How to recover from neck pain? The status of a little stabilizing muscle in your neck may determine if you recover quickly or have long term chronic pain. This little muscle can also be easily seen on an MRI, but the likelihood that the radiologist reading your report knows to take a look at and comment on it is less than finding a needle in a haystack. What’s going on?
Your neck, like the rest of your spine, has muscles that stabilize it. Each little building block known as a vertebra has a small muscle called multifidus that keeps it stable and positioned with extreme precision on the next vertebra. In fact, these muscles are also in your low back and have been the subject of many studies. For example, when the low back version of multifidus atrophies (gets smaller), you’re more likely to have back or leg pain. Why? When the muscle atrophies, all hell breaks loose at the vertebra, which moves abnormally against the next vertebra which can lead to injuries in the disc, spinal nerve, and facet joints.
The story of the research behind cervical multifidus begins with a talented physical therapist who worked for our clinic just out of PT school in the late 90s. Jim Elliott was always very curious and we were interested at the time in looking at low back mulifidus atrophy on MRI. Jim wondered if the neck also had the same problem. However, seeing if that was the case would take Jim on an amazing journey across the world to Australia where he eventually settled on doing his PhD thesis on this topic. Now back in the U.S. as a professor at Northwestern in Chicago, Jim’s latest paper is an amazing testament to more than a decade of hard work and dedication. All of Jim’s work on the neck on this and other topics is here.
The new research followed 36 neck injury patients who were categorized at 3 months as either recovered or disabled. The status of the neck multifidus muscle was tracked on serial MRIs along with pain and function scores. Like other studies that Elliott had performed, the multifidus muscle withered away rapidly, but only in patients who hadn’t yet recovered by 3 months! This is ground breaking because having an MRI finding that predicts who will and won’t recover is a huge leap forward for physicians treating these patients.
Elliott concluded that routine MRI protocols need to be altered to better see this phenomenon, but I’ll add a finer point to that comment. Decades of psychological conditioning of physicians needs to be changed to better see this phenomenon. Most physicians, because of a lack of training and a lack of keeping up with the published literature still treat whiplash patients like it’s the 1970s and blame the patient for not recovering. Others do treat things like facet injuries (which began to be recognized in the 1990s and early 2000s), but are stuck in an injured facet joint mentality. In reality, research like Elliott’s and others point to many other things like ligament injury, nerve sensitization, and muscle atrophy being extremely important to understanding scientifically why these patients aren’t recovering.
The upshot? It’s nutty and scary that most whiplash patients get treated like they’re crazy. Given research like Elliott’s, the only person in the equation that’s crazy is the doctor who has neglected to get the education necessary to help the patient!