SaveYourself.ca • Sensible advice for aches, pains & injuries
published 1/20/09
One of the strangest things about low back pain and neck pain is how much they seem to be affected not just by emotional factors, but even specifically by our confidence that we will recover. Some of the evidence for this is explained in detail in my full tutorials, particularly the low back pain tutorial:
However, in this short article I am zooming in on a significant 2006 study about neck pain. Note that what applies to neck pain probably also applies to low back pain.
Physical therapists may be interested in the scientific evidence, but the idea itself will probably be old news.
Unfortunately, anti-scientific and irrational beliefs are much too common in my profession of massage therapy. And yet amidst all that poor thinking there has long been a popular therapeutic idea that is probably quite sound: both your emotional and physical health before you have an accident has a lot do with with how much pain you are going to have afterwards. This idea is a specific case of our more general belief in the importance of prevention: that therapy isn’t just for fixing problems, but for reducing the chance of having problems later.
This emphasis on pre-trauma health has long been an almost iconic feature of physical therapies like massage therapy and chiropractic, one of the things that distinguishes us from so-called “mainstream” medicine. That old belief, once one of the symbols of how wisely alternative we were, is now increasingly mainstream, increasingly based on hard scientific evidence.
In 2006, a UK research group at University College London studied people in the aftermath of whiplash accidents.1 They surveyed almost 500 people at three points — one, three and twelve months after collision — asking them about their neck pain. It was surely no surprise to them to find that people who were hurt the worst initially, with the clearest signs of whiplash injury — people who had truly damaged neck muscles and ligaments — also had the worst pain later on.
A little more surprising is that these factors were actually outweighed by less obvious ones.
The researchers concluded (my emphasis), “The greatest predictors of persistent neck pain following a motor vehicle collision relate to psychological distress and aspects of pre-collision health rather than to various attributes of the collision itself.”
It’s easy enough to see how your physical health going into an accident would have something to do with how well you recover. The “psychological distress” part is quite a bit weirder (and deserves considerable discussion in itself). But the real news here is that both of these factors are actually more important than the severity of your accident. All other things being equal, a severe accident is going to hurt worse than a lesser accident … but your mental and physical health actually trumps the severity of the accident as a predictor of long term pain. Wow.
Another way of putting that: a person who has a severe accident with awful whiplash could actually recover quite quickly and have no chronic neck pain, if they went into the accident without a history of body pain and minimal emotional stress. By contrast, someone who has a relatively minor accident may be far worse off a year down the road … if they went into the accident with those psychological and physical risk factors.
Adding yet another layer of newsworthiness is that a combination of pre-injury risk factors results in a disproportionate stubborn-ness of post-injury pain. Patients who had all of the measured risk factors were five times as likely to have persistent neck pain. That is such a striking effect that I would consider advising people under stress, with a history of widepsread body pain, not to drive — the stakes are too high. It’s bad enough to have whiplash, but it’s absolutely devastating for whiplash to turn into severe chronic pain!
All of this is quite surprising, but it is also what nearly any massage therapist or chiropractor would have said about it throughout the last two or three decades… without the benefit of evidence. This is a rare case of good evidence actually supporting a sensible idea (it’s more common, I think, for experiments to turn “common sense” on its head). And even now that the evidence is available, I doubt that many massage therapists and chiropractors are aware of it!
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