Brazilian Journal of Pain
Brazilian Journal of Pain
Original Article

Is kinesiophobia associated with disturbances in dynamic balance in individuals with chronic non-specific low back pain?

A cinesiofobia está associada a distúrbios de equilíbrio dinâmico em indivíduos com dor lombar crônica não-específica?

Marina Cardoso de Melo Silva; Caroline Ribeiro Tottoli; Katharina Mascarenhas; Yara Andrade Marques; Aline Martins Toledo; Rodrigo Luiz Carregaro

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BACKGROUND AND OBJECTIVES: Chronic non-specific low back pain is a disabling condition that has a high worldwide prevalence. The aim of the study was to investigate the association between deficits in dynamic balance, age and body mass index (BMI), and kinesiophobia, as well as to establish a comparison between men and women.

METHODS: A cross-sectional study with 145 individuals between 18 and 50 years of age with non-specific chronic low back pain. Sociodemographic data were collected, and dynamic balance was assessed using the Y-Balance Test. The Tampa Scale was used to assess kinesiophobia. A linear regression was applied to investigate the association between kinesiophobia and a set of predictor variables (balance, gender, BMI). Men and women were compared using the Student’s t-test (kinesiophobia and dynamic balance).

RESULTS: The overall mean kinesiophobia score was 41.3. The Y-Balance Test mean for the right and left lower limb, respectively, was 59.4 and 59.5. An association was found between kinesiophobia and two predictors: balance and BMI (R2:6.8%). No significant differences were found between gender for kinesiophobia (42.1 for women and 40.3 for men). However, women had worse dynamic balance compared to men (mean reach of 56.1 versus 63.5, respectively; p<0.05).

CONCLUSION: Kinesiophobia was found to be associated with disturbances in dynamic balance and BMI of individuals with non-specific chronic low back pain. However, the model explained a small variation in kinesiophobia. Women showed worse dynamic balance compared to with men.


Chronic pain, Low back pain, Postural balance, Age and gender distribution


JUSTIFICATIVA E OBJETIVOS: A dor lombar crônica não-específica é uma condição incapacitante que possui alta prevalência mundial. O objetivo deste estudo foi analisar a associação entre déficits do equilíbrio dinâmico, idade e índice de massa corporal (IMC) e a cinesiofobia, além de realizar uma comparação entre homens e mulheres.

MÉTODOS: Este estudo transversal incluiu 145 indivíduos com idade entre 18 e 50 anos com dor lombar crônica não-específica. Foram coletados dados sociodemográficos. O equilíbrio dinâmico foi avaliado por meio do Y-Balance Test. A escala Tampa foi usada para avaliar a cinesiofobia. Aplicou-se uma regressão linear para investigar a associação entre cinesiofobia e um conjunto de variáveis preditoras (equilíbrio, sexo, IMC). Homens e mulheres foram comparados por meio do teste T de Student (cinesiofobia e equilíbrio dinâmico).

RESULTADOS: O escore médio geral de cinesiofobia foi de 41,3. A média do Y-Balance Test para o membro inferior direito e esquerdo, respectivamente, foi de 59,4 e 59,5. Verificou-se uma associação entre cinesiofobia e dois preditores, a saber, equilíbrio e IMC (R2:6,8%). Não foram encontradas diferenças significantes entre sexo para cinesiofobia (42,1 para mulheres e 40,3 para homens). Entretanto, as mulheres apresentaram pior equilíbrio em comparação aos homens (média de 56,1 de alcance versus 63,5, respectivamente; p<0,05).

CONCLUSÃO: Verificou-se que a cinesiofobia apresentou associação com distúrbios no equilíbrio dinâmico e IMC de indivíduos com dor lombar crônica não-específica. Entretanto, o modelo explicou uma pequena variação na cinesiofobia. As mulheres apresentaram um pior equilíbrio dinâmico em comparação aos homens.


