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Kinesiophobia is associated with pain intensity in people suffering from chronic pain. The number of publications highlighting this relationship has increased significantly in recent years, emphasizing the importance of investigating and synthesizing research evidence on this topic. The purpose of this scoping review was to answer the following questions: 1) What types of interventions have been or are currently being studied in randomized controlled trials for the management of kinesiophobia in patients with chronic pain? 2) What chronic pain conditions are targeted by these interventions? 3) What assessment tools for kinesiophobia are used in these interventions? According to the studies reviewed, 1) physical exercise is the most commonly used approach for managing irrational fear of movement, 2) interventions for kinesiophobia have primarily focused on musculoskeletal pain conditions, particularly low back pain and neck pain, and 3) the Tampa Scale of Kinesiophobia is the most commonly used tool for measuring kinesiophobia. Future randomized controlled trials should consider multidisciplinary interventions that can help patients confront their irrational fear of movement while taking into account the patient's personal biological, psychological, and social experiences with pain and kinesiophobia.

Background: Professional and pre-professional musicians are characterized by physical and psychological demands inherent to their musical activity, and therefore at risk for developing performance related musculoskeletal pain. Physical and psychological demands are known to influence human pain modulation. Objectives: In this study we compared the influence of a physically and emotionally stressful task on pain thresholds in musicians with and without shoulder pain. Study Design: A single-blinded randomized and controlled crossover study design was used to compare the effects of a physical versus emotional testing procedure on pressure pain thresholds (PPTs) in musicians with and without shoulder pain. Setting: All data were obtained in the field (e.g., at the physiotherapy accommodation in the Royal Conservatory). Methods: During the physical testing procedure, the subjects performed an isometric exercise of the glenohumeral external rotators. The emotional task comprised watching “unpleasant” images selected from the International Affective Picture System. The outcome was the assessment of change in PPTs before and after the physical and emotional task. Results: Our results indicate similar effects of both protocols in either group, i.e., musicians with and without shoulder pain (P > 0.05). All musicians showed elevated PPTs at local and remote areas after isometric exercise (P < 0.05). The emotional stress task increased PPTs at remote areas only (P < 0.05). Limitations: Despite the small sample size of musicians without shoulder pain, a power of 78.5% was achieved to detect the necessary effect size of Cohen’s d = 1. Furthermore, comparing these results with those of non-musicians (both healthy subjects and patients with shoulder pain) might reveal information regarding the specific adaptations. Finally a high variability was observed in shoulder disability (i.e., SDQ-scores) as typically seen in a population with shoulder pain. Conclusions: In musicians with and without regional shoulder pain, no significant differences were found with respect to pain modulation during a physically and an emotionally stressful task. Both interventions adequately activated central and widespread pain inhibitory mechanisms in both groups. Key words: Pressure pain threshold, PPT, exercise induced hypoalgesia, exercise induced analgesia, stress induced hypoalgesia, shoulder pain, musicians, regional pain:

Two previous studies showed kinematic differences between novice and experienced performers during unchoreographed movements executed in standing position. However, no study explores if these kinematic differences holds during unchoreographed movements executed in quadrupedal position. The aim of this study is to compare the movement behaviour of experienced and novice performers during an exercise wherein they are challenged to use dynamic and largely unchoreographed movement patterns executed in quadrupedal position. The exercise studied was the Cat exercise, in which participants were asked to behave like a feline for 10 minutes. An inventory of the chosen movements and the assessment of their average and coefficient of variation of the ground contact temporal parameters, computed by analysing the tri-dimensional whole-body kinematics of 25 performers (n = 13 novices and n = 12 experienced), was compared according to their experience level. No significant difference was found between the groups for the number of chosen movements, and median or coefficient of variation of ground contact temporal parameters, except for a greater foot/ knee swing coefficient of variation in experienced performers. This suggests that biomechanical constraints induced by quadrupedal position “prevent” a different selection of motor strategies by experienced performers, although the latter can be more variable in their movements.

