Original Editor - Jasrah Javed

Top Contributors - Jasrah Javed, Kim Jackson and Olajumoke Ogunleye  

Introduction[edit | edit source]

Kinesiophobia is defined as an excessive irrational and debilitating fear of movement or physical activity. The fear of motion is associated with a feeling of vulnerability to injury in response to movement. The advancement of acute pain to persistent and chronic pain occurs as a result of decreased use of the painful area due to fear of increase in pain as a result of movement.[1]

Kinesiophobia includes three components[2]:

  • Threatening stimulus
  • Increased Sympathetic Arousal
  • Defensive behavior

Mechanism of acquiring kinesiophobia[edit | edit source]

Two major events are expected to develop kinesiophobia.[3]

  1. Past experience of pain or trauma: Having a painful experience in past associated with pain followed by a specific activity
  2. Social learning and observation: developing a thinking of movement related pain by observing others having a painful experience.

Role of Kinesiophobia in various conditions[edit | edit source]

  • Older Adults: The effects of inactivity and disuse in older population can be substantial, increasing the likelihood of a variety of health issues, functional impairment, and early mortality[4]. At the outset, kinesiophobia in older adults is linked to high pain intensity and poor self-perception of health[5]. Kinesiophobia is identified in high concentrations among older individuals in care facilities, regardless of gender[6].
  • Cardiovascular conditions: A cardiovascular disease may be terrifying and painful, and it can become an existential threat that changes patients' goals and perspectives in life[7]. Depression, aggression, and social isolation are found to be frequent in people with coronary artery disease[8]. Anxiety symptoms are present in up to 40% of these individuals having a cardiovascular disease[9]. Following an acute coronary event, numerous individuals with cardiac illness have shown to be afraid of physical activity and exercise[10]. Fear and related avoidance behaviors are common psychological reactions in the aftermath of an acute myocardial infarction. Patients who are unable to manage with their fear are susceptible to develop kinesiophobia. According to the underlying theoretical paradigm, fear of movement combined with catastrophizing behavior results in maladaptive avoidance behavior, resulting in unfavorable health outcomes such as physical inactivity, disability, and depression[11]. Twenty percent of individuals with coronary artery disease were found to have kinesiophobia six months after their coronary incident[10]. Lower levels of physical activity and attendance had a detrimental impact on clinical factors crucial to rehabilitation outcomes and prognosis in the secondary prevention of coronary artery disease when kinesiophobia was present.[8]
  • Neurological conditions: Kinesiophobia was found to be a frequent condition among persons with Stroke, Multiple Sclerosis, and Parkinson Disease, affecting the great majority of patients. Kinesiophobia is not found to be related with the length of the illness or the severity of the discomfort. Its predictors self-assessment of performance and age have a little impact on it, pointing to psychological rather than biological origins for the problem.[12] Physical activity (PA) has a strong meaning in the literature, and it is required for minimizing the symptoms of neurological illnesses and, in the event of strokes, the opportunity for better functioning. The perception that physical activity would exacerbate pain and/or illness symptoms is the root of the problem addressed in reduced recovery in stroke patients.[13]
  • Musculoskeletal conditions: Physical inactivity has been linked to the development and maintenance of Chronic musculoskeletal pain, whereas physical activity has been shown to reduce pain and impairment in some musculoskeletal diseases, such as lower limb osteoarthritis[14]. Individuals with musculoskeletal pain frequently avoid activities that they believe would cause an actual or future injury/reinjury, resulting in increased physical inactivity. This anxiety of doing particular motions can lead to a vicious cycle in which persons with person experience more pain, disability, and emotional distress, as well as a poor quality of life.[15] A previous study showed that walking speed of patients with LBP was less than healthy individuals due to pain and fear of movement[16]. Fear avoidance behavior and kinesiophobia are both potential perpetuators and promoters of chronic pain, particularly in lower back pain. Kinesiophobia is present in around 79% of subjects with musculoskeletal pain.[17]

Migraine: Kinesiophobia and fear avoidance has been acknowledged as an important factor in migraine, defined by hyperexcitability of the trigeminovascular pathway. An increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input. It can be diagnosed clinically by the presence of cutaneous allodynia, which is found in roughly 80% of migraine sufferers and is thought to be a risk factor for chronic pain and poor prognosis.[17]

Causes of Kinesiophobia[edit | edit source]

Nature (Centrally Mediated)[edit | edit source]

