Search Results (199)

Background: Work disability in fibromyalgia is only partially explained by symptom severity, suggesting a relevant contribution of cognitive–behavioral mechanisms. Objective: This study aimed to determine whether kinesiophobia is associated with fibromyalgia impact and work-related disability and to assess whether pain catastrophizing mediates these relationships within a hierarchical biopsychosocial framework. Methods: This cross-sectional study included 2096 women with fibromyalgia recruited through a nationwide online survey. Participants completed validated instruments assessing fibromyalgia impact (FIQ), pain catastrophizing (PCS), depressive symptoms (PHQ-9), central sensitization (CSI), and kinesiophobia (Tampa Scale). Pain-related work disability was defined using the Graded Chronic Pain Scale–Revised (GCPS-R). Hierarchical logistic regression models identified factors independently associated with work disability. Mediation was tested using bootstrapped analyses (5000 resamples). Results: Kinesiophobia demonstrated a robust independent association with work disability (OR 1.03; 95% CI 1.02–1.05) after adjustment for sociodemographic factors, clinical pain phenotype, systemic burden, pain severity, psychocognitive load, and medication burden. Other relevant contributors included pain severity (OR 1.96; 95% CI 1.70–2.27), psychocognitive burden (OR 1.35; 95% CI 1.15–1.58), use of benzodiazepines (OR 1.74; 95% CI 1.33–2.28), and opioid use (OR 1.29; 95% CI 1.06–1.56). Mediation analysis indicated a significant indirect effect of kinesiophobia on work disability through pain catastrophizing (β = 0.131; 95% CI 0.078–0.188). Conclusions: Kinesiophobia is a proximal determinant of work disability in fibromyalgia, exerting direct and cognitively mediated effects through pain catastrophizing, reinforcing the fear-avoidance framework and the need for psychologically informed rehabilitation. Full article

Background: Patellar tendinopathy is a common musculoskeletal condition that may impair functional performance and limit physical activity. While structural and mechanical factors have been widely investigated, the role of proprioceptive function and its interaction with behavioral and central pain-related mechanisms remain unclear. This study aimed to investigate the relationship between knee joint position sense, kinesiophobia, and central sensitization in individuals with chronic patellar tendinopathy. Methods: A total of 42 recreational athletes with clinically diagnosed chronic patellar tendinopathy were included in this cross-sectional study. Knee joint proprioception was assessed using joint position sense testing at multiple knee flexion angles with a continuous passive motion device. Kinesiophobia and central sensitization were evaluated using the Tampa Scale of Kinesiophobia and the Central Sensitization Inventory, respectively. Joint position sense values of the involved and contralateral extremities were compared, and correlation analyses were performed to examine associations between joint position sense and psychosocial variables. Results: The involved extremity demonstrated significantly greater absolute angular error compared to the contralateral side at higher knee flexion angles (≥60°, p < 0.01), whereas no significant differences were observed at lower angles. A moderate positive correlation was found between joint position sense error and kinesiophobia at higher flexion angles (≥30°, p < 0.01). No significant association was identified between joint position sense error and central sensitization across any of the tested angles (p > 0.05). Conclusions: Proprioceptive function is impaired in individuals with chronic patellar tendinopathy, particularly under increased mechanical demand. The association between joint position sense deficits and kinesiophobia, but not central sensitization, suggests a potential relationship between movement-related fear and sensorimotor alterations. These findings highlight the importance of incorporating proprioceptive assessment and addressing kinesiophobia in the clinical management of patellar 36 tendinopathy. Full article

