Karimi and Saeidi, J Spine 2013, 2:4 DOI: 10.4172/2165-7939.1000139 Review Article Open Access Volume 2 • Issue 4 • 1000139 J Spine, an open access journal ISSN: 2165-7939 A Review of Relationship between Fear Avoidance Beliefs and Postural Stability in Non Specific Chronic Low Back Pain Abdolkarim Karimi 1 and Marzieh Saeidi 2 * 1 Assistant Professor, School of Rehabilitation, Isfahan University of Medical Sciences, Iran 2 Physiotherapist of Shariati Hospital, Management Treatment of Isfahan social security organization, Iran Abstract Introduction: Low back pain (LBP) is one of the most prevalent diseases in most developed and developing countries, affecting 70% to 80% of adults at some time during their lives. Recent evidence suggests that psychosocial factors especially fear-avoidance beliefs (FAB) are important in predicting patients who will progress from an acute to a chronic stage as well as failure of interventions. The aim of this study is to review the Relationship between Fear Avoidance Beliefs and Postural stability in non specifc Chronic Low Back Pain (CLBP). Methods: In this narrative article we have searched PubMed, CINHAL, APTA and MEDLINE data bases. The key words included: chronic low back pain, fear avoidance beliefs, posture, stability, balance, motor control, center of pressure and force plate. The inclusion criteria were being related to FAB and postural stability and adults with non specifc CLBP, in English language, up to 2013, regardless of their study design. Results: The results showed that psychological factors such as FAB infuence the chronicity of LBP, a group of studies indicated that FAB is related to pain and disability. Another group of studies indicated that postural stability is related to pain and disability. The only study on the relationship between postural stability and FAB did not found any signifcant relationship. Conclusion: FAB is related to pain and disability. Postural stability is related to pain and disability. More studies with stronger methodology such as larger population with control group are needed for evaluating the relationship of FAB and postural control. *Corresponding author: Marzieh Saeidi, Physiotherapist of Shariati Hospital, Management Treatment of Isfahan Social Security Organization, Iran, E-mail: pt_msaeidi@yahoo.com Received April 30, 2013; Accepted July 08, 2013; Published July 10, 2013 Citation: Karimi A, Saeidi M (2013) A Review of Relationship between Fear Avoidance Beliefs and Postural Stability in Non Specifc Chronic Low Back Pain. J Spine 2: 139. doi:10.4172/2165-7939.1000139 Copyright: © 2013 Karimi A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Chronic low back pain; Fear avoidance beliefs; Stability; Motor control Introduction Low back pain (LBP) is one of the most common health problems which afect 60% to 80% of adults at some time during their lives [1,2]. About 85% of patients with back pain are classifed as non specifc chronic low back pain [3]. Although most of the time, LBP is a self- limiting disorder and a majority of these patients will improve rapidly [4], half of them has a long history of multiple episodes [5] and in a small group of them (about10%), pain will become chronic [6-8]. Tis group of patients allocate about 80% of costs to themselves [9]. Consequently, LBP is a major public health problem with an immense socioeconomic burden in most developed and developing countries. Studies on patients with acute or sub acute LBP reveal several factors infuence on progression to chronicity of LBP such as: high level of psychological distress, dissatisfaction with employment, longer duration of symptoms, previous history of LBP, radiating pain and higher initial disability level [10-13], psychosocial factors like the patients attitudes and beliefs, pain and movement related fear, stress, depression, job satisfaction, self confdence and self assurance are very important in CLBP [14,15]. Te cognitive-behavior concept of developing chronic pain is appearing as fear-avoidance behavior at early stage. Cox et al. explained in a model the reason of pain exaggeration and the reason of developing pain in to chronic stage in some of the patients while improving in others [16]. According to this model, the patient’s fear of pain, and subsequent avoidance behavior, are determined by the relation between sensory and emotional components of pain. Te hypothesis is that the patients believes and fears concerning symptoms and activity lead to unhelpful ways of managing symptoms, including avoidance behaviors, decreasing activities of daily living, job and recreation which refect a state of not feeling well. Also failing to diagnose factors which infuence their condition can lead to use an inappropriate treatment approach. In individuals with LBP, the Fear-Avoidance Belief Questionnaire (FABQ) quantifes pain-related fears and believes about the necessity of changing the behavior of pain avoidance [17]. Pain related fear refers to a condition in which the patient has an excessive, irrational, and debilitating fear of physical movement and activity, resulting in feelings of vulnerability to painful injury or re-injury [18,19]. Biomechanical factors such as strength or endurance, fexibility spinal stability and neurophysiologic factors have been studied in several investigations [20-22]. It is important for physicians and physiotherapists to have enough information in this area in order to be able to recognize the obstacles of the patients’ improvement and adopt an appropriate strategy accordingly. Optimal postural control is an essential requirement to perform daily activities. Postural stability is a component of postural balance which indicates the ability of maintaining a certain posture and is described by center of pressure (COP) excursion [23,24]. Many factors may contribute to control postural stability including age, neurological or musculoskeletal disorders such as LBP and biomechanical factors such as muscle endurance [21,25]. Te infuence of LBP on postural balance is complex and afected by co-existing factors: pain, fear of pain, positive neurologic fndings, adoption of an alternate movement strategy, and low muscular conditioning [24,26-30]. Several studies Journal of Spine J o u r n a l o f S p i n e ISSN: 2165-7939