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Physical Therapist Management of a Patient With Acute Low Back Pain and Elevated Fear-Avoidance Beliefs

SZ George, PT, PhD, is Assistant Professor, Department of Physical Therapy, Brooks Center for Rehabilitation Study, University of Florida, PO Box 100154, Gainesville, FL 32610-0154 (USA) (sgeorge{at}phhp.ufl.edu).
JE Bialosky, PT, MS, OCS, FAAOMPT, is Physical Therapist, Concentra Medical Center, Pittsburgh, Pa
JM Fritz, PT, PhD, ATC, is Assistant Professor, Division of Physical Therapy, University of Utah, Salt Lake City, Utah

Address all correspondence to Dr George

Background and Purpose. Elevated fear-avoidance beliefs are believed to be a precursor of chronic disability, yet effective intervention options have not been described in the literature. The purpose of this case report is to describe physical therapist management of a patient with acute low back pain and elevated fear-avoidance beliefs. Case Description. The patient was a 42-year-old sales manager with acute low back pain. The patient had no previous history of activity-limiting low back pain and initially had limitations in straight leg raising, limitations in lumbar movement, and elevated fear-avoidance beliefs. Intervention. Treatment-based classification and graded exercise were used. Outcome. Disability, fear-avoidance beliefs, and pain decreased 4 weeks after starting physical therapy. Six months later, disability and fear-avoidance beliefs had increased, but were still improved when compared with the initial measurements. Discussion. Disability and fear-avoidance beliefs improved following a fear-avoidance-based physical therapy intervention. Research is warranted to investigate the effectiveness of this approach.

Key Words: Acute low back pain • Disability • Fear-avoidance beliefs • Graded exercise

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