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8 
The kinesiopathological model and mechanical
low back pain
Linda R. Van Dillen*, Shirley A. Sahrmann† and Barbara J. Norton‡
*Program in Physical Therapy and Department of Orthopaedic Surgery, †Program in Physical Therapy, Department of Cell Biology and Physiology,
Department of Neurology and Neurophysiology and ‡Program in Physical Therapy and Department of Neurology, Washington University School
of Medicine at Washington University Medical Center, St Louis, Missouri, USA
CHAPTER CONTENTS
The kinesiopathological model 89
The kinesiopathological model and low
back pain 90
Low back pain subgroups 90
Studies of select aspects of the
kinesiopathological model 90
Movement and alignment patterns 91
Repetition of movements and
alignments 92
Contributing factors 94
Summary 96
References 97
Characteristic patterns of movements and alignments can
be recognized in many musculoskeletal pain conditions,
including mechanical low back pain (LBP). In some
instances the patterns displayed by patients can be linked
to a specific pathology, disease or injury. There are,
however, several musculoskeletal pain conditions in which
a specific causal link cannot be identified. A key question
in all instances is whether the movements and alignments
displayed by the person with musculoskeletal pain are a
consequence of the condition or contribute to the devel­
opment of the condition. One potential answer to this
question may be found in the kinesiopathological model
(Sahrmann 2002). A basic premise of the kinesiopatho­
logical model is that continual repetition of specific move­
ments and alignments which are requisite to performing
daily activities can lead to the development of musculo­
skeletal pain conditions (Fig. 8.1). The purposes of this
chapter are to: (i) describe the kinesiopathological model;
(ii) describe the application of the model to LBP; and (iii)
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review the findings from studies that have been conducted
to test assumptions of the model in patients with LBP.
THE KINESIOPATHOLOGICAL MODEL
The kinesiopathological model, hereinafter referred to as
the Model, describes a process that is proposed to contrib­
ute to the development, as well as the course, of many
musculoskeletal pain conditions, including mechanical
LBP. The process begins with repetition of a daily activity
associated with specific movements or specific alignments.
The repetitions are proposed to lead to adaptations in the
musculoskeletal and neural systems, for example, changes
in muscle strength, flexibility, stiffness, timing and level of
muscle activity, to name just a few. Although such adapta­
tions often may be beneficial, continual repetition of
specific movements and alignments may be increasingly
detrimental because the associated adaptations contribute
to imbalances about the joint(s). For example, repeated
trunk rotation to the right to reach for the phone (a trunk
rotation activity) could cause the muscles that contribute
to right trunk rotation to become shorter and stronger
while the muscles that contribute to left trunk rotation to
become longer and weaker. With continued repetition, the
adaptations would result in alterations in the joint motions
(accessory and physiological) and in joint alignments. The
alterations due to repeated performance of trunk rotation
to the right, in turn, lead to alterations in the motions and
alignments associated with many other daily activities, i.e.
patterns of altered movements and alignments. The repeti­
tion of altered patterns of movements and alignments are
proposed to result in localized regions of tissue stress,
symptoms and, eventually, tissue injury (Adams 2004).
According to the Model, the deleterious process can be
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