Background: No systematic review has yet been conducted simultaneously on the effectiveness of psychological interventions across multiple outcome measures during rehabilitation following anterior cruciate ligament reconstruction (ACLR). This study aims to assess the effects of such interventions on pain, psychological outcomes, patient-reported knee function, objective knee measures, and quality of life following ACLR. Methods: We searched PubMed, Medline, Embase, PsycINFO, and the Cochrane Library from inception to 20 April 2026 (PROSPERO CRD42023483889). Eligible randomized controlled trials compared psychological interventions with usual care in ACLR patients. Two reviewers assessed eligibility, risk of bias, and extracted data. Random-effects models were used; effect sizes were interpreted using Cohen’s guidelines. Results: Of 401 records screened, 11 RCTs (440 participants) were included. Psychological interventions significantly improved pain (six trials, SMD = −0.96, 95% CI −1.40 to −0.52, p < 0.001, I² = 47%; large effect), kinesiophobia (TSK-11: five trials, SMD = −0.48, −0.74 to −0.22, I² = 0%; small effect), knee self-efficacy (K-SES: three trials, SMD = 0.53, 0.19–0.86, I² = 0%, moderate effect), patient-reported knee function (IKDC: two trials, SMD = 0.58, 0.26–0.90, I² = 0%, moderate effect), and physical role function (SF-36: two trials, SMD = 0.41, 0.04–0.78, I² = 0%, small effect). No significant effects were found for KT1000, knee strength, SF-36 mental well-being, or ACL-RSI (all p > 0.05, with substantial heterogeneity for ACL-RSI). Particularly, imagery therapy reduced pain (three trials, SMD = −1.54, I² = 15%). Conclusions: This meta-analysis provides preliminary evidence that psychological interventions, especially imagery therapy, may improve pain, psychological outcomes, patient-reported knee function, and quality of life after ACLR. Adequately powered trials with standardized protocols are needed to confirm these findings. Full article

Introduction: Chronic non-specific neck pain (CNSNP) is a prevalent condition where active myofascial trigger points (A-MTrPs) are commonly detected in cervical muscles and may be associated with altered electromyographic activity (EMGact). However, their association with EMGact during functional tasks remains unclear. Objectives: This study aimed to explore this relationship, hypothesizing that A-MTrPs in cervical muscles would be associated with altered EMGact. Methods: An analytical cross-sectional exploratory study was conducted in 52 patients with CNSNP. Surface EMGact of the sternocleidomastoid (SCM), anterior scalene (AS), and upper trapezius (UT) muscles was recorded during the craniocervical flexion test (CCFT) and an isometric shoulder abduction task (ABD-90). Linear mixed-effects models were constructed to identify factors associated with EMGact. Age, pain intensity, pain duration, analgesic dose, anti-inflammatory dose, and kinesiophobia score were included as covariates, while gender, physical activity level, and the presence or absence of A-MTrPs were included as categorical factors. Results: At the 22 mmHg CCFT level, analgesic consumption was positively associated with peak EMGact and average AS activation (B = 0.791 and B = 0.223, respectively) and with SCM peak EMG act (B = 0.510). At the same level, kinesiophobia was associated with average SCM EMGact (B = 0.231). At the 26 mmHg CCFT level, average AS activation remained positively associated with analgesic consumption (B = 0.148) and SCM without A-MTrPs was associated with lower EMGact compared to SCM with A-MTrPs. At the 30 mmHg CCFT level, kinesiophobia was negatively associated with average EMGact of AS. In the UT muscle, during ABD-90, kinesiophobia was negatively associated with both peak (B = −0.378) and average EMGact (B = −0.132). Conclusions: The presence of A-MTrPs may be related to SCM EMGact during CCFT in individuals with CNSNP, while analgesic consumption and kinesiophobia also could be associated with cervical muscles EMGact during functional tasks. Full article