Dor crônica, Dor lombar, Equilíbrio postural, Distribuição por idade e sexo


Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356-5667.

Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J.. 2006;15(Suppl 2):S192-300.

Carregaro RL, Tottoli CR, Rodrigues DDS, Bosmans JE, da Silva EN, van Tulder M. Low back pain should be considered a health and research priority in Brazil: lost productivity and healthcare costs between 2012 to 2016. PLoS One. 2020;15(4).

Barbosa-Branco A, Souza WR, Steenstra IA. Incidence of work and non-work related disability claims in Brazil. Am J Ind Med. 2011;54(11):858-71.

Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1204-22.

Salvetti G, Pimenta CA, Braga PE, Corrêa CF. Disability related to chronic low back pain: prevalence and associated factors. Rev Esc Enferm USP. 2012.

Trocoli TO, Botelho RV. Prevalence of anxiety, depression and kinesiophobia in patients with low back pain and their association with the symptoms of low back spinal pain. Rev Bras Reumatol. 2016;56(4):330-6.

Barbosa FM, Vieira EB, Garcia JB. Beliefs and attitudes in patients with chronic low back pain. BrJP. 2018;1(2):116-21.

Silva MC, Fassa AG, Valle NC. Chronic low back pain in a Southern Brazilian adult population: prevalence and associated factors. Cad Saude Publica. 2004;20(2):377-85.

Ruhe A, Fejer R, Walker B. Is there a relationship between pain intensity and postural sway in patients with non-specific low back pain?. BMC Musculoskelet Disord. 2011;12:162.

Hooper TL, James CR, Brismée JM, Rogers TJ, Gilbert KK, Browne KL. Dynamic balance as measured by the Y-Balance Test is reduced in individuals with low back pain: A cross-sectional comparative study. Phys Ther Sport. 2016;22(1):29-34.

Mok NW, Brauer SG, Hodges PW. Changes in lumbar movement in people with low back pain are related to compromised balance. Spine. 2011;36(1).

Silfies SP, Mehta R, Smith SS, Karduna AR. Differences in feedforward trunk muscle activity in subgroups of patients with mechanical low back pain. Arch Phys Med Rehabil. 2009;90(7):1159-69.

Davarian S, Maroufi N, Ebrahimi I, Farahmand F, Parnianpour M. Trunk muscles strength and endurance in chronic low back pain patients with and without clinical instability. J Back Musculoskelet Rehabil. 2012;25(2):123-9.

Braga AB, Rodrigues ACMA, Lima GVMP, Melo LR, Carvalho AR, Bertolini GRF. Comparação do equilíbrio postural estático entre sujeitos saudavéis e lombálgicos. Acta Ortop Bras. 2012;20(4):210-2.

Hlaing SS, Puntumetakul R, Wanpen S, Boucaut R. Balance control in patients with subacute non-specific low back pain, with and without lumbar instability: a cross-sectional study. J Pain Res. 2020;13:795-803.

Claeys K, Brumagne S, Dankaerts W, Kiers H, Janssens L. Decreased variability in postural control strategies in young people with non-specific low back pain is associated with altered proprioceptive reweighting. Eur J Appl Physiol. 2011;111(1):115-23.

Altuğ, F Ünal, A, Kilavuz G, Kavlak E, Çitişli V, Cavlak U. Investigation of the relationship between kinesiophobia, physical activity level and quality of life in patients with chronic low back pain. J Back Musculoskelet Rehabil. 2016;29(3):527-31.

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 Geriatr. 2016;16:128.

Vlaeyen JW, Crombez G. Fear of movement/(re)injury, avoidance and pain disability in chronic low back pain patients. Man Ther. 1999;4(4):187-95.

Tottoli CR, van Tulder M, Silva EN, Marques YA, Martins WR, Carregaro RL. Effectiveness and cost-effectiveness of Pilates versus home-based exercises in individuals with chronic non-specific low back pain: randomised controlled trial protocol. Eur J Physiother. 2021;23(2):95-101.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495-9.

