Rethinking Pain Behaviour in Physiotherapy: Beyond Fear-avoidance (part 1)
A biopsychosocial approach to lumbar disc herniationBy Jeroen van Dijken
Length5h 24m
About this audiobook
"If I lost this too, there would be nothing left."
A 67-year-old woman returns to physiotherapy with a recurrence of lumbar radiculopathy. She scores well above the clinical threshold for pain catastrophizing. And yet she is not avoiding anything. She gardens until her leg gives out, rests, and begins again the next day.
On the fear-avoidance model, the dominant framework in contemporary pain science, this patient should not exist. Catastrophic thinking is supposed to produce withdrawal. Hers produced the opposite.
Beyond Fear-Avoidance follows that single case from referral to discharge, and uses it to argue that physiotherapists have been taught one behavioural route from pain to disability when there are at least two. The second route, described by the avoidance-endurance model, is recognizable inside an ordinary consultation, carries the poorer prognosis of the two, and calls for a different intervention than the one most clinicians would reach for first.
Audiobook details
Rating★★★★★ 5.0 (1)
GenreEducation and Learning, Psychology
Length5 hrs 24 mins
Narrated byListen with 1,000+ voices
FormateBook with Audio
Publish dateOct 24, 2026
LanguageEnglish
Table of contents
1Preface
2Part I - The Foundation
3Chapter 1 - Introduction
4The dilemma that runs underneath
5The case at the heart of this book
Show all chaptersShow less
6Who this book is for
7How this book is organized
8Chapter 2 - Low Back Pain and Radiculopathy: The Biopsychosocial Context
9The scale of the problem
10What actually happens at the nerve root
11Why a purely biomedical account falls short
12The particular challenge of recurrence
13Setting the stage
14Chapter 3 - When the symptoms return
15The asymmetry between a first episode and a recurrence
16The weight of what else had changed
17Expectation as a clinical variable
18Two possible responses, and why this book focuses on one
19Chapter 4 - The Fear-Avoidance Model: A Foundational Account
20Origins: a model built to explain an uncomfortable observation
21The cycle, step by step
22Why the model has endured
23A model, not a universal law
24Where the model sits in a longer history
25What is now understood about the neurobiology of catastrophizing
26Sleep, rumination, and the sensitized nervous system
27Part II - Beyond Avoidance
28Chapter 5 - The Blind Spot
29The patient who will not stop
30Why the model does not see it
31The problem of the score that does not match the behaviour
32Overactivity as a clinical phenomenon
33What is needed
34Chapter 6 - The Avoidance-Endurance Model
35Four patterns, not two
36The mechanism: how persistence becomes harmful
37Which subgroup fares worst
38Where the patient in this book sits
39The clinical implication
40How the model developed
41The neuromuscular evidence in more detail
42Chapter 7 - Recognizing the Pattern in the Consulting Room
43Why the standard questions are not enough
44Formal instruments
45Four instruments bear on this assessment, each answering a different question.
46Applying this to the case
47A note on what recognition is for
48Chapter 8 - Two Patients, Two Patterns
49A patient who avoids: Mr. de Ruiter
50A patient who pushes through cheerfully: Alberts
Series
More from Jeroen van Dijken
A Brief History of IntelligenceMax S. Bennett12h 18m4.6 (6.6K)$29 · $0.00
HomeschooledStefan Merrill Block7h 10m3.6 (18.5K)$28 · $0.00
Children Under FireJohn Woodrow Cox10h 17m4.5 (1.6K)$29 · $0.00
The State Must ProvideAdam Harris7h 15m4.5 (775)$24 · $0.00
The Call of the Wild and FreeAinsley Arment9h 7m4.4 (21.2K)$29 · $0.00
The Freelance WayRobert Vlach19h 48m4.5 (528)$40 · $0.00
Race to the BottomLuke Rosiak9h 20m4.5 (600)$29 · $0.00
They Came for the SchoolsMike Hixenbaugh9h 5m4.5 (2.6K)$8 · $0.00
Find Me UnafraidKennedy Odede, Jessica Posner11h 11m4.5 (2.7K)$29 · $0.00
Asking for ItKate Harding8h 55m4.4 (5.3K)$20 · $0.00
Defining Moments in Black HistoryDick Gregory7h 37m4.4 (6K)$26 · $0.00
The Emerald Tablets of Thoth the AtlanteanMaurice Doreal3h 4m4.4 (8.8K)$6 · $0.00
