Fear of Pain Alters Movement in Chronic Low Back Pain
Movement scientist Meta Wildenbeest examines in her doctoral research how fear of pain affects movement patterns. She concludes that there is a link between fear of pain and altered movement in people with low back pain.
People with chronic low back pain move differently than those without pain. “We don’t know why this happens or how best to treat these patients,” says Meta Wildenbeest. “We suspect that fear leads to altered movement, aiming for more control—for instance, by moving with increased stiffness. This is referred to in English as guarded movement.”
This strategy can be helpful when injured, but maintaining this movement pattern over the long term might have adverse effects, as it increases stress on the spine and muscles. Therefore, Wildenbeest investigated the relationship between “fear of pain” and movement in people with and without low back pain.
Wildenbeest, a Mensendieck therapist and movement scientist, has been a lecturer at Utrecht University of Applied Sciences (HU) in the Institute for Human Movement Studies since 2004. In 2018, she received a Doctoral Grant for Teachers from the Dutch Research Council (NWO) to conduct her research at Vrije Universiteit Amsterdam.
Wildenbeest found a link between fear of pain and altered movement patterns in people with low back pain but not in those without pain. She also identified two effects of guarded movement:
- Increased resistance to sudden movements, which may be advantageous in the acute phase of injury to protect damaged tissue.
- Decreased movement precision, which could be disadvantageous, possibly contributing to a sense of uncertainty about spinal movement.
Both phenomena occurred in the same group of individuals with low back pain.
The increased resistance is beneficial for acute injuries, but in later stages, after tissue recovery, it may be necessary to normalize movement to reduce stress on the spine and muscles. The reduced precision, however, could be problematic, as it may lead to insecurity in movement.
Wildenbeest conducted experiments in the movement lab at Utrecht University of Applied Sciences. Sixty participants, with and without low back pain, performed identical movement tasks under various conditions.
Participants were exposed to scenarios that threatened their balance to observe the effects on spinal movement. Reflective markers placed on participants’ backs allowed specialized cameras to record and analyze movement patterns. Additionally, participants’ fear of pain was assessed using two standard questionnaires and a task-specific question: “How burdensome do you think this task will be for your back?” Only the task-specific question correlated with altered movement.
“The Dutch Healthcare Authority recently concluded that exercise and physical therapy for low back pain are not effective, which is why this care is no longer reimbursed under basic health insurance,” says Wildenbeest. “A significant reason for this limited effectiveness is that we don’t know what causes persistent low back pain. Research into underlying mechanisms is needed.”
This study is a first step in addressing that gap. Wildenbeest adds, “We now have a clearer understanding of what guarded movement looks like, how it is triggered, and how to measure it. The next crucial step is investigating whether this contributes to chronic pain.”
More information on the thesis