Background/Objective: Kinesiophobia is a major fear-avoidance concept in chronic low back pain (CLBP); however, its independent contribution to pain, disability, and health-related quality of life (HRQoL) beyond sociodemographic and clinical variables remains unclear. This study aimed to evaluate the associations between kinesiophobia and patient-reported outcomes in adults with chronic low back pain regarding (i) pain intensity, (ii) functional disability, and (iii) HRQoL. Methods: This cross-sectional study included 298 participants with CLBP (average age 38.7 ± 13.2 years; 58.0% female). Kinesiophobia was evaluated using the Tampa Scale of Kinesiophobia (range, 17–68). Outcomes were pain intensity (Numerical Pain Rating Scale; 0–10), functional disability (Roland–Morris Disability Questionnaire; 0–24), and HRQoL (RAND-36; 0–100). Two multivariable linear regression models were used per outcome. Model 1 was adjusted for sex and age, and Model 2 was additionally adjusted for BMI, marital status, education, employment, smoking status, and chronic disease. Hierarchical regression analysis evaluated the incremental variance explained by kinesiophobia (ΔR²) when entered after all covariates. Effects were reported per 10-point increase in Tampa score, with 95% confidence intervals (CI). Results: In the fully adjusted models, higher kinesiophobia was associated with greater pain intensity (B = +1.17 points per 10 Tampa; 95% CI 0.55–1.79, p < 0.001), greater disability (B = +3.24 points; 95% CI 2.05–4.43; p < 0.001), and lower HRQoL (B = −7.98 points; 95% CI −11.1–−4.81; p < 0.001). Hierarchical regression analyses showed that kinesiophobia explained additional variance in pain (ΔR² = 0.11), disability (0.12), and HRQoL (0.11), all p < 0.001. Conclusions: In adults with CLBP, kinesiophobia was associated with greater pain intensity, functional disability, and lower HRQoL, accounting for 11–12% of variance in each outcome beyond demographic and clinical covariates. These findings support routine assessment of kinesiophobia and justify longitudinal and interventional studies to determine temporal relationships and treatment effects. Full article

Background and Objectives: Chronic neck pain is a prevalent condition linked to functional disability and maladaptive pain-related behaviors. Although the physical and psychosocial impairments have been extensively studied in the literature, the factors related to cognitive impairments are not fully understood. This study aimed to examine the physical, psychosocial, and cognitive impairments associated with chronic neck pain and examine the variables associated with cognitive performance in this population. Materials and Methods: This cross-sectional study included 87 individuals with chronic neck pain. Pain sensitivity, neck disability, physical capacity, cervical muscle strength, pain catastrophizing, kinesiophobia, and self-reported central sensitization were assessed in all participants. Within the scope of the neuropsychological assessment, global cognition, processing speed, attention, and executive functioning were evaluated. The relationship between physical, psychosocial, and cognitive impairments was assessed using Spearman correlation. Additionally, a multiple linear regression analysis was performed to assess the extent to which the independent variables were associated with cognitive performance. Results: Global cognition was moderately correlated with pain intensity (r = −0.427, p < 0.001) and pain catastrophizing (r = −0.414, p < 0.001). Difficulties in response inhibition were moderately related to age (r = 0.440, p < 0.001). Cervical muscle strength (r = 0.384–0.233) and physical capacity (r = 0.332) were also weakly correlated with global cognition (p < 0.05). Age exhibited the strongest relationship with global cognition (β = −0.332, p < 0.001), followed by pain intensity (β = −0.291, p = 0.004) and pain sensitivity (β = 0.253, p = 0.011), with an explained variance of 30.8%. Additionally, age showed the strongest association with difficulties in processing speed (β = 0.448, p < 0.001), followed by kinesiophobia (β = 0.325, p = 0.001) and neck disability (β = 0.262, p = 0.030), with an explained variance of 34.2%. Conclusions: These findings suggest that increased nociceptive sensitization and deficits in physical health may be associated with maladaptive pain-related coping strategies in individuals with chronic neck pain. Furthermore, cognitive impairments in these individuals may reflect a multidimensional association of demographic, physical, psychosocial, and sensorial mechanisms. Full article