Background The assessment of cervical spine kinematic axial rotation performance is of great importance in the context of the study of neck sensorimotor control. However, studies addressing the influence of the level of provocation of spinal pain and the potential benefit of passive manual therapy mobilizations in patients with acute-subacute non-specific neck pain are lacking. Methods A non-randomized prospective clinical trial with an intervention design was conducted. We investigated: (1) the test-retest reliability of kinematic variables during a fast axial head rotation task standardized with the DidRen laser test device in 42 Healthy pain-free Control Participants (HCP) (24.3 years ±6.8); (2) the differences in kinematic variables between HCP and 38 patients with Acute-subacute Non-Specific neck Pain (ANSP) assigned to two different groups according to whether their pain was localized in the upper or lower spine (46.2 years ±16.3); and (3) the effect of passive manual therapy mobilizations on kinematic variables of the neck during fast axial head rotation. Results (1) Intra-class correlation coefficients ranged from moderate (0.57 (0.06-0.80)) to excellent (0.96 (0.91-0.98)). (2) Kinematic performance during fast axial rotations of the head was significantly altered in ANSP compared to HCP (age-adjusted) for one variable: the time between peaks of acceleration and deceleration ( p <0.019). No significant difference was observed between ANSP with upper vs lower spinal pain localization. (3) After the intervention, there was a significant effect on several kinematic variables, e.g., ANSP improved peak speed ( p <0.007) and performance of the DidRen laser test ( p <0.001), with effect sizes ranging from small to medium. Conclusion (1) The DidRen laser test is reliable. (2) A significant reduction in time between acceleration and deceleration peaks was observed in ANSP compared to HCP, but with no significant effect of spinal pain location on kinematic variables was found. (3) We found that neck pain decreased after passive manual therapy mobilizations with improvements of several kinematic variables. Trial registration Registration Number: NCT 04407637

Background Physiotherapists encounter many barriers in their management of low back pain (LBP). However, little attention has been paid to what content physiotherapists find useful to improve their LBP management. We aimed to: (1) explore the experiences of physiotherapists regarding the educational content after completing either an “experimental” or “traditional” e-learning intervention, (2) identify in both interventions which content physiotherapists reported beneficial or lacking in order to enhance their management of LBP. Methods A purposive, criterion-based sampling strategy was employed to process-evaluate the experiences of 269 Dutch-speaking physiotherapists who participated in an RCT consisting of two different interventions aimed to improve LBP management. Both interventions were based on the same clinical guidelines, but emphasized different aspects. While the traditional e-learning discussed these guidelines in a more theoretical approach, the experimental e-learning demonstrated them in a concrete, practical, and interactive way. An inductive thematic framework approach was used to analyse and categorise responses to seven open-ended questions in a post-intervention online. Results All 269 physiotherapists’ responses were analysed, identifying four broad themes. The first theme, ‘Practical application’, revealed contrasting views between groups: physiotherapists in the “experimental” intervention highly appreciated the inclusion of concrete communication strategies, whereas those in the “traditional” group criticized the absence of such content as a major shortcoming. Both groups emphasized the need for clearer examples of effective exercises to treat LBP. The second theme, ‘Relevancy and adequacy of the intervention’, highlighted divergent attitudes. While some participants valued content on red flags, spinal pathologies, and pain mechanisms, others considered such information irrelevant or outside their professional scope. The third theme, ‘Knowledge’, showed more consistency: participants in both interventions appreciated content that offered practical tools and biopsychosocial strategies. The final theme, ‘Confirmation of practice’, captured the view of physiotherapists who felt reassured that their current clinical approach aligned with scientific recommendations. Conclusion These qualitative findings suggest that educational interventions to enhance LBP management may benefit from prioritising clear communication strategies, supporting physiotherapists’ confidence in prescribing individualised exercise therapy, and considering tailored approaches that reflect differing views on spinal pathologies and red flags.

