Decades of research have convincingly shown that fear of pain and pain-related avoidance
behavior are important precursors of disability in daily life. Reduced activity as a consequence of avoidance
, however, cannot be blamed for chronic disability in all patients. A contrasting behavior, pain-related dysfunctional endurance
in a task and overactivity
has to be considered. Currently, there is a need to better understand the psychological determinants of overactivity
, dysfunctional endurance
, and neurobiomechanical consequences.
This is a narrative review.
The first part of this review elucidates research on self-reported overactivity
, showing associations with higher levels of pain and disability, especially in spinal load positions, for example, lifting, bending, or spending too long a time in specific positions. In addition, measures of habitual endurance-related pain responses, based on the avoidance
-endurance model, are related to objective assessments of physical activity and, again, especially in positions known to cause high spinal load (part 2). The final part reveals findings from neuromuscular research on motor control indicating the possibility that, in particular, overactivity
and dysfunctional endurance
may result in a number of dysfunctional adaptations with repetitive strain injuries of muscles, ligaments, and vertebral segments as precursors of pain.
This narrative review brings together different research lines on overactivity
, pain-related endurance, and supposed neuromuscular consequences. Clinicians should distinguish between patients who rest and escape from pain at low levels of pain, but who have high levels of fear of pain and those who predominantly persist in activities despite severely increasing pain until a break will be enforced by intolerable pain levels.