Background/Objectives: Early mobilization following open-heart surgery is a key component of postoperative recovery, yet psychological barriers such as kinesiophobia (fear of movement) may limit patient participation. This study examined the association between kinesiophobia and mobilization level in patients after open-heart surgery and explored sociodemographic and clinical correlates of both variables. Methods: A cross-sectional descriptive design was used. The sample comprised 96 adult cardiac surgery patients recruited consecutively from cardiovascular surgery ICUs at two centers in Istanbul—a public training and research hospital and a foundation-affiliated university hospital—between December 2024 and April 2025. Data were collected via a Personal Information Form, the Tampa Scale of Kinesiophobia (TSK), and the Intensive Care Units Mobility Scale (IMS). Analyses (SPSS 25.0) included Mann–Whitney U and Kruskal–Wallis H tests, Pearson correlation with 95% confidence intervals (CIs) calculated via Fisher’s z-transformation, Bonferroni correction for k = 12 subgroup comparisons within each outcome, and a multivariable linear regression adjusted for sex, age, smoking, and history of surgery. Results: Of the 96 patients enrolled, 76.0% were male, with a mean age of 58.30 ± 6.50 years (SD) and a mean body mass index of 27.53 ± 5.84 kg/m². The mean TSK total score was 46.81 ± 6.51 and the mean IMS score was 5.48 ± 0.73. Kinesiophobia and mobilization showed a small inverse association that reached statistical significance (r = −0.104; 95% CI: −0.298 to 0.099; r² = 0.011; p = 0.041), accounting for approximately 1% of the variance in mobilization. After multivariable adjustment, kinesiophobia was no longer a significant predictor (β = −0.092; p = 0.360), whereas smoking (β = −0.279; p = 0.008) and female sex (β = 0.215; p = 0.039) emerged as the strongest independent correlates. Mobilization level differed by gender and smoking, and kinesiophobia level differed by marital status, history of surgery, and family history of heart disease at the uncorrected level; however, none of these subgroup differences remained significant after Bonferroni correction. Conclusions: Higher kinesiophobia scores were associated with lower mobilization levels following open-heart surgery, but the effect size was small and the association did not persist after adjustment for clinical confounders. The cross-sectional design precludes causal inference. Kinesiophobia may be considered as one of several psychosocial factors potentially relevant to postoperative mobilization rather than as a primary determinant. Full article

Background/Objectives: Chronic pain in older adults is a highly disabling epidemic, often overtreated with passive pharmacological approaches. Although clinical guidelines recommend active strategies combining multicomponent exercise and Pain Neuroscience Education (PNE), robust geriatric evidence remains scarce. Therefore, the central objective of this randomized controlled trial (RCT) is to evaluate the efficacy of combined PNE and exercise versus exercise alone. Crucially, this RCT addresses a major literature gap by investigating the long-term dose–response effect of PNE (an 8-week intensive vs. a 32-week maintenance program) to determine the optimal strategy for sustaining behavioral change and pain relief. Methods: A prospective, single-blind RCT (1:1:1 allocation) will recruit 90 older adults (≥65 years) with primary chronic musculoskeletal pain. The 32-week intervention comprises three arms: a control group (multicomponent exercise), Intervention Group 1 (exercise + 8 weeks of PNE), and Intervention Group 2 (exercise + 32 weeks of PNE). The primary outcome is pain intensity (assessed via the Numeric Rating Scale [NRS]). Secondary outcomes include kinesiophobia, pain catastrophizing, chronic pain grade and related disability, quality of life, physical performance, body composition and analgesic consumption. Data collected at baseline, 8, and 32 weeks will be analyzed using mixed-effects models for repeated measures. Results: As this is a study protocol, there are no results to report yet. Upon completion of the trial, data will be analyzed using mixed-effects models for repeated measures to evaluate intra- and intergroup changes over time, and the findings will be disseminated in future publications. Conclusions: By evaluating the long-term dose–response effect, this study will determine the optimal PNE dosage required for sustained pain relief and behavioral change in older adults. If our hypotheses are confirmed, the findings will generate high-quality evidence to support the integration of combined active interventions into community settings, promoting active aging and reducing the burden of chronic pain. Trial Registration: ClinicalTrials.gov Identifier: NCT07287501. Full article

