The association of fear of movement and postural sway in people with low back pain

Abstract

BackgroundFear of movement is thought to interfere with the recovery from low back pain (LBP). To date, the relationship between fear of movement and postural balance has not been adequately elucidated. Recent findings suggest that more specific fears need to be assessed and put in relation to a specific movement task. We propose that the fear to bend the trunk in a certain direction is distinctly related to the amount of postural sway in different directions. Therefore, our aim was to investigate whether fear of movement in general and fear of bending the trunk in a certain plane is related to postural sway.MethodsData was collected from participants with LBP during two assessments ~3 weeks apart. Postural sway was measured with a force-platform during quiet standing with the eyes closed. Fear of movement was assessed with an abbreviated version of the Tampa Scale of Kinesiophobia (TSK-11) and custom items referring to fear of bending the trunk in the sagittal and the frontal plane.ResultsBased on data from 25 participants, fear of bending the trunk in the frontal plane was positively related to displacement in the sagittal and frontal plane and to velocity in the frontal plane (χ2 = 4.35, p = 0.04; χ2 = 8.15, p = 0.004; χ2 = 9.79, p = 0.002). Fear of bending the trunk in the sagittal plane was not associated with any direction specific measure of sway. A positive relation of the TSK-11 with velocity of the frontal plane (χ2 = 7.14, p = 0.008) was found, but no association with undirected measures of sway.DiscussionFear of bending the trunk in the frontal plane may be especially relevant to postural sway under the investigated stance conditions. It is possible that fear of bending the trunk in the frontal plane could interfere with balance control at the hip, shifting the weight from side to side to control balance.ConclusionFor the first time the directional relationship of fear of movement and postural sway was studied. Fear of bending the trunk in the frontal plane was positively associated with several measures of postural sway.

Association between functional disability with postural balance among patients with chronic low back pain

“…However, although there is a lack of evidence on the effect of pain-related anxiety and depression on postural balance, it is theoretically possible that anxiety and depression could affect postural balance ( 16 ). Furthermore, CLBP patients with high fear-avoidance beliefs were not only vigilant but also significantly restricted their range of motion during lumbar flexion and extension ( 18 ). Fear may also disrupt the automaticity of neural control pathways, leading to deficits in trunk motor control and increased trunk variability during maintaining balance, which may also increase the risk of LBP ( 33 ).…”

“…In addition, CLBP patients might modify their motor control strategies in an attempt to prevent further pain ( 16 , 17 ). Postural balance may be influenced by other factors, such as age, impaired proprioception, muscle strength, and coordination ( 16 , 18 ). As there is a lack of evidence on the effect of negative emotions on postural balance in those with CLBP ( 16 ), their relationships remain to be determined.…”

The association between pain-related psychological variables and postural control in low back pain: A systematic review and meta-analysis

“…Across the 16 included studies, the average age of the participants was 34.4 (±7.7) years [8,15,23,[50][51][52][53][54][55][56][57][58][59][60][61][62], the average body mass index was 25.5 (±3.0) kg/m² [15, 23, 53-57, 60, 61], and 60.3% (±12.6%) of the participants were female [8,15,23,50,51,[53][54][55][56][57][58][59][60][61]. The average intensity of LBP was 3.4 (±1.5) measured by the numeric rating scale (NRS) and visual analogue scale (VAS) (converted to a score on 10) [8,15,23,[50][51][52][53][54][55][56][57][58][59][60][61][62]. The average disability score was 18.4% (±4.5%) for the Oswestry Disability ...…”

“…Individuals with chronic, recurrent, and subacute LBP were included in respectively six [23, 50-52, 60, 62], three [54,56,61], and one [58] study. Six studies did not specify the patient population based on the duration of the LBP complaints [8,15,53,55,57,59]. [8,23,[50][51][52][53][57][58][59][60][61][62], and two studies [8,58].…”

The associations between lumbar proprioception and postural control during and after calf vibration in people with and without chronic low back pain

“…A review has concluded that poor proprioception was one of the main causes of decreased postural control in elderly patients with low back pain (Sakai et al, 2022). Recent studies also found that fear of movement (Meinke et al, 2022) and functional disability (Sun et al, 2023) were significantly correlated with postural sway in patients with CLBP. Thus, the negative relationship between postural sway and lumbar proprioception in healthy subjects may be explained as an exploratory role of postural sway for acquiring effective proprioceptive information to maintain standing balance, while the ability of postural sway as an exploratory role may be impaired in the CLBP group.…”