Kinesiophobia independently predicts muscle strength and functional capacity in university students with musculoskeletal pain

Musculoskeletal pain may impair functional performance in university students. Although kinesiophobia, defined as excessive movement-related fear and fear of re-injury, is associated with pain-related disability, its relationship with muscle strength and functional capacity in young adults remains unclear. This study examined the associations between kinesiophobia, lower extremity muscle strength, and functional capacity in university students with chronic musculoskeletal pain. This cross-sectional study included 115 students aged 18–30 years with musculoskeletal pain lasting at least three months. Data were collected at the Department of Therapy and Rehabilitation, Kayseri University, between February 2026 and May 2026. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia (TSK). Pain intensity and physical activity were evaluated using the Numeric Rating Scale and International Physical Activity Questionnaire–Short Form. Lower extremity strength was measured by handheld dynamometry, and functional capacity was assessed using the Timed Up and Go (TUG), Five Times Sit-to-Stand (5xSTS), and Six-Minute Walk Tests (6MWT). Associations were analyzed using Pearson or Spearman correlation analysis, and hierarchical multiple regression was used to determine whether kinesiophobia independently predicted functional outcomes after adjustment for demographic variables, pain intensity, and physical activity. Higher kinesiophobia was associated with lower muscle strength and poorer functional capacity. TSK scores correlated with knee extensor strength (r = −0.46), TUG (r = 0.44), 5xSTS (r = 0.48), and 6MWT (r = −0.52) (all p < 0.001). Kinesiophobia remained an independent predictor of functional capacity after adjustment for demographic variables, pain intensity, and physical activity (β = −0.41, p < 0.001). Kinesiophobia was independently associated with impaired physical function in university students with chronic musculoskeletal pain. Kinesiophobia should be considered when evaluating functional limitations in this population.