A perceived inability to cope with stress
Stress over a long period of time suppresses the immune system function, creates endocrine (hormonal imbalances) and can increase musculoskeletal tension. Body positions that are associated with fear include spinal flexion (hunched shoulders or curling into a ball) which removes the lordotic curve of the spine and places it at a load bearing disadvantage.
In addition, while the body experiences stress it diverts blood away to the muscles and away from the gut and increases muscle tone as part of the flight or fight response. This is advantageous as far as physical activity is concerned but in many modern situations, the body is sitting inactive so the additional blood flow and tension can lead to spasms and tightness.
Avoidance of normal activities out of fear for worsening pain
This is the natural instinct to protect a body part.
A better understanding of pain means we now know that pain is a function of the central nervous system. Although initially triggered by peripheral nociceptors, after this acute incidence the pain exists in the nervous system and is not being caused by trauma to tissues. Understanding this and gently beginning to move in a normal way, helps the body to realise that it is safe to move and stop sending the pain signals.
If movement is avoided out of fear this prevents the body from relearning natural movement and reinforces the pain pathways, which can make recovery much slower.
Catastrophising about worst-case scenarios
Associated with the all or nothing way of thinking. Some people are more prone to thinking this way and making generalisations. They may think of the worst-case scenarios and limit their activities to what they think a person with back pain ‘should’ and shouldn’t do. Often this is based on inaccurate beliefs and involve them protecting themselves from pain by avoiding certain movement, a belief that their back pain is due to a serious pathology may also develop.
Holding negative expectations and beliefs about pain and recovery
Having a pessimistic or negative outlook often occurs alongside catastrophising and is known to reduce the impact of treatment interventions. The relationship between body and mind is so strong that emotions and beliefs have a physiological influence on the body. The reverse is also true.
This is one of the reasons that psychological therapies including Cognitive Behavioural Therapy are used as a second line treatment for those whose LBP persist for longer than 6 weeks.