As a clinical-research physiotherapist, my goal is to address the complex nature of chronic spinal pain by looking at each individual’s unique presentation, selecting the most appropriate rehabilitation approach, and promoting a growth mindset of the body and mind. Evidence indicates that education, exercise, and behavioral therapies are the most efficacious treatments, but there are many forms to choose from. The current challenges lie in not only predicting who will best respond to one specific approach over another, but in understanding the processes that explain how or why specific treatments work. My research path helps address this challenge by focusing on understanding how chronic spinal pain affects posture and movement, developing novel clinical decision-making approaches, and refining rehabilitation programs to obtain the most positive outcomes.

Honors & Awards

  • Board Certified Orthopaedic Clinical Specialist, American Board of Physical Therapy Specialties (2008-Present)
  • Fellow, American Academy of Orthopaedic Manual Physical Therapists (2008-Present)
  • AAOMPT-Cardon Research Grant, AAOMPT (2010-2011)
  • CCRE-Spine PhD scholarship and International Research Tuition Award, The University of Queensland (2009-2012)
  • Certified Yoga Teacher, Yoga Alliance 200-hour Teacher Training Program (2013)
  • Postdoctoral Research Fellow, Stanford University School of Medicine (2014-Present)
  • Leader, Stanford Chronic Disease and Pain Self-Management Programs, Stanford Patient Education and Research Center (2014-Present)
  • Certified Tai Chi for Rehabilitation Teacher, Dr. Paul Lam Tai Chi for Health Institute (2016-Present)

Boards, Advisory Committees, Professional Organizations

  • Member, American Physical Therapy Association, SIG-Orthopaedics, Pain Management (1997 - Present)
  • Fellow, American Academy of Orthopaedic Manual Physical Therapists (2008 - Present)
  • Member, International Association for the Study of Pain, SIG-Pain and Movement (2011 - Present)
  • MBSR Leader, University of Massachusetts, Center for Mindfulness in Medicine, Healthcare and Society (2012 - Present)
  • Journal Reviewer, Arch Phys Med and Rehab; J Orthop Sports and Phys Ther; Manual Ther (2013 - Present)
  • Member, American Pain Society, SIG-Pain Rehabilitation, Pain Education (2014 - Present)
  • Member, The Stanford Center for Population Health and Sciences, SIG-The Study of Care Delivery Working Group (2015 - Present)
  • Member, Association for Contextual and Behavioral Science, SIG-Research in Clinical Practice Collaborative (2016 - Present)

Professional Education

  • Bachelor of Science, Ohio University, Biological Sciences (1995)
  • Master of Science, Ohio University, Physical Therapy (2000)
  • FAAOMPT, American Academy of Orthopaedic Manual Physical Therapists, Manual Therapy (2008)
  • OCS, American Board of Physical Therapy Specialties, Orthopaedics (2008)
  • Doctor of Philosophy, The University of Queensland, Physiotherapy, Human Neuroscience (2013)

Stanford Advisors

Community and International Work

  • Stanford Chronic Pain Education Day, 2014


    Bay Area

    Ongoing Project


    Opportunities for Student Involvement


  • Volunteers in Medicine, 2002-2006, Springfield, OR



    Ongoing Project


    Opportunities for Student Involvement


  • Health Volunteers Overseas, 2000, Umtata, South Africa


    Education of physical therapy students

    Partnering Organization(s)

    Health Volunteers Overseas

    Populations Served

    Clinical students and patients



    Ongoing Project


    Opportunities for Student Involvement


Current Research and Scholarly Interests

My research aims to improve the health status, beliefs and behaviors of people suffering from chronic spinal pain through innovative refinement of clinical decision-making, patient education and rehabilitation. Specifically, my work focuses on developing a better understanding of patient selection—i.e., to determine which patients will respond to one type of mind and body therapy and educational paradigm over another—in addition to understanding the content and delivery of these forms of pain management. It is a top research priority to providing a clear understanding of which interventions are the most effective clinically and the most cost effective for chronic spinal pain and, more importantly, to determine which individuals will derive the most benefit from these therapies.

Physiotherapy currently offers many types of assessment and treatment for chronic spinal pain, and the treatment a patient receives is often based on the clinician’s bias, i.e., their post-professional training and treatment preference, rather than on best-practice standards informed by clinical practice guidelines and patient education research. Because chronic low back pain is such a heterogeneous disorder, identifying more homogeneous subgroups that may preferentially benefit from certain treatment approaches over others holds promise in tailoring interventions to each patient, and is the basis of my PhD research. Deeper phenotyping that can predict a more favorable response to certain therapeutic approaches is in its research infancy, but it holds promise in delivering both better health and better healthcare. My dissertation addressed this aspect by examining the motor adaptations to pain, the movement patterns and psychological features unique to certain subgroups. These subgroups were identified by conducting a clinical examination of the patient’s pain history and by assessing movement behaviors observed during the physical exam.