Background/objectives: Total knee arthroplasty is one of the most commonly performed orthopedic procedures of the lower extremities, primarily for patients with osteoarthritis or rheumatoid arthritis. Despite its widespread use, evidence remains limited regarding the association between patient satisfaction, kinesiophobia, and pain during the early postoperative period. The purpose of the present study was to examine the relationships and differences among satisfaction, kinesiophobia, and pain in hospitalized patients following total knee arthroplasty, as well as to compare these variables across four postoperative time points. Methods: A total of 41 patients, aged 65–85 years, participated in this study. Patient satisfaction was assessed using a structured satisfaction questionnaire, kinesiophobia was assessed using the Greek version of Tampa Scale of Kinesiophobia, and pain was assessed using the Visual Analogue Scale. Measurements were obtained on the first postoperative day, on the day of hospital discharge, fifteen days after discharge, and four weeks after discharge. Normality was assessed using the Shapiro–Wilk test, indicating non-normally distributed data. The relationship between the variables were examined using Spearman’s correlation coefficient. Comparisons between the four postoperative time points were conducted using the Friedman test with Kendall’s W for effect size estimation, followed by Wilcoxon post hoc analyses with Bonferroni corrections. Results: The results showed that a significant negative correlation between satisfaction and kinesiophobia was observed at the fourth phase (r = −0.41, p = 0.04). Satisfaction was also negatively correlated with pain from the third to the fourth phase (r = −0.41, p = 0.008), whereas kinesiophobia demonstrated a significant positive correlation with pain from the second to the fourth phase (r = 0.47–0.56, p = 0.002). Friedman test comparisons revealed a significant increase in satisfaction over time (χ² (3) = 13.88, p = 0.003), a significant progressive decrease in kinesiophobia with a moderate effect size (χ² (3) = 76.40, p < 0.001; Kendall’s W = 0.62), and a significant progressive reduction in pain with a large effect size (χ² (3) = 89.60, p < 0.001; Kendall’s W = 0.73). Conclusions: These findings indicate that satisfaction, kinesiophobia, and pain are significantly interrelated during the early postoperative period following total knee arthroplasty. Further studies with larger samples and longer follow-up periods are required to confirm these associations and support the development of targeted rehabilitation strategies. Full article

Background/Objectives: Psychological barriers, particularly kinesiophobia and diminished psychological readiness, represent critical yet undertreated obstacles to a successful return to sport following anterior cruciate ligament reconstruction (ACLR). Scalable, preference-aligned educational interventions capable of addressing these barriers during early rehabilitation are lacking. We aimed to evaluate the effectiveness of structured educational content delivered via Snapchat, as an adjunct to standard ACLR rehabilitation, in reducing kinesiophobia (primary outcome) and improving psychological readiness and perceived knee function (secondary outcomes). Methods: A total of 120 adults with clinically elevated kinesiophobia (TSK-17 > 37) undergoing post-operative ACLR rehabilitation were enrolled in a quasi-experimental, two-arm study with non-randomized allocation at the clinic-branch level at two branches of the same sports rehabilitation clinic (Joint Clinics, Riyadh, Saudi Arabia). Branch allocation assigned 60 participants to each group (intervention and control). The intervention group received 12 weekly structured educational videos via Snapchat alongside standard rehabilitation; the control group received standard rehabilitation alongside general ACLR information videos via Snapchat. TSK-17, ACL-RSI, and IKDC were assessed at baseline and at 12 weeks. Primary analysis used ANCOVA covarying baseline scores, complemented by mixed repeated measures ANOVA and intent-to-treat analysis. Results: Both groups improved across all outcomes; the intervention group demonstrated significantly greater gains. ANCOVA revealed significant between-group differences favoring the intervention for TSK-17 (adjusted mean difference = −2.82; d = 0.54; p < 0.001; d represents Cohen’s d calculated from adjusted mean differences and pooled SD), ACL-RSI (+8.06; d = 0.77; p < 0.001), and IKDC (+8.90; d = 0.54; p = 0.002). Mean video completion was 82.8% among intervention participants. Intent-to-treat analyses using Multiple Imputation confirmed all findings. Conclusions: Snapchat-based structured education was associated with improvements in kinesiophobia, psychological readiness, and perceived knee function among the 102 analyzed participants (control n = 52; intervention n = 50) of the 120 enrolled. High engagement supports preference-based digital delivery as a scalable adjunct to standard rehabilitation. Full article