Kinematic behavior during fast cervical rotations is a useful parameter for assessing sensorimotor control performances in neck-pain patients. However, the influence of age in asymptomatic individuals from children to older people still needs to be explored. Our aim was to assess the impact of age on sensorimotor control performance of the head-neck with execution time and kinematic variables (time of task, mean speed/acceleration/deceleration, overshoots (OSs), minimum/maximum speed) during standardized fast rotation target task using the DidRen Laser test. A total of 80 volunteers were stratified in four different age-groups: Children (8–14 years): n = 16; Young Adults (18–35 years): n = 29; Old Adults (36–64 years): n = 18; Seniors (65–85 years): n = 17. Results showed that to perform the test, Children were slower (69.0 (60.6–87.3)s) compared to Young Adults (49.6 (45.6–55.6)s) with p < 0.001, and Old Adults (51.7 (48.4–55.8)s) with p < 0.001. It was also slower in Seniors (57 (52.3–67.6)s) compared to Young Adults with p < 0.013. Mean speed was slower in Children (9.4 ± 2.3 °s −1 ) and Seniors (10.6 ± 2.4 °s −1 ) compared to Young Adults (13.7 ± 1.9 °s −1 ) with p < 0.001 and Old Adults (13.3 ± 2.4 °s −1 ) with p < 0.001. Mean acceleration was slower for Children (8.4(7.6–10.2) °s −2 ) compared to Young Adults (11.1 (8.8–15.3) °s −2 ) with p < 0.016, and Old Adults (12.0(8.4–15.3) °s −2 ) with p < 0.015. Mean deceleration was slower for Children (−1.9(−2.6–1.4) °s −2 ) compared to Young Adults (−2.9(−3.7–2.5) °s −2 ) with p < 0.001 and Old Adults (−3.2(−3.7–2.3) °s −2 ) with p < 0.003. The DidRen Laser test allows us to discriminate age-specific performances for mean speed, acceleration and deceleration. Seniors and Children needed to be slower to become as precise as Young Adults and Old Adults. No difference was observed for OSs which assesses accuracy of movement. Age should therefore be considered as a key parameter when analyzing execution time and kinematic results during DidRen Laser test. These normative data can therefore guide clinicians in the assessment of subjects with neck pain.

The objective of the study was to evaluate the breathing pattern in patients with chronic non-specific low back pain (LBP) and in healthy subjects, both at rest and during motor control tests. Ten healthy subjects and ten patients with chronic LBP participated at this case–control study. The breathing pattern was evaluated at rest (standing and supine position during both relaxed breathing and deep breathing) and while performing clinical motor control tests, i.e. bent knee fall out and active straight leg raise. A blinded observer analyzed the breathing pattern of the participants using visual inspection and manual palpation. Costo-diaphragmatic breathing was considered as optimal breathing pattern. Subjects filled in visual analog scales for the assessment of pain intensity during the tests. At rest, no significant differences were found between the breathing pattern of patients and healthy subjects ( P  > 0.05). In contrast, significantly more altered breathing patterns were observed in chronic LBP-patients during motor control tests ( P  = 0.01). Changes in breathing pattern during motor control tests were not related to pain severity ( P  > 0.01), but were related to motor control dysfunction ( P  = 0.01).

Chronic spinal pain (CSP) is a severely disabling disorder, including nontraumatic chronic low back and neck pain, failed back surgery, and chronic whiplash-associated disorders. Much of the current therapy is focused on input mechanisms (treating peripheral elements such as muscles and joints) and output mechanisms (addressing motor control), while there is less attention to processing (central) mechanisms. In addition to the compelling evidence for impaired motor control of spinal muscles in patients with CSP, there is increasing evidence that central mechanisms (ie, hyperexcitability of the central nervous system and brain abnormalities) play a role in CSP. Hence, treatments for CSP should address not only peripheral dysfunctions but also the brain. Therefore, a modern neuroscience approach, comprising therapeutic pain neuroscience education followed by cognition-targeted motor control training, is proposed. This perspective article explains why and how such an approach to CSP can be applied in physical therapist practice.

Chronic low back pain (CLBP) is one of the most common chronic musculoskeletal disorders worldwide. Guidelines recommend exercise therapy (ET) in CLBP management, but more research is needed to investigate specific ET modalities and their underlying mechanisms. The primary goal of this study is to evaluate the short-term and long-term effectiveness of a time-contingent individualised high-intensity training (HIT) protocol on disability compared with a time-contingent moderate-intensity training (MIT) as used in usual care, in persons with severely disabling CLBP. Additionally, the effectiveness on central effects, the added value of prolonged training at home and technology support, and the cost-effectiveness are evaluated. In this randomised controlled trial, CLBP patients will be randomly divided into three groups of 56 participants. Group 1, ‘TechnoHIT’, receives HIT with technology-support in the home-phase. Group 2, ‘HIT’, receives HIT without technology support. Group 3, ‘MIT’, receives MIT, reflecting training intensity as used in usual care. The primary outcome is patient-reported disability, measured by the Modified Oswestry Disability Index. Secondary outcomes include quantitative sensory testing, psychosocial factors, broad physical fitness, quality of life, cost-effectiveness, adherence and usability of technology. Trial registration number NCT06491121.