Learning AmericaLuma Mufleh6h 37m4.4 (564)$24 · $0.00
Math-ishJo Boaler7h 21m4.4 (588)$24 · $0.00
Daddy-Long-LegsJean Webster12h 18m4.2 (91K)$0.99 · $0.00
It Worked For MeColin Powell7h 42m4.3 (9.8K)$26 · $0.00
Grammar-land; Or, Grammar in Fun for the Children of Schoolroom-shireM. L. Nesbitt2h 36m4.4 (488)$1 · $0.00
Financial FeministTori Dunlap8h 3m4.2 (22.2K)$8 · $0.00
DarkwaterWilliam Edward Burghardt Du Bois6h 40m4.3 (1.4K)$11 · $0.00
The Highway Code UKDepartment for Transport3h 33m4.2 (36.6K)$11 · $0.00
On Democracies and Death CultsDouglas Murray10h 38m4.6 (6.5K)$29 · $0.00
TerraformPropaganda5h 39m4.7 (594)$24 · $0.00
Southern Horrors: Lynch Law in All Its Phases (Annotated)Ida B. Wells-Barnett2h 44m4.6 (1.3K)$2 · $0.00
Hour of the HeartIrvin D. Yalom, Benjamin Yalom8h 19m4.6 (2.3K)$26 · $0.00
Braving the TruthRachel Held Evans11h 31m4.7 (359)$29 · $0.00
Level UpRob Dial7h 42m4.6 (3.3K)$26 · $0.00
As a JewSarah Hurwitz8h 36m4.6 (1.2K)$26 · $0.00
Saint Joan (Annotated)George Bernard Shaw6h 20m4.6 (1.2K)$1.20 · $0.00
Burn the HaystackJennie Young, PhD9h 30m4.6 (543)$29 · $0.00
Woman and the New Race (Annotated)Margaret Sanger6h 30m4.6 (1K)$1.99 · $0.00
Good InsideBecky Kennedy9h 55m4.5 (59.3K)$29 · $0.00
The Mis-Education of the NegroCarter Godwin Woodson5h 4m4.5 (29.4K)$1.20 · $0.00
Du Bois: EssaysW.E.B. Du Bois6h 22m4.6 (1.5K)$1 · $0.00
The North American Indian (Illustrated Edition)Edward S. Curtis, Frederick Webb Hodge5h 59m4.6 (1.4K)$2 · $0.00
Valley of the BirdtailAndrew Stobo Sniderman, Douglas Sanderson10h 1m4.6 (2.4K)$29 · $0.00
Lies My Therapist Told MeGreg E. Gifford9h 3m4.6 (503)$29 · $0.00
Disturbed in Their NestsAlephonsion Deng, Judy A. Bernstein11h 22m4.6 (595)$23 · $0.00
No Name in the StreetJames Baldwin5h4.5 (8.5K)$20 · $0.00
Narrative of the Life of Frederick DouglassFrederick Douglass4h 13m4.5 (309.9K)$1.20 · $0.00
Magic SeasonWade Rouse6h 41m4.6 (855)$24 · $0.00
You may also like
Reasons Not to WorryBrigid Delaney8h 25m4.1 (3.2K)$26 · $0.00
The Mindful DayLaurie J. Cameron8h 15m4.1 (2.8K)$20
Breathe In, Breathe OutStuart Sandeman11h 39m4.3 (2K)$29 · $0.00
13 Things Mentally Strong People Don't DoAmy Morin6h 36m4.0 (42.7K)$7 · $0.00
The Essays of Arthur Schopenhauer; Counsels and MaximsArthur Schopenhauer5h 57m4.4 (977)$1 · $0.00
I Know an Influencer Better Than My Own Neighbor - How to Recognize Parasocial Relationships, Keep Your Distance from Content Creators, and Stop Mistaking Regularly Watching Someone's Life for Truly Knowing ThemMax Paradox6h 31m$7.70
StoicismSaraban K. K. 1h 17m5.0 (8) Only with Ultra
I Can't Accept a Compliment Without Immediately Saying “But” - How to Accept Recognition, Stop Downplaying Yourself, and Stop Bouncing Every Kind Word Back Like a Ping-Pong BallMax Paradox6h 12m$5.10
Find True LoveFalco Wisskirchen30m$17 · $0.00
Negative Emotions: Emotional Self Help for Controlling Negative Feelings (Complete Step by Step Guide to Transforming Your Negativity Into Positive Energy)Martin Dempsey1h 41m4.1 (20)$3.50 · $0.00
Lament XVIJan Kochanowski (tłum. Dorothea Prall)2m4.1 (118)Free
Negative Emotions: Emotional Self Help for Controlling Negative Feelings (Complete Step by Step Guide to Transforming Your Negativity Into Positive Energy)John Culpepper47m5.0 (1)$3.50 · $0.00
Our Friendship Ended Without a Goodbye - How to Get Through the Quiet End of an Important Relationship, Accept the Lack of Closure, and Stop Waiting for a Conversation That May Never HappenMax Paradox6h 9m$5.10
How to Move Through Grief and Find Life After LossMax Paradox7h 17m$7.70
After the GoodbyeDanniel Silva3h 30m$1.80 · $0.00
They Laid Off Half the Team, and I Was Left with Their Work and My Guilt - How to Cope with Uncertainty, Extra Workloads, and Survivor's Guilt After Layoffs and Set Realistic ExpectationsMax Paradox6h 35m$5.10
Conquering ShadowsWillow R. Stone7h 40m$4.10 · $0.00
Spiritual Healing: Music For Meditation, Healing & Inner Peace (432 Hz)Sound Healing Academy10h 24m$23 · $0.00
StoicismHarrison Walton1h 8m4.0 (73) Only with Ultra
I Can't Let People Go - How to Stop Resuscitating Relationships That Left the Building Long AgoMax Paradox7h 20m$7.70