Acute Lower Back Pain? How To Prevent Chronic Low Back Pain: Fear Avoidance

By Dr Ken Nakamura+

Acute Lower Back Pain? How To Prevent Chronic Lower Back Pain: Downtown Toronto Chiropractic

Do you avoid the pain from your acute lower back pain at all costs or do you go about your life despite your lower back pain?


What you think about your lower back will determine if your acute lower back pain will turn into chronic low back pain.


Your attitude towards your lower back is one important factor in your recovery. Exercises are great, many treatments including chiropractic care and rehabilitation are helpful but one of the key hurdles to your recovery is how you preceive lower back pain and pain in general.


More than any other pain, lower back pain is influenced by your attitude towards pain. Headaches, neck pain, jaw pain all are affected by what you think the pain will do to you. Lower back pain recovery on the hand is heavily influenced by your mind.


When you avoid certain movements and positions it’s called Fear-Avoidance Beliefs (FAB).  FAB are either based on how you feel emotionally or based on information you heard about, read about on-line or what your mother told you about. Excessive FAB will affect how long it takes you to recover, how many treatments you will need, the severity of your pain and whether it will turn into chronic low back pain.


Your fear even affects how disabled you will become. If left unchecked your acute lower back pain can become chronic low back pain.


You will fit into one of three types.

Misinformed Avoiders

Most of you are in this category. You believe that certain movements will cause you re-injury and increase pain so you simply avoid these movements.  You are not particularly stressed or disabled by the pain.


A proper explanation by your chiropractor of why you are having pain and how it can be helped and most important of all, to not fear your back pain, will help your acute lower back pain from continuing on to become chronic low back pain.


Learned Avoiders

You don’t have any particular beliefs about pain so you don’t fear re-injury or increased pain. You simply avoid the movements and activities that cause you pain. You don’t have irrational fears about pain.


Your pain likely won’t turn into chronic low back pain. Your pain will only become chronic low back pain if your lower back is seriously hurt.


Affective Avoiders

You are deeply distressed about doing physical activities as this may cause you chronic low back pain. You are disabled and committed to being disabled.

Acute Lower Back Pain? How To Prevent Chronic Low Back Pain: Downtown Toronto Chiropractic

Whether you have acute or chronic pain if you are an affective avoider you will most likely have more severe pain for a longer period and have more disability. The consequence is that you will miss more time off work and any acute pain will turn into chronic low back pain. Any treatments meant to help you will be less effective. Symptoms may even decrease but your fear will remain.


If you are in this category you need to have your catastrophic thinking addressed. For example you will think a minor fender bender has done you irreparable harm. You can address this by counselling. Physical treatments are rendered less effective and sometimes even ineffective as you feel that you have been permanently harmed and turn into chronic low back pain.


Your Health Practitioner’s Beliefs


Your health practitioner’s belief and motives will also affect your recovery. Be aware that some health practitioners will try to play on your fears when they are explaining your diagnosis. By exaggerating the seriousness of your problem the aim of their game is to get you to return more often.


To prevent this from happening to you, think about the following.

  1. Think about how your pain or problem is affecting your life. For example you might have trouble standing or sitting for long periods of time or you might not be able to do your daily run without pain afterwards. The more it affects your life the more likely your treatment will take longer.
  2. How long have you had the problem. The longer you have a problem the more likely that it will take longer to recover
  3. The younger you are the shorter the recovery time.
  4. What grade is your injury? A first-degree ankle sprain usually heals by itself within a week, while a second-degree sprain will take anywhere from 3-8 weeks. A third degree sprain will take the longest as their is more of an injury.
  5. Do you have other diseases or illness? If you have diabetes or high cholesterol, high blood pressure, etc… the longer it will take you to recover. These are signs that the body already has an imbalance and one more things to deal with puts a burden on the healing process.
  6. Get a second opinion. I have had other chiropractors offer 80 visits for most of their conditions. I know of no condition that takes 80 visits to get better. You should move on long before then. As a general rule give it one month, for more severe and chronic problems two months.
  7. Do you feel like you are being sold something. Than be very wary. You should feel that your health practitioner is trying to explain your diagnosis not trying to scare you or sell you on their treatment plan.
  8. You should get the feeling that your health practitioner is trying to decrease your fears.
  9. Can they treat you that day. Some clinics won’t treat you that day so they can get one more treatment out of you and minimize their time with you.


Tell us what you think in the comments below and like us on Facebook. I will answer all questions in the comments section here at this downtown Toronto Chiropractic clinic.




1. Rainville J, Smeets RJEM, Bendix T et al.Fear-avoidance beliefs & pain avoidance in low back pain – translating research into clinical practice, March 2012

2. Fritz JM, George SZ, Delitto A. The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status. Pain 2001; 94(1): 7-15.

3. Jensen JN, Albertsen K, Borg V, Nabe-Nielsen K. The predictive effect of fear-avoidance beliefs on lowback pain among newly qualified health care workers with and without previous low back pain: a prospective cohort study. BMC Musculoskeletal Disorders 2009; 10: 117.

4. Coudeyre E, Tubach F, Rannou F, BaronG et al. Fear-avoidance beliefs about back pain in patients with acute LBP. Clin J Pain 2007; 23(8): 720-5.

5. Vlaeyen JWS, Linton SJ (2000) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000; 85(3): 317-332.


Dr Ken Nakamura

6 Responses to Acute Lower Back Pain? How To Prevent Chronic Low Back Pain: Fear Avoidance
  • Susanna says:
    October 7, 2014 at 10:17 pm

    Thank you for this wonderful blog-post. Fear avoidance after my discectomy 6 weeks ago is huge. I haven’t found a professional yet to guide me through a proper program to regain strength and confidence in my body. On the other side: “pushing through the pain” and continuing workouts is what got me to my mega herniation to begin with. So my wish for your blog would be: exercises to regain strength (you do have some) and how to continuously build and increase fitness without re-injuring myself and maintaining spine health.

  • Sara says:
    August 10, 2014 at 4:27 am

    This is one of the greatest articles on the fear of relapsing that I have ever come across. Kudos to you Ken. You hit the nail on the head for me at least. I am a classic avoider for the last 3 months since having herniated L4/L5 and other subluxations. You were also correct on the hard sell and 80 visits and getting nowhere. Today, I changed my hard sell Chiropractor and went to the one who minimized my fear, asked me to get my butt back to work and also told me that I am going to do great. I felt a reliief running down my spine since I have been out for 6 weeks from work.

    Thank you and for the others including myself. Print this and stick to your wall so that you can read this every single day

    You’re the best Ken!!!! Sara

    • Dr Ken Nakamura says:
      August 11, 2014 at 2:28 am

      Thanks for your vote of confidence. I am just trying to make a difference for the better for as much of the people in this world.

  • Primla Luthra says:
    July 9, 2014 at 12:31 pm

    I have got a slipped disc. Still waiting for consultant appointment. I very muscle spasm and pains on my leg I m taking painkillers. Should I b doing exercise any exercise now to reduce pain.

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