Perception versus Reality: Is your back really stiff, or is it just you?


Feelings of stiffness in your low back are often cause for concern, and they can indicate a burgeoning problem that may require medical attention. But what if it’s all in your head? Of course, it is insulting and a bit denigrating when someone implies that your feelings of back stiffness are not real. Yet new research has unearthed some interesting findings about the relationship between feelings of stiffness and objective measures of actual mechanical stiffness.

Stiffness itself is a vague term that alludes to movement, but some studies suggest that stiffness is a learned construct that may reflect fear of movement, especially in cases where a patient has previously experienced injury and pain, and therefore restricts their own movement as a protective mechanism.

The Research

In a recent study, researchers set out to explore the relationship between perceptions of back stiffness and objective measure of the same. They hypothesized that, “feelings of back stiffness are a protective perceptual construct, rather than reflecting biomechanical properties of the back.”

The study consisted of three experiments that sought to see if perceptions of stiffness were multi-sensory in nature.

In the study, 15 individuals reporting chronic low back pain accompanied by feelings of stiffness were matched by age and gender to a control group of 15 healthy people who did not have low back pain or feelings of stiffness.

  • Experiment 1: In the first experiment, a custo 100 (most stiffness imaginable). Results indicated that feelings of stiffness did not correlate with objective measures of stiffness.
  • Experiment 2: In the second experiment, researchers compared objective measures of back stiffness in the experimental group to changes in force.
  • Experiment 3: In the third experiment, researchers used multisensory integration principles to see whether adding a sound when pressure was applied would modulate the perception of force in participants with feelings of back pressure, and found that it did.

Conclusion and Significance

The findings of this study suggest that perceptions of low back pain and stiffness do not necessarily correlate with objective measure of stiffness, and that perceived stiffness may be a protective mechanism to avoid pain and injury.

People who report feeling back pain and stiffness often over-estimate applied forces and are adept at detecting changes in applied force. When sound was added to protect the body from pain and injury.

The study’s outcomes may be helpful to healthcare providers when diagnosing patients who present with back pain and stiffness. Perceptions are by nature subjective, and may not necessarily correlate with actual structural damage. Hence, modes of evaluating patients that do not place undue emphasis on perceptions of pain and stiffness may be more useful in accurately assessing a patient’s needs.

Back Pain Specialists in NYC

At NYDNRehab, we pride ourselves on accurate diagnosis and appropriate treatment for back pain and stiffness. Using cutting edge technology and progressive methodologies, our goal is today, and see why we are the very best rehabilitation clinic in NYC.


Stanton, Tasha R, et al. “Feeling stiffness in the back: a protective perceptual inference in chronic back pain.” Scientific Reports 7.1 (2017): 9681.



In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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