What you see is what you get?   November 24th, 2016

​What you see is what you get, no? Not for whiplash patients!

What they see is not always what their brain expects to get. This mismatch between what you get and what you expected to get might cause warning sensations such as feelings of heaviness in the limbs, paraesthesia and even pain.

Can this partially explain the symptoms of patients with chronic whiplash associated disorders? Providing whiplash patients with extra visual input of their neck was not able to reduce pain sensitivity. This is in contrast to patients with low back pain or healthy persons; who experience less pain sensitivity when they see their spine through a mirror or by means of video feedback. If the mismatch between the actual image and the expected image is enlarged, the symptoms become worse. When chronic whiplash patients were confronted with a modified image of their neck, where the neck looks like it has a bulging similar to the cartoon figure Quasimodo, their physical sensations and symptoms were much stronger. This reaction is site specific, only modified input from the neck provoked this reaction.

All this learns us that patients with chronic whiplash are sensitive to visual feedback of their neck. They react abnormal to both correct and modified visual input, provoking symptoms. The use of visual feedback in therapy might therefore be useful, but similar results as in other pathologies should not be expected. A subject to be continued!

Margot De Kooning

2016  Pain in Motion

References and further reading:

Coming soon:

Sanneke Don, Margot De Kooning, Lennard Voogt, Kelly Ickmans, Liesbeth Daenen, Jo Nijs. The Effect of Visual Feedback of the Neck during Movement in People With Chronic Whiplash-Associated Disorders: an Experimental Study. JOSPT accepted for publication.

De