Plisky PJ, Gorman PP, Butler RJ, Kiesel KB, Underwood FB, Elkins B. The reliability of an instrumented device for measuring components of the star excursion balance test. N Am J Sports Phys Ther. 2009;4(2):92-9.

Siqueira FB, Teixeira-Salmela LF, Magalhães LC. Análise das propriedades psicométricas da versão brasileira da escala tampa de cinesiofobia. Acta Ortop Bras. 2007;15(1):19-24.

Weir CB, Jan A. BMI classification percentile and cut off points. 2022.

Ishak NA, Zahari Z, Justine M. Kinesiophobia, pain, muscle functions, and functional performances among older persons with low back pain. Pain Res Treat. 2017;2017:3489617.

Ferrer-Peña R, Moreno-López M, Calvo-Lobo C, López-de-Uralde-Villanueva I, Fernández-Carnero J. Relationship of dynamic balance impairment with pain-related and psychosocial measures in primary care patients with chronic greater trochanteric pain syndrome. Pain Med. 2019;20(4):810-7.

Meulders A, Vlaeyen JW. The effect of differential spatiotopic information on the acquisition and generalization of fear of movement-related pain. PeerJ. 2019;7.

Ganesh GS, Chhabra D, Mrityunjay K. Efficacy of the star excursion balance test in detecting reach deficits in subjects with chronic low back pain. Physiother Res Int. 2015;20(1):9-15.

Mazaheri M, Heidari E, Mostamand J, Negahban H, van Dieen JH. Competing effects of pain and fear of pain on postural control in low back pain?. Spine. 2014;39(25).

La Touche R, Grande-Alonso M, Arnes-Prieto P, Paris-Alemany A. How does self-efficacy influence pain perception, postural stability and range of motion in individuals with chronic low back pain?. Pain Physician. 2019;22(1).

Vincent HK, Seay AN, Montero C, Conrad BP, Hurley RW, Vincent KR. Kinesiophobia and fear-avoidance beliefs in overweight older adults with chronic low-back pain: relationship to walking endurance--part II. Am J Phys Med Rehabil. 2013;92(5):439-45.

Zanuto EA, Codogno JS, Christófaro DG, Vanderlei LC, Cardoso JR, Fernandes RA. Prevalence of low back pain and associated factors in adults from a middle-size Brazilian city. Cienc Saud Colet. 2015;20(5):1575-82.

Ibrahimi-Kaçuri D, Murtezani A, Rrecaj S, Martinaj M, Haxhiu B. Low back pain and obesity. Med Arch. 2015;69(2):114-6.

Monticone M, Ambrosini E, Rocca B, Foti C, Ferrante S. Responsiveness of the Tampa Scale of Kinesiophobia in Italian subjects with chronic low back pain undergoing motor and cognitive rehabilitation. Eur Spine J. 2016;25(9):2882-8.

Digitale JC, Martin JN, Glymour MM. Tutorial on directed acyclic graphs. J Clin Epidemiol. 2021;S0895-4356(21):00240-7.

Ozcan Kahraman B, Kahraman T, Kalemci O, Salik Sengul Y. Gender differences in postural control in people with nonspecific chronic low back pain. Gait Posture. 2018;64:147-51.

Bränström H, Fahlström M. Kinesiophobia in patients with chronic musculoskeletal pain: differences between men and women. J Rehabil Med. 2008;40(5):375-80.

Fehrmann E, Kotulla S, Fischer L, Kienbacher T, Tuechler K, Mair P. The impact of age and gender on the ICF-based assessment of chronic low back pain. Disabil Rehabil. 2019;41(10):1190-9.

Rovner GS, Sunnerhagen KS, Björkdahl A, Gerdle B, Börsbo B, Johansson F. Chronic pain and sex-differences; women accept and move, while men feel blue. PLoS One. 2017;12.

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