PURPOSE: This study examines the relationship between low back pain, disability 
and fatigue and overt physical activity with respect to fear-avoidance and 
endurance-related subgroups.
METHOD: 49 patients completed questionnaires (Pain, Disability, Fatigue, 
Depression, Pain-responses pattern) 6 months after lumbar disc surgery and 
underwent an 8-hour accelerometer assessment measuring overall physical activity 
(PAL), constant strain postures (CSP), standing time (ST) and lying time (LT). 
Four subgroups, representing patterns of distress-endurance (DER), 
eustress-endurance (EER), fear-avoidance (FAR) and adaptive responses (AR) due 
to the avoidance-endurance model of pain-regulation were investigated.
RESULTS: Multivariate analyses of covariance revealed significantly higher pain, 
disability and fatigue in FAR compared to AR patients and, as expected lower PAL 
and CSP in FAR than in endurance patients. Both endurance groups revealed higher 
pain accompanied by higher accelerometer-based physical activity (PAL, CSP) than 
AR and FAR patients. Most of the subgroup differences displayed moderate to high 
effect sizes.
CONCLUSIONS: The results indicate different pathways to chronic pain and 
disability with physical underuse in FAR patients and overuse/overload in 
endurance patients suggesting the need for individually targeted 
cognitive-behavioral treatments in the maladaptive groups. Implications for 
Rehabilitation Improving the return to a normal physical activity level is an 
important goal for the rehabilitation of patients after lumbar disc surgery. 
Different pathways to chronic pain and disability with physical underuse in 
fear-avoidance patients and overuse in endurance patients should be considered. 
Different pain-related pain response pattern, based on the avoidance-endurance 
model, indicate the need for individual targeting of rehabilitation programs.