  • Central symtpoms are often mediated by kinesiophobia, or fear of movement, secondary gain issues (as seen with positive Waddel’s signs). This may be do to severe pain or often associated with fear that is mediated by past pain.This may also be mediated by conditions such as as traumatic brain injury, spinal cord injury, phantom limb pain, and complex regional pain syndrome lead to neuropathic pain and may have a component of centrally mediated symptoms.
  • Additionally, there may be a disruption of osteokinematics or tissue lengthening secondary to centrally mediated protective mechanisms.
  • Some studies have shown that spinal ROM and even a SLR can be improved by simply helping the patient understand their symptoms to reduce the fear of movement. [18][19][20][21][22]

Assessment Scale[edit | edit source]

The Tampa Scale of Kinesiophobia a 17 itemed, self-administered questionnaire is used for objective rating of fear of movement. This valid and reliable questionnaire was formed to assess and differentiate non-excessive fear and phobia in individuals with musculoskeletal pain. The scale can be used for different parts of body including cervical spine. The score ranges from 17-68 with higher scores indicating more severe kinesiophobia.[23]

Coping strategies[edit | edit source]

Kinesiophobia can make adherence to exercise difficult and may necessitate particular management measures such as setting functional objectives, learning how to regulate safe behaviors, and gradually exposing oneself to fearful activities.[24]

Relevance in Physiotherapy[edit | edit source]

Individuals with Kinesiophobia often find it difficult to opt for and continue with an exercise routine. This results in a decreased satisfaction with the expected physiotherapy results. A preventive analgesic treatment is suggested in initial stages prior to a physiotherapy session. This practice can improve patient satisfaction and adherence to exercise. [25]

A physiotherapy treatment in individuals with kinesiophobia has resulted in reducing fear of movement and hence improved function, disability and quality of life.[26]As pain and Kinesophobia are inter-related, conventional physiotherapy treatment is believed to cause a decrease in pain and therefore reduces fear of movement. [27]

Hot pack causes increased vasodilatation which increases oxygen uptake and promotes healing of the affected tissues. An increased activity of collagenase at the site of injury caused reduced pain, which gives confidence to the patient to increase movement. [28]

Exercises that promote range of motion, strengthening and flexibility results in a reduced disability. Strengthening of the tissues further reduces pain and flexibility allows the muscles to avoid injury when the movement is performed. This allows the motion at the affected area to increase with a reduced fear of injury and pain.[29]

References[edit | edit source]