Background: This cross-sectional study aimed to determine the status of kinesiophobia in patients with fibromyalgia syndrome (FMS) and to evaluate its relationship with cognitive functions, anxiety, depression, disease severity, and pain level. Methods: Fifty FMS patients (mean age 44.06 years; range 18 to 60 years) were included in the study. Fifty healthy participants (mean age 42.04 years; range 18 to 60 years) were included in the study as a control group. Participant recruitment for the study was conducted in a state hospital in Türkiye. Disease severity level in the FMS group was assessed using the Fibromyalgia Impact Questionnaire (FIQ). The Tampa Scale for Kinesiophobia (TSK) was administered to determine the participants’ kinesiophobia status. The Hospital Anxiety and Depression Scale (HADS) was used to assess the participants’ anxiety and depression status. The Montreal Cognitive Assessment (MoCA) test was administered to assess cognitive functions. Results: TSK, HADS-Anxiety, Visual Analog Scale (VAS), and FIQ scores were higher in the FMS group compared to the control group (p < 0.05). MoCA total scores, MoCA-Visuospatial/Executive, and MoCA-Attention scores were higher in the control group (p < 0.05). There was a weak positive correlation between TSK and FIQ scores in the FMS group (p: 0.02, r: 0.31). There was a weak negative correlation between TSK and MoCA-Naming scores in the FMS group (p: 0.02, r: −0.31). Conclusions: Increased kinesiophobia was found in FMS patients compared to the general population. It was determined that the level of kinesiophobia in FMS patients was related to disease severity and naming-related cognitive functions. Clinicians dealing with FMS should take this into particular consideration. Full article

Background: Temporomandibular disorders (TMDs) are frequently underdiagnosed in patients with psoriatic arthritis (PsA), and the mechanisms underlying their development remain poorly understood. While inflammatory processes may contribute, central pain sensitization and psychological factors could play a significant role in TMD pathogenesis. Objective: The objectives of this study were to evaluate clinical characteristics, disease activity, psychiatric comorbidities, and pain processing mechanisms in PsA patients with and without TMD and to identify factors independently associated with temporomandibular involvement. Methods: This cross-sectional observational study included 190 consecutive PsA patients (CASPAR criteria) from a single tertiary center. Patients with fibromyalgia were excluded. TMD was assessed by maxillofacial specialists. Disease activity (cDAPSA), functional status (HAQ-DI), disease impact (PsAID-12), central sensitization (Central Sensitization Inventory, CSI), kinesiophobia (Tampa Scale for Kinesiophobia, TSK-11), pressure pain threshold (algometry), and emotional comorbidities (Hospital Anxiety and Depression Scale, HADS) were evaluated. An exploratory binary logistic regression identified a factor independently associated with TMD. Results: Twenty-five patients (13.1%) had confirmed TMD, with a significant female predominance (76% vs. 39%; p = 0.001). Only 24% of patients exhibited structural damage on orthopantomography. TMD patients showed higher CSI scores (52 vs. 32; p < 0.001), greater kinesiophobia (TSK-11: 30 vs. 23; p = 0.002), lower pressure pain thresholds (2.1 vs 2.7 kg/cm²; p = 0.03), and higher anxiety (HADS-A: 9 vs. 5; p = 0.001) and depression scores (HADS-D: 6.5 vs. 3; p = 0.001). TMD patients also exhibited worse functional status (HAQ-DI: 0.7 vs. 0.3; p = 0.001) and greater disease impact (PsAID-12: 4.8 vs. 2.9; p = 0.001). In multivariate analysis, central sensitization (OR: 1.1; 95%CI: 1.04–1.18; p = 0.001) and anxiety (OR: 1.2; 95%CI: 1.02–1.61; p = 0.02) were independently associated with TMD (Nagelkerke R² = 0.48). Conclusion: TMD in PsA is associated with central sensitization and anxiety rather than mechanisms secondary to bone damage. These findings support a multidimensional approach incorporating screening for central sensitization and psychiatric comorbidities in PsA patients with temporomandibular symptoms. Full article

