Most Back Pain has this Hidden Source

In 2001, German researchers built an elaborate hoax. Test subjects sat in a stationary car, and, with a curtain across the rear window so they couldn't know what was coming, they had the sound and sensation of a rear end collision.

Though there wasn't any impact or any whiplash forces, almost 1 in 5 people developed whiplash symptoms anyway. Yet the volunteers didn't experience anything that could realistically hurt a neck.

Because their brains had been convinced a crash happened, 20% of people had the type of injury that would follow a crash. This well known study, "No Stress, No Whiplash?" (Castro et al., 2001), has created ripples in the field of pain science for over two decades.

Next we'll contrast this with a whole country where whiplash barely exists.

The Country Where Whiplash Doesn't Happen

In the 1990s, researchers went to Kaunas, a town in Lithuania, and pulled 202 people from police records who had been in real rear end collisions. They surveyed them 1-3 years post accident, then compared them to a control group who had never been in a car accident.

In the first group, 33 percent reported neck pain. But so did 33% of the people who had never crashed. No difference in neck pain. How about headaches? 53 percent of the accident group had headaches. Yet so did 50% of the controls. A different study on jaw pain and TMJ symptoms after whiplash found the same thing again, showing almost no difference between people who had been in rear end collisions and people who hadn't!

How could this be?

When researchers told the Lithuanian participants what they were studying, the idea that a minor car accident could cause months or years of pain was almost unbelievable to them. Lithuania had little insurance coverage for this kind of claim, almost no litigation culture around whiplash, and no public narrative warning people that a fender bender could cause long term damage to their neck.

In short, they had no narrative around pain for their nervous systems to confirm.

Compare that to the United States, where whiplash is a known, feared, often litigated diagnosis with its own name, its own expectation, and its own timeline for how long the suffering is supposed to last. These very different outcomes have more to do with cultural conditioning than they do with the condition of anyone's neck.

What Your MRI Won't Tell You

The same pattern shows up again and again in back pain research, and in even more broad ways.

More than one reputable study has found disc bulges, meniscal tears, rotator cuff tears, labral injuries, Morton's neuromas, and spinal degeneration in huge numbers of people who report zero pain. That's zero. No symptoms, no complaints. Their backs are comfortable yet, on a scan, they look like they should be in agony.

Yet when someone who is in pain has the same results on an MRI, it triggers fear, a diagnosis, and sometimes a scalpel.

Just like your skin and eyes are not as smooth or clear as they were when you were three, a perfectly pristine spine is really only found in young children. The rest of us, whether we hurt or not, carry compressions, bulges, and wear. The strongest correlation between pain and "abnormal" findings may simply be this: people in pain are the ones who get imaged in the first place.

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The Map Is Not the Territory

When I studied NLP, we used to repeat this phrase often: the map is not the territory. A map is useful largely because it leaves things out. It highlights certain elements and edits out everything else, and an MRI works that way, too.

An MRI will show you anatomy in ways that nothing else can.

What it won't show you is so much more.

It can't show you what it feels like to live in that body. How much fear you have about the diagnosis.

How much pressure you're under.

How well you sleep or how you breathe.

How much you've limited your exercise or guard your movement because you're afraid to make it worse. None of that shows up on the film, and but of it shapes how much you suffer.

To be clear, none of this means imaging is meaningless or that the findings should be disregarded.

Acute injuries are obviously real. I tore my ACL skiing when I was in my 20's. The MRI helped us see what was wrong. Many of us have relatives with arthritis, which can grow to be debilitating.

Fascia restriction and tissue quality matter, and inflammation is impactful. But when it comes to chronic pain, limiting our perspective to structure also limits our recovery. Because if so many "abnormalities" exist in people who are well-functioning, what are we really looking at when we look at a scan?

Why Medicine Fell in Love with Structure

Modern medicine is fantastic at finding some physical problems and fixing them. A cast is useful for supporting the healing of your broken femur. Burning off skin problems can save your life. When MRIs let doctors see inside the body in detail without having to get out a scalpel, it made sense to assume that seeing more meant we would have more answers.

But as imaging got sharper, clinicians kept observing things that doesn't make sense. People with terrifying scans are walking around pain free. People with "normal" scans are in agony. Structure matters, but the line between tissue and pain is blurred and disconcerting. (Don't worry, more science is coming forward that plays a role in recovery. That's where I'm here to help.)

As a former ballerina, back pain coach, bodyworker, yoga educator, and (unfortunately) a former pain patient myself, I've been curious about this for decades, because I knew all the right things to do, but sometimes they would help, and sometimes they wouldn't. Maybe they helped briefly, but not long term. In my early 30s, my search for the relationship between structure and pain eventually led me to the work of the late John Sarno, M.D.. His ideas challenged nearly everything rehabilitative medicine assumed.

In the next post, I'll get into the physicians and research that John Sarno's work inspired, where I agree with him, where I don't, and a miracle knee moment that taught me more about healing pain than any book ever could have.