  1. Vlaeyen JW, Kole-Snijders AM, Rotteveel AM, Ruesink R, Heuts PH. The role of fear of movement/(re) injury in pain disability. Journal of occupational rehabilitation. 1995 Dec;5(4):235-52.
  2. Rachman S, Hodgson R. I. Synchrony and desynchrony in fear and avoidance. Behaviour research and therapy. 1974 Nov 1;12(4):311-8.
  3. de Freitas CD, Costa DA, Junior NC, Civile VT. Effects of the pilates method on kinesiophobia associated with chronic non-specific low back pain: Systematic review and meta-analysis. Journal of Bodywork and Movement Therapies. 2020 Jul 1;24(3):300-6.
  4. Tak E, Kuiper R, Chorus A, Hopman-Rock M. Prevention of onset and progression of basic ADL disability by physical activity in community dwelling older adults: a meta-analysis. Ageing research reviews. 2013 Jan 1;12(1):329-38.
  5. Elliott AM, Smith BH, Hannaford PC, Smith WC, Chambers WA. The course of chronic pain in the community: results of a 4-year follow-up study. Pain. 2002 Sep 1;99(1-2):299-307.
  6. Larsson C, Ekvall Hansson E, Sundquist K, Jakobsson U. Kinesiophobia and its relation to pain characteristics and cognitive affective variables in older adults with chronic pain. BMC geriatrics. 2016 Dec;16(1):1-7.
  7. Bäck M, Öberg B, Krevers B. Important aspects in relation to patients’ attendance at exercise-based cardiac rehabilitation–facilitators, barriers and physiotherapist’s role: a qualitative study. BMC cardiovascular disorders. 2017 Dec;17(1):1-0.
  8. 8.0 8.1 Bäck M, Caldenius V, Svensson L, Lundberg M. Perceptions of kinesiophobia in relation to physical activity and exercise after myocardial infarction: a qualitative study. Physical therapy. 2020 Dec;100(12):2110-9.
  9. Hagström E, Norlund F, Stebbins A, Armstrong PW, Chiswell K, Granger CB, López‐Sendón J, Pella D, Soffer J, Sy R, Wallentin L. Psychosocial stress and major cardiovascular events in patients with stable coronary heart disease. Journal of internal medicine. 2018 Jan;283(1):83-92.
  10. 10.0 10.1 Bäck M, Cider Å, Herlitz J, Lundberg M, Jansson B. The impact on kinesiophobia (fear of movement) by clinical variables for patients with coronary artery disease. International journal of cardiology. 2013 Jul 31;167(2):391-7.
  11. Vlaeyen JW, Kole-Snijders AM, Boeren RG, Van Eek H. Fear of movement/(re) injury in chronic low back pain and its relation to behavioral performance. Pain. 1995 Sep 1;62(3):363-72.
  12. Wasiuk-Zowada D, Knapik A, Szefler-Derela J, Brzęk A, Krzystanek E. Kinesiophobia in Stroke Patients, Multiple Sclerosis and Parkinson’s Disesase. Diagnostics. 2021 May;11(5):796.
  13. Knapik A, Saulicz E, Gnat R. Kinesiophobia–introducing a new diagnostic tool. Journal of Human Kinetics. 2011 Jun;28:25.
  14. Uthman OA, Van Der Windt DA, Jordan JL, Dziedzic KS, Healey EL, Peat GM, Foster NE. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis. Bmj. 2013 Sep 20;347.
  15. Luque-Suarez A, Martinez-Calderon J, Falla D. Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. British journal of sports medicine. 2019 May 1;53(9):554-9.
  16. de Freitas CD, Costa DA, Junior NC, Civile VT. Effects of the pilates method on kinesiophobia associated with chronic non-specific low back pain: Systematic review and meta-analysis. Journal of Bodywork and Movement Therapies. 2020 Jul 1;24(3):300-6.
  17. 17.0 17.1 Benatto MT, Bevilaqua-Grossi D, Carvalho GF, Bragatto MM, Pinheiro CF, Straceri Lodovichi S, Dach F, Fernández-de-Las-Peñas C, Florencio LL. Kinesiophobia is associated with migraine. Pain Medicine. 2019 Apr 1;20(4):846-51.
  18. Beales DJ, O’Sullivan PB, Briffa NK. Motor control patterns during an active straight leg raise in chronic pelvic girdle pain subjects. Spine. 2009;34(9):861-870. Available at:
  19. Flynn T, Fritz J, Whitman J, Wainner R, Prediction C. FEAR AVOIDANCE BELIEFS QUESTIONNAIRE ( FABQ ) Purpose : The FABQ was developed by Waddell to investigate fear-avoidance beliefs among LBP patients in the clinical setting . 3 This survey can help predict those that have a high pain avoidance behavior . Cl. 2002.
  20. George SZ. Fear-Avoidance Beliefs and Clinical Outcomes for Patients Seeking Outpatient Physical Therapy for Musculoskeletal Pain Conditions. Journal of Orthopaedic and Sports Physical Therapy. 2011. Available at: [Accessed April 5, 2011].
  21. Moseley GL, Nicholas MK, Hodges PW. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. The Clinical Journal of Pain. 2004;20(5):324-330. Available at:
  22. 1Moseley GL. Widespread brain activity during an abdominal task markedly reduced after pain physiology education: fMRI evaluation of a single patient with chronic low back pain. Australian Journal of Physiotherapy. 2005;51:49–52.
  23. Hudes K. The Tampa Scale of Kinesiophobia and neck pain, disability and range of motion: a narrative review of the literature. The Journal of the Canadian Chiropractic Association. 2011 Sep;55(3):222.
  24. Luque-Suarez A, Martinez-Calderon J, Falla D. Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. British journal of sports medicine. 2019 May 1;53(9):554-9.
  25. Perrot S, Trouvin AP, Rondeau V, Chartier I, Arnaud R, Milon JY, Pouchain D. Kinesiophobia and physical therapy-related pain in musculoskeletal pain: A national multicenter cohort study on patients and their general physicians. Joint Bone Spine. 2018 Jan 1;85(1):101-7.
  26. Kothari PH, Palekar TJ, Shah MR, Mujawar S. Effects of conventional physiotherapy treatment on kinesiophobia, pain, and disability in patients with mechanical low back pain. Journal of Dental Research and Review. 2020 Feb 1;7(5):76.
  27. Chang WD, Lin HY, Lai PT. Core strength training for patients with chronic low back pain. Journal of physical therapy science. 2015;27(3):619-22.
  28. Akhtar MW, Karimi H, Gilani SA. Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic non-specific low back pain: A randomized controlled clinical trial. Pakistan journal of medical sciences. 2017 Jul;33(4):1002.
  29. Kothari PH, Palekar TJ, Shah MR, Mujawar S. Effects of conventional physiotherapy treatment on kinesiophobia, pain, and disability in patients with mechanical low back pain. Journal of Dental Research and Review. 2020 Feb 1;7(5):76.