Nature (Centrally Mediated)

  • 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. [1][2][3][4][5]

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  1. 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:
  2. 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.
  3. 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].
  4. 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:
  5. 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.