My current postdoctoral work encompasses two projects. The first involves characterizing the sensory-motor aspects of people with chronic low back pain and monitoring changes in this dimension after the patients’ participation in a Mindfulness-Based Stress Reduction program. The primary goal of the second project is to phenotype individuals with chronic low back pain who may preferentially respond to either (i) a self-tailored, patient-education-focused approach (Stanford Chronic Pain Self-Management Program), (ii) an expert-tailored, movement-impairment-focused approach (physiotherapy care informed by low back pain clinical practice guidelines), or (iii) a combined self-tailored and expert-tailored program. Results from both projects will culminate in a deeper understanding of the motor adaptations to pain, and will enable clinicians to match individuals to targeted therapies in an effort to better support patient management and to restore their physical function.

I will use the results of my postdoctoral research to develop a stratified, integrated care management model for individuals with chronic spinal pain. This model will include psychosocial risk factor profiles that will provide additional help for patients who would benefit from more psychologically informed therapies. It will also involve several decision-making pathways that will match each patient with a specific pain etiology. This research agenda will ultimately integrate clinical-guideline-informed physiotherapy with self-efficacy-informed practice, and will further elucidate those means that effectively integrate a variety of therapeutic approaches into a comprehensive rehabilitation system.


  • Physiotherapy Care Integrated with the Stanford Chronic Pain Self-Management Program for People with Low Back Pain, Stanford University (7/1/2015 - Present)

    The primary aim of this study is to compare the effectiveness of a combined self-tailored and expert-tailored chronic low back pain management approach with guideline informed PT used in isolation in regards to improving ability and reducing pain interference.
    The secondary aim of this study is to compare the effectiveness of the combined intervention with guideline informed PT care used in isolation in regards to healthcare use, and to evaluate the extent to which health beliefs and behaviors modify the primary outcome (disability).


    Redwood City, CA


    • Sean Mackey, Postdoctoral Mentor, Stanford University
    • Kate Lorig, Postdoctoral Co-Mentor, Stanford University
    • Tiffany Asp, Physical Therapist, Stanford Health Care
    • Lori Beyer, Physical Therapist, Stanford Health Care
    • Corinne Cooley, Physical Therapist, Stanford Health Care
    • Tala Khalaf, Physical Therapist, Stanford Health Care
    • Gretchen Leff, Physical Therapist, Stanford Health Care
    • Landon Toma, Physical Therapist, Stanford Health Care
    • Alexander Blacker, Leader, Chronic Pain Self-Management Program, Stanford Health Care
    • Dennis Keane, Leader, Chronic Pain Self-Management Program, Stanford Health Care
    • Haley Brogan, Research Assistant, Stanford University
    • John Mack, Physical Therapist, Stanford Health Care

    For More Information:

  • Complementary and Alternative Medicine for Low Back Pain, Stanford University (3/3/2014 - Present)


    Palo Alto, CA

Lab Affiliations

Graduate and Fellowship Programs

  • Pain Management (Fellowship Program)

All Publications

  • Movement-based subgrouping in low back pain: synergy and divergence in approaches. Physiotherapy Karayannis, N. V., Jull, G. A., Hodges, P. W. 2015


    Classification systems for low back pain (LBP) aim to guide treatment decisions. In physiotherapy, there are five classification schemes for LBP which consider responses to clinical movement examination. Little is known of the relationship between the schemes.To investigate overlap between subgroups of patients with LBP when classified using different movement-based classification schemes, and to consider how participants classified according to one scheme would be classified by another.Cross-sectional cohort study.University clinical laboratory.One hundred and two participants with LBP were recruited from university, hospital outpatient and private physiotherapy clinics, and community advertisements.Participants underwent a standardised examination including questions and movement tests to guide subgrouping.Participants were allocated to a LBP subgroup using each of the five classification schemes: Mechanical Diagnosis and Treatment (MDT), Movement System Impairment (MSI), O'Sullivan Classification (OSC), Pathoanatomic Based Classification (PBC) and Treatment Based Classification (TBC).There was concordance in allocation to subgroups that consider pain relief from direction-specific repeated spinal loading in the MDT, PBC and TBC schemes. There was consistency of subgrouping between the MSI and OSC schemes, which consider pain provocation to specific movement directions. Synergies between other subgroups were more variable. Participants from one subgroup could be subdivided using another scheme.There is overlap and discordance between LBP subgrouping schemes that consider movement. Where overlap is present, schemes recommend different treatment options. Where subgroups from one scheme can be subdivided using another scheme, there is potential to further guide treatment. An integrated assessment model may refine treatment targeting.

