Fear of Movement and Whiplash Recovery

Another study has examined the issue of whiplash prognosis, but this time from a perspective of psychological responses to trauma: in this case, catastrophizing and fear of movement. Catastrophizing is the tendency some patients have to believe that things are worse than they really are. Fear of movement is an issue in some patients who feel that movement will somehow permanently damage the injured area.

In this study, Dutch psychologists gave 42 acute whiplash injury patients a daily diary to complete for three weeks. The subjects were to record pain, disability, pain catastrophizing, and fear of movement in the diary.

The authors found the following:

Most patients showed a decline in pain over the course of the three weeks, and they also showed a decline in fear of movement and catastrophizing.
Fear of movement and pain catastrophizing "were significantly associated with pain and disability when measured on the same day."
There were significant differences between the amount of catastrophizing and fear in individual subjects. This is not surprising, as different patients react differently to injury.
Fear of movement in a diary entry predicted more pain the next day.
The majority of patients still had significant pain at the end of the study. One day 1, 95% reported pain and 85% considered themselves somewhat disabled; on day 21, 66.3% reported daily pain and 62.5% reported disability.

This study is important for a few reasons. First, it shows us that many patients continue to have whiplash pain at three weeks post-injury. Second, some patients have different ways of coping with an injury that can affect their treatment and can lead to chronic problems and disability.

Previous studies have shown that catastrophizing can have negative affects on recovery. For patients that show signs of catastrophizing and fear, it's important to reassure them that proper treatment can help them recover from their injury, and that movement will help them in that process.

For some patients, counseling may be useful in helping them to change their outlook regarding their injury.

Vangronsveld KLH, Peters M, Goossens M, Vlaeyen J. The influence of fear of movement and pain catastrophizing on daily pain and disability in individuals with acute whiplash injury: a daily diary study.

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