• Steven Z George, Joel E Bialosky, and Julie M Fritz.
• Department of Physical Therapy, Brooks Center for Rehabilitation Study, University of Florida, PO Box 100154, Gainesville, FL 32610-0154, USA. sgeorge@phhp.ufl.edu
• Phys Ther. 2004 Jun 1;84(6):538-49.

Background And PurposeElevated 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 DescriptionThe 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.InterventionTreatment-based classification and graded exercise were used.OutcomeDisability, 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.DiscussionDisability and fear-avoidance beliefs improved following a fear-avoidance-based physical therapy intervention. Research is warranted to investigate the effectiveness of this approach.

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