Introduction
Kinesiophobia, defined as the fear of movement or physical activity due to the belief that it may cause pain or re-injury, is increasingly recognised as a significant factor in the persistence and chronicity of musculoskeletal conditions (Kori et al., 1990). While originally described in patients with chronic low back pain, it is now known to affect a wide range of conditions including chronic neck pain, whiplash-associated disorders, and post-surgical recovery (Luque-Suarez et al., 2019).
Conceptual Basis
Kinesiophobia is best understood through the fear-avoidance model of pain (Vlaeyen & Linton, 2000). This framework explains how patients who catastrophise pain may develop a cycle of avoidance behaviour. Instead of gradual re-engagement in physical activity, they restrict movement due to fear, which contributes to reduced mobility, muscle weakness, and ultimately, greater disability.
Clinical Impact
The presence of kinesiophobia has been shown to correlate with:
- Higher levels of pain and disability (Asiri et al., 2021)
- Prolonged recovery times following musculoskeletal injury or surgery (Picavet et al., 2002).
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Lower quality of life and physical performance (Demirbüken et al., 2016).
In chronic neck pain specifically, kinesiophobia has been associated with impaired proprioception and sensorimotor control, suggesting that both physical and psychological mechanisms interact (Luque-Suarez et al., 2019).
Assessment
The most widely used tool for measuring kinesiophobia is the Tampa Scale of Kinesiophobia (TSK), a self-reported questionnaire assessing fear of pain and fear of physical activity (Kori et al., 1990). Scores on the TSK have been linked with both objective and subjective measures of impairment.
Rehabilitation Approaches
Addressing kinesiophobia requires a multidimensional approach:
Education: Helping patients understand the difference between safe and harmful movement can reduce fear and catastrophising (Vlaeyen & Linton, 2000).
Graded exposure and exercise: Gradual reintroduction of feared movements has been shown to improve outcomes (Leeuw et al., 2008).
Sensorimotor training: Recent evidence indicates that exercises targeting proprioception and cervical control may reduce kinesiophobia in patients with chronic neck pain (Tejera et al., 2020; Luznik et al., 2025).
Conclusion
Kinesiophobia is not merely a psychological curiosity, but a clinically relevant barrier to recovery in musculoskeletal rehabilitation. Its presence perpetuates pain, disability, and functional limitations. Effective management requires both physical rehabilitation and cognitive strategies, with emerging evidence suggesting that sensorimotor-based interventions can play a valuable role. Technologies that provide real-time feedback on head and neck movement, such as head-mounted laser systems like the HeadX Kross, may help patients rebuild confidence in their ability to move safely by making progress visible and tangible.
References
Asiri, F., Reddy, R. S., Tedla, J. S., AlMohiza, M. A., Alshahrani, M. S., Govindappa, S. C., & Sangadala, D. R. (2021). Kinesiophobia and its correlations with pain, proprioception, and functional performance among individuals with chronic neck pain. PLOS ONE, 16(7), e0254262.
Demirbüken, İ., Özgül, B., Kuru Çolak, T., Aydoğdu, O., Sarı, Z., & Yurdalan, S. U. (2016). Kinesiophobia in relation to physical activity in chronic neck pain. Journal of Back and Musculoskeletal Rehabilitation, 29(1), 41–47.
Kori, S. H., Miller, R. P., & Todd, D. D. (1990). Kinesiophobia: A new view of chronic pain behaviour. Pain Management, 3, 35–43.
Leeuw, M., Goossens, M. E. J. B., Linton, S. J., Crombez, G., Boersma, K., & Vlaeyen, J. W. S. (2008). The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence. Journal of Behavioral Medicine, 30(1), 77–94.
Luque-Suarez, A., Martinez-Calderon, J., & Falla, D. (2019). 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, 53(9), 554–559. https://doi.org/10.1136/bjsports-2017-098673
Luznik, I., Pajek, M., Sember, V., & Majcen Rosker, Z. (2025). The effectiveness of cervical sensorimotor control training for the management of chronic neck pain disorders: A systematic review and meta-analysis. Montenegrin Journal of Sports Science and Medicine, 21(1), Ahead of print.
Picavet, H. S. J., Vlaeyen, J. W. S., & Schouten, J. S. A. G. (2002). Pain catastrophizing and kinesiophobia: Predictors of chronic low back pain. American Journal of Epidemiology, 156(11), 1028–1034.
Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85(3), 317–332.