    View details for DOI 10.1016/

    View details for PubMedID 26126426

  • Response to letter to the editor re: Movement-based subgrouping in low back pain: synergy and divergence in approaches Physiotherapy Karayannis, N. V., Jull, G. A., Hodges, P. W. 2015
  • Fear of Movement Is Related to Trunk Stiffness in Low Back Pain. PloS one Karayannis, N. V., Smeets, R. J., van den Hoorn, W., Hodges, P. W. 2013; 8 (6): e67779


    Psychological features have been related to trunk muscle activation patterns in low back pain (LBP). We hypothesised higher pain-related fear would relate to changes in trunk mechanical properties, such as higher trunk stiffness.To evaluate the relationship between trunk mechanical properties and psychological features in people with recurrent LBP.The relationship between pain-related fear (Tampa Scale for Kinesiophobia, TSK; Photograph Series of Daily Activities, PHODA-SeV; Fear Avoidance Beliefs Questionnaire, FABQ; Pain Catastrophizing Scale, PCS) and trunk mechanical properties (estimated from the response of the trunk to a sudden sagittal plane forwards or backwards perturbation by unpredictable release of a load) was explored in a case-controlled study of 14 LBP participants. Regression analysis (r (2)) tested the linear relationships between pain-related fear and trunk mechanical properties (trunk stiffness and damping). Mechanical properties were also compared with t-tests between groups based on stratification according to high/low scores based on median values for each psychological measure.Fear of movement (TSK) was positively associated with trunk stiffness (but not damping) in response to a forward perturbation (r(2) = 0.33, P = 0.03), but not backward perturbation (r(2) = 0.22, P = 0.09). Other pain-related fear constructs (PHODA-SeV, FABQ, PCS) were not associated with trunk stiffness or damping. Trunk stiffness was greater for individuals with high kinesiophobia (TSK) for forward (P = 0.03) perturbations, and greater with forward perturbation for those with high fear avoidance scores (FABQ-W, P = 0.01).Fear of movement is positively (but weakly) associated with trunk stiffness. This provides preliminary support an interaction between biological and psychological features of LBP, suggesting this condition may be best understood if these domains are not considered in isolation.

    View details for DOI 10.1371/journal.pone.0067779

    View details for PubMedID 23826339

  • Physiotherapy movement based classification approaches to low back pain: comparison of subgroups through review and developer/expert survey BMC MUSCULOSKELETAL DISORDERS Karayannis, N. V., Jull, G. A., Hodges, P. W. 2012; 13


    Several classification schemes, each with its own philosophy and categorizing method, subgroup low back pain (LBP) patients with the intent to guide treatment. Physiotherapy derived schemes usually have a movement impairment focus, but the extent to which other biological, psychological, and social factors of pain are encompassed requires exploration. Furthermore, within the prevailing 'biological' domain, the overlap of subgrouping strategies within the orthopaedic examination remains unexplored. The aim of this study was "to review and clarify through developer/expert survey, the theoretical basis and content of physical movement classification schemes, determine their relative reliability and similarities/differences, and to consider the extent of incorporation of the bio-psycho-social framework within the schemes".A database search for relevant articles related to LBP and subgrouping or classification was conducted. Five dominant movement-based schemes were identified: Mechanical Diagnosis and Treatment (MDT), Treatment Based Classification (TBC), Pathoanatomic Based Classification (PBC), Movement System Impairment Classification (MSI), and O'Sullivan Classification System (OCS) schemes. Data were extracted and a survey sent to the classification scheme developers/experts to clarify operational criteria, reliability, decision-making, and converging/diverging elements between schemes. Survey results were integrated into the review and approval obtained for accuracy.Considerable diversity exists between schemes in how movement informs subgrouping and in the consideration of broader neurosensory, cognitive, emotional, and behavioural dimensions of LBP. Despite differences in assessment philosophy, a common element lies in their objective to identify a movement pattern related to a pain reduction strategy. Two dominant movement paradigms emerge: (i) loading strategies (MDT, TBC, PBC) aimed at eliciting a phenomenon of centralisation of symptoms; and (ii) modified movement strategies (MSI, OCS) targeted towards documenting the movement impairments associated with the pain state.Schemes vary on: the extent to which loading strategies are pursued; the assessment of movement dysfunction; and advocated treatment approaches. A biomechanical assessment predominates in the majority of schemes (MDT, PBC, MSI), certain psychosocial aspects (fear-avoidance) are considered in the TBC scheme, certain neurophysiologic (central versus peripherally mediated pain states) and psychosocial (cognitive and behavioural) aspects are considered in the OCS scheme.

    View details for DOI 10.1186/1471-2474-13-24

    View details for Web of Science ID 000301949600002

    View details for PubMedID 22348236