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 increased muscle tone and perceptions of force. Stiffness is often described as perceived resistance 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 demonstrate that feelings of stiffness are unrelated to objective measures of spinal stiffness, and furthermore, that there is no difference in objective measures between participants who reported feeling stiff and those who did not. They also wanted 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 customized device was used to calculate objective measures of back stiffness, and results were compared to subjective reports by participants of perceived stiffness on a scale of 0 (no stiffness at all) to 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 those of the control group. Identical forces were applied to the low backs of both groups in pairs of two consecutive forces of different magnitudes, and subjective perceptions of applied force were recorded. Results indicated that the experimental group demonstrated a protective profile, overestimating applied force and exhibiting heightened sensitivity 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 applied pressure, it modulated the perception of pressure, suggesting that feelings of stiffness are multisensory, and may serve 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 to get to the source of your pain and eliminate it. If you suffer from back pain and stiffness, make an appointment with the back pain specialists at NYDNRehab today, and see why we are the very best rehabilitation clinic in NYC.

Source:

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