Background/Objectives: Inflammatory bowel diseases (IBDs) cause gastrointestinal symptoms that affect patients’ quality of life. IBD improves with physical activity; however, fear of movement is a limiting factor. This study aimed to evaluate the impact of kinesiophobia and assess patients’ knowledge on the role of physical activity and physiotherapists in IBD management. Methods: Participants completed online questionnaires to evaluate demographic and clinical data, lifestyle, physical activity, joint complaints, and physiotherapy preferences. The Tampa Kinesiophobia Scale (TKS) was employed to assess kinesiophobia, and the Godin scale was used to assess regular physical activity. Results: Overall, 356 patients with IBD were analyzed. In total, 51% of the patients reported a decrease in physical activity. Of these, 93% have not consulted a physiotherapist, with 51% expressing a need for it. Meanwhile, 75% of the patients wanted additional information. Higher TKS scores were associated with CD, age, and joint pain. The level of kinesiophobia was high and negatively correlated with the amount of physical activity. Conclusions: Physiotherapists play an important role in patient education and influencing lifestyle in IBD. Their expertise is underutilized, and patients should be sufficiently informed regarding their illness. Integrating education and physiotherapy may reduce kinesiophobia and improve patients’ quality of life. Full article

Non-organic (muscle) weakness (NOw) is proposed as a distinct pathological entity characterized by maladaptive neuroplasticity (learning) affecting motor control. Functional deficits are most directly revealed through the manual muscle testing (MMT) break test, which uniquely exposes a muscle’s ability to adapt to increasing external load, potentially serving as an index of motor control integrity. We advance the “muscle-motor-movement PTSD” (mPTSD) model in which learning during pain or stress (trauma) yields chronic avoidance (inhibition) of the associated muscles. In a second stage, compensatory synergies develop, overriding attempts at hypertrophy-oriented training. This non-systematic, integrative review synthesizes clinical reports, learning theories, motor control and pain literature, and objective tests of force and movement over time during MMT. Predictive processing and reinforcement learning offer complementary accounts of how hyper-precise priors and passive avoidance may maintain NOw beyond functional recovery. Unexplained muscle weakness is found in non-specific musculoskeletal disorders and functional motor disorder (functional weakness), but may also contribute to other conditions, such as kinesiophobia. Effective alternative treatments for NOw may act by updating or erasing maladaptive motor learning by disrupting memory reconsolidation, allowing immediate restoration of function. Analogous to psychoneuroimmunology’s role in immune function, we propose “psychoneurokinesiology”, the study of how maladaptive learning affects movement. Full article

Background/Objectives: Anterior cruciate ligament reconstruction (ACLR) is a common orthopedic procedure; however, successful return to sport (RTS) remains a major challenge influenced by both physical and psychological factors. Kinesiophobia and psychological readiness are crucial yet inadequately studied components of rehabilitation that may change across distinct phases. This study aimed to examine longitudinal, phase-specific changes in kinesiophobia, psychological readiness, and patient-reported knee function across standardized ACLR rehabilitation phases. Methods: A retrospective longitudinal cohort design was employed. Data were extracted from 45 patients who completed ACLR rehabilitation at a specialized musculoskeletal center in Riyadh, Saudi Arabia. Participants were assessed across four rehabilitation phases: Phase One (0–1 month), Phase Two (>1–3 months), Phase Three (>3–6 months), and Phase Four (>6 months post-ACLR). Outcomes included the Tampa Scale of Kinesiophobia (TSK-17), the ACL–Return to Sport after Injury scale (ACL-RSI), and the International Knee Documentation Committee subjective knee form (IKDC), administered using validated Arabic versions. Linear mixed-effects models with Bonferroni-adjusted pairwise comparisons were used to evaluate phase-related changes. Results: Significant fixed effects of rehabilitation phase were observed for all outcomes (p < 0.001). Kinesiophobia declined substantially from Phase One (mean 51.5) to Phase Three (34.7), with the greatest reduction between Phases Two and Three, followed by stabilization in Phase Four. Psychological readiness increased progressively across all phases (ACL-RSI: 37.1 to 61.8). Knee function demonstrated the greatest improvement during late rehabilitation (IKDC: 37.6 to 75.8). Conclusions: Psychological and functional recovery following ACLR follow distinct temporal trajectories rather than improving synchronously. Kinesiophobia declines most markedly during mid-rehabilitation, while functional gains peak in late rehabilitation. These findings support integrating structured psychological screening into phase-specific ACLR rehabilitation protocols. Full article