How many times have you gone to a mechanic about a problem with your car, then struggled to put into words the exact experience that made you bring it in in the first place? Have you tried to duplicate a sound you’ve heard, or to imitate a strange vibration that you’ve felt?
The same thing is true for many patients who come in seeking help with back or neck pain. They try to capture the sensation that they’re having, but communicating discomfort is a very difficult thing to do. The experience of pain is personal, and it’s hard to put into words.
A recent study conducted by the University of Alberta’s Faculty of Rehabilitation Medicine made it very clear just how universal this problem is. Researchers discovered that patients complaining of a stiff back did not actually have the condition they were describing – it’s just the way that they felt, and the words that they had available to them.
According to Greg Kawchuk, professor and back and spine expert in the university’s department of physical therapy, “A conscious experience of feeling stiff does not reflect true biomechanical back stiffness. When we use the same word, stiffness, to describe a feeling and how we measure actual stiffness, we assume these words are describing the same thing. But that is not always the case.”
Kawchuk and his colleagues spoke to each patient, asking them to gauge the degree to which they were experiencing stiffness, then used examination techniques to measure exactly what level of physical stiffness the patients actually had. They found that there was no relation between the two. “What people describe as stiffness is something different than the measurement of stiffness.”
In reviewing their research, the group has come to the conclusion that the sensation that people are describing as stiffness may be a result of messages that our nervous system sends to the brain in order to guard against further injury. Lead author and senior research fellow of pain neuroscience at the University of South Australia Tasha Stanton said, “It’s our body’s way of protecting ourselves, possibly from strain, further injury or more pain.”
The lesson for our cervical and lumbar spine specialist practice in New Jersey is to listen to what our patients have to say with the understanding that it may not be exactly reflective of what is going on within the body. As Kawchuk said in the group’s report, “Words are important. The words patients use to describe a problem in the clinic may not be the same thing we as clinicians measure in the clinic. We need to find out what it means exactly when someone says they have a stiff back. We now know it might not mean that their back is mechanically stiff. It could mean they feel their movements are slower and more painful.”