Tampa Scale of Kinesiophobia

The Tampa Scale of Kinesiophobia (TSK) is a foundational 17-item self-report measure developed to assess fear of movement, or fear of (re)injury, primarily…

Questions: 17
Duration: 5 min
Original title: Tampa Scale of Kinesiophobia
Adaptation: Tampa Scale of Kinesiophobia
Authors: Kori, S.H., Miller, R.P., & Todd, D.D.
Created: 1990

The Tampa Scale of Kinesiophobia (TSK) is a foundational 17-item self-report measure developed to assess fear of movement, or fear of (re)injury, primarily in populations experiencing chronic musculoskeletal pain. Originally formulated by Kori, Miller, and Todd, the TSK helps clinicians identify the cognitive and emotional barriers that cause patients to struggle against their symptoms rather than engage in physical activity. High levels of kinesiophobia often trap individuals in a vicious cycle of avoidance, deconditioning, and worsening disability, making it a critical construct to evaluate during rehabilitation and pain management.

Using the TSK provides a validated, repeatable metric to monitor fear-avoidance beliefs over the course of treatment. This is particularly valuable when patients present with high distress or when their physical impairment appears disproportionate to the organic pathology. By quantifying this fear, clinicians can tailor their psychoeducation, gradually dismantle automatic avoidance behaviors, and confidently guide the patient toward safely re-engaging with movement.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

41/ 68

The Tampa Scale for Kinesiophobia (TSK) is a 17-item self-report questionnaire that assesses fear of movement or (re)injury related to pain. It is used to identify patients in whom kinesiophobia (fear of movement) acts as a barrier to functional recovery, particularly in the context of chronic pain (low back pain, fibromyalgia).

17–36

Kinesiophobia below the threshold

37–68

high score

high degree of kinesiophobia, predictive of poorer health outcomes

Scoring

Sum, total score from 17 to 68, each item is scored on a 4-point scale (from 1 to 4).

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What the test measures

The TSK quantifies a patient's fear of movement and their beliefs about the relationship between physical activity and pain exacerbation. The items probe several interlocked cognitive facets:

Fear of (re)injury: The persistent belief that physical activity or exercise inherently puts the body at risk of new or worsening structural damage.
Somatic focus: The tendency to interpret bodily sensations, especially pain, as reliable indicators that something is dangerously wrong.
Activity avoidance: The conviction that restricting movement and practicing extreme caution are necessary strategies to prevent pain from intensifying.
Catastrophic appraisals: The overestimation of the threat value of pain, often fueling unwanted automatic thoughts and rigid safety behaviors.

The instrument is validated for adults experiencing chronic pain conditions, such as low back pain, fibromyalgia, and osteoarthritis, though it is widely applied across various rehabilitation settings.

When and why to use it

The TSK is highly useful in pain clinics, physical therapy settings, and psychological consultations for chronic pain. It is indicated in the following clinical scenarios:

Intake baseline for chronic pain: To systematically identify if fear of movement is a primary driver of the patient's disability and physical deconditioning.
Tailoring psychoeducation: To highlight specific misconceptions about pain (e.g., "hurt equals harm") and structure targeted interventions that address catastrophizing.
Monitoring treatment progress: To track changes in fear-avoidance beliefs as the patient engages in graduated exposure, physical therapy, or cognitive restructuring.
Identifying treatment barriers: To understand why a patient might be non-compliant with home exercise programs or resistant to functional restoration efforts.

Measuring these beliefs with a validated score adds objective clarity to the clinician's impression, allowing for precise tracking of psychological shifts that often precede behavioral change.

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The questions

Please read each statement carefully and indicate to what extent you agree or disagree with it.
1. I'm afraid of injuring myself if I do physical activity.
Assesses the direct fear that physical exertion will lead to physical injury.
- Strongly disagree
- Somewhat disagree
- Somewhat agree
- Strongly agree
2. My pain would only get worse if I tried to overcome it.
Probes the belief that pushing through pain is inherently harmful and will exacerbate symptoms.
- Strongly disagree
- Somewhat disagree
- Somewhat agree
- Strongly agree
3. My body is telling me that something is seriously wrong.
Evaluates somatic focus and the catastrophic interpretation of bodily sensations.
- Strongly disagree
- Somewhat disagree
- Somewhat agree
- Strongly agree
4. If I were physically active, my pain would probably be relieved.
Captures the patient's willingness to see movement as a therapeutic tool rather than a threat.
- Strongly disagree
- Somewhat disagree
- Somewhat agree
- Strongly agree
5. People don't take my health condition seriously enough.
Explores the sense of invalidation and the belief that the severity of the condition is misunderstood.
- Strongly disagree
- Somewhat disagree
- Somewhat agree
- Strongly agree
6. My accident has put my body at risk for the rest of my life.
Assesses the perception of permanent structural vulnerability following an initial trauma.
- Strongly disagree
- Somewhat disagree
- Somewhat agree
- Strongly agree
7. Pain always means I've injured myself.
Probes the rigid equation that pain is an infallible signal of tissue damage.
- Strongly disagree
- Somewhat disagree
- Somewhat agree
- Strongly agree
8. Even if something makes my pain worse, it doesn't mean it's dangerous.
Measures the ability to decouple transient pain flare-ups from actual physical danger.
- Strongly disagree
- Somewhat disagree
- Somewhat agree
- Strongly agree
9. I'm afraid of accidentally injuring myself.
Evaluates generalized hypervigilance regarding unexpected or uncontrolled movements.
- Strongly disagree
- Somewhat disagree
- Somewhat agree
- Strongly agree
10. The best way to prevent my pain from getting worse is to avoid making unnecessary movements.
Assesses the rationalization of extreme movement restriction as a necessary safety behavior.
- Strongly disagree
- Somewhat disagree
- Somewhat agree
- Strongly agree
11. I wouldn't have this much pain if there weren't something seriously wrong with my body.
Probes the conviction that high pain intensity definitively proves a severe underlying pathology.
- Strongly disagree
- Somewhat disagree
- Somewhat agree
- Strongly agree
12. Although my condition is painful, I'd be better off if I were physically active.
Captures the cognitive flexibility to recognize the long-term benefits of activity despite short-term discomfort.
- Strongly disagree
- Somewhat disagree
- Somewhat agree
- Strongly agree
13. Pain tells me when to stop physical activity so I don't injure myself.
Evaluates the use of pain as a strict, non-negotiable boundary for physical exertion.
- Strongly disagree
- Somewhat disagree
- Somewhat agree
- Strongly agree
14. It isn't safe for a person with my condition to be physically active.
Assesses the internalized belief that the patient's specific diagnosis makes movement fundamentally unsafe.
- Strongly disagree
- Somewhat disagree
- Somewhat agree
- Strongly agree
15. I can't do everything a normal person can because I'm more likely to injure myself.
Explores feelings of fragility and the perceived loss of normal physical capacity.
- Strongly disagree
- Somewhat disagree
- Somewhat agree
- Strongly agree
16. Even though something is causing me a lot of pain, I don't think it's actually serious.
Measures the capacity to experience severe pain without automatically catastrophizing its meaning.
- Strongly disagree
- Somewhat disagree
- Somewhat agree
- Strongly agree
17. No one should have to exercise when they are in pain.
Probes the moral or prescriptive belief that pain should exempt an individual from physical effort.
- Strongly disagree
- Somewhat disagree
- Somewhat agree
- Strongly agree