. https://doi.org/10.1016/j.jelekin.2013.02.003

    Article  PubMed  Google Scholar 

  45. Marich AV, Hwang CT, Salsich GB, Lang CE, Van Dillen LR (2017) Consistency of a lumbar movement pattern across functional activities in people with low back pain. Clin Biomech (Bristol, Avon) 44:45–51. https://doi.org/10.1016/j.clinbiomech.2017.03.004

    Article  Google Scholar 

  46. Poitras S, Loisel P, Prince F, Lemaire J (2000) Disability measurement in persons with back pain: a validity study of spinal range of motion and velocity. Arch Phys Med Rehabil 81:1394–1400. https://doi.org/10.1053/apmr.2000.9165

    Article  CAS  PubMed  Google Scholar 

  47. Maribo T, Schiottz-Christensen B, Jensen LD, Andersen NT, Stengaard-Pedersen K (2012) Postural balance in low back pain patients: criterion-related validity of centre of pressure assessed on a portable force platform. Eur Spine J 21:425–431. https://doi.org/10.1007/s00586-011-1981-5

    Article  PubMed  Google Scholar 

  48. Champagne A, Prince F, Bouffard V, Lafond D (2012) Balance, falls-related self-efficacy, and psychological factors amongst older women with chronic low back pain: a preliminary case-control study. Rehabil Res Pract 2012:430374. https://doi.org/10.1155/2012/430374

    Article  PubMed  PubMed Central  Google Scholar 

  49. Sung W, Abraham M, Plastaras C, Silfies SP (2015) Trunk motor control deficits in acute and subacute low back pain are not associated with pain or fear of movement. Spine J 15:1772–1782. https://doi.org/10.1016/j.spinee.2015.04.010

    Article  PubMed  PubMed Central  Google Scholar 

  50. Shanbehzadeh S, Salavati M, Talebian S, Khademi-Kalantari K, Tavahomi M (2018) Attention demands of postural control in non-specific chronic low back pain subjects with low and high pain-related anxiety. Exp Brain Res 236:1927–1938. https://doi.org/10.1007/s00221-018-5267-6

    Article  PubMed  Google Scholar 

  51. Ozcan Kahraman B, Kahraman T, Kalemci O, Salik Sengul Y (2018) Gender differences in postural control in people with nonspecific chronic low back pain. Gait Posture 64:147–151. https://doi.org/10.1016/j.gaitpost.2018.06.026

    Article  PubMed  Google Scholar 

  52. Turk DCJRA, Medicine P (2003) Cognitive-behavioral approach to the treatment of chronic pain patients. Reg Anesth Pain Med 28:573–579

    Article  PubMed  Google Scholar 

  53. Gatzounis R, Van Vliet C, Meulders A (2021) Will that hurt? A contingency learning task to assess pain-expectancy judgments for low back postures. J Behav Ther Exper Psychiatr 70:101622

    Article  Google Scholar 

  54. Harvie DS, Moseley GL, Hillier SL, Meulders A (2017) Classical conditioning differences associated with chronic pain: a systematic review. J Pain 18:889–898

    Article  PubMed  Google Scholar 

  55. Meulders A (2020) Fear in the context of pain: lessons learned from 100 years of fear conditioning research. Behav Res Therapy 131:103635

    Article  Google Scholar 

  56. Bible JE, Biswas D, Miller CP, Whang PG, Grauer JN (2010) Normal functional range of motion of the lumbar spine during 15 activities of daily living. Clin Spine Surg 23:106–112

    Google Scholar 

  57. Fairbank J, Couper J, Davies J, O’brien J (1980) The Oswestry low back pain disability questionnaire. J Physiother 66:271–273

    CAS  Google Scholar 

  58. Sadler SG, Spink MJ, Ho A, De Jonge XJ, Chuter VH (2017) Restriction in lateral bending range of motion, lumbar lordosis, and hamstring flexibility predicts the development of low back pain: a systematic review of prospective cohort studies. J BMC Musculoskelet Disord 18:179

    Article  Google Scholar 

  59. Cobian DG, Daehn NS, Anderson PA, Heiderscheit BC (2013) Active cervical and lumbar range of motion during performance of activities of daily living in healthy young adults. J Spine 38:1754–1763

    Article  Google Scholar 

  60. Bland JM, Altman DG (2011) Correlation in restricted ranges of data. J BMJ 342:d556

    Article  Google Scholar 

  61. Reynolds RF (2010) The ability to voluntarily control sway reflects the difficulty of the standing task. Gait Posture 31:78–81

    Article  PubMed  Google Scholar 

  62. Zok M, Mazzà C, Cappozzo A (2008) Should the instructions issued to the subject in traditional static posturography be standardised? Med Eng Phys 30:913–916

    Article  CAS  PubMed  Google Scholar 

  63. Wulf G (2007) Attentional focus and motor learning: a review of 10 years of research. 4

  64. Bonnet CT (2016) Advantages and disadvantages of stiffness instructions when studying postural control. Gait Posture 46:208–210

    Article  PubMed  Google Scholar 

  65. Salavati M, Hadian MR, Mazaheri M, Negahban H, Ebrahimi I, Talebian S, Jafari AH, Sanjari MA, Sohani SM, Parnianpour M (2009) Test–retest reliabty of center of pressure measures of postural stability during quiet standing in a group with musculoskeletal disorders consisting of low back pain, anterior cruciate ligament injury and functional ankle instability. Gait Posture 29:460–464

    Article  PubMed  Google Scholar 

  66. Mohammadi F, Salavati M, Akhbari B, Mazaheri M, Khorrami M, Negahban H (2012) Static and dynamic postural control in competitive athletes after anterior cruciate ligament reconstruction and controls. Knee Surg Sports Traumatol Arthrosc 20:1603–1610

    Article  PubMed  Google Scholar 

  67. Bosco FA, Aguinis H, Singh K, Field JG, Pierce CA (2015) Correlational effect size benchmarks. J Appl Psychol 100:431

    Article  PubMed  Google Scholar 

  68. Gignac GE, Szodorai ET (2016) Effect size guidelines for individual differences researchers. Personal Individ Differ 102:74–78

    Article  Google Scholar 

  69. Hemphill JF (2003) Interpreting the magnitudes of correlation coefficients

  70. Wrase J, Kahnt T, Schlagenhauf F, Beck A, Cohen MX, Knutson B, Heinz AJN (2007) Different neural systems adjust motor behavior in response to reward and punishment. Neuroimage 36:1253–1262

    Article  PubMed  Google Scholar 

  71. Lewthwaite R, Wulf G (2010) Grand challenge for movement science and sport psychology: embracing the social-cognitive–affective–motor nature of motor behaviour. Front Psychol 1:42

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was supported by Iran University of Medical Sciences (984-99-16690), Iran, and JWSV is supported by the Asthenes research program “From Acute Aversive Sensations to Chronic Bodily Symptoms,” a long-term structural Methusalem funding (METH/15/011) by the Flemish government, Belgium.

Author information

Authors and Affiliations

  1. Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran

    Sanaz Shanbehzadeh, Shabnam ShahAli & Isamael Ebrahimi Takamjani

  2. KU Leuven - University of Leuven, Health Psychology Research Group, Leuven, Belgium

    Johan W. S. Vlaeyen & Hassan Jafari

  3. Experimental Health Psychology, Maastricht University, Maastricht, Netherlands

    Johan W. S. Vlaeyen

  4. Rehabilitation Research Center, Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran

    Reza Salehi

  5. Department of Biostatistics and Health Informatics, Institute of Psychology Psychiatry and Neuroscience, King’s College London, London, United Kingdom

    Hassan Jafari

Authors
  1. Sanaz Shanbehzadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shabnam ShahAli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Isamael Ebrahimi Takamjani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Johan W. S. Vlaeyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Reza Salehi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hassan Jafari
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SS, SSA and IET conceived, planned and designed the study. SS and SSA searched databases, screened title/abstract and full text and extracted the data. SSA and RS contributed to risk of bias assessment. HJ, SS and RS contributed to data analysis. SS, SSA, IET, HJ and JWSV contributed to the interpretation of the results and drafted the article. JWSV, SS, RS and HJ provided critical feedback and revised and provided the final version of the manuscript, and all authors have approved the final version.

Corresponding author

Correspondence to Shabnam ShahAli.

Ethics declarations

Conflicts of interest

The authors have no competing interests to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 12 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shanbehzadeh, S., ShahAli, S., Ebrahimi Takamjani, I. et al. Association of pain-related threat beliefs and disability with postural control and trunk motion in individuals with low back pain: a systematic review and meta-analysis. Eur Spine J 31, 1802–1820 (2022). https://doi.org/10.1007/s00586-022-07261-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-022-07261-4

Keywords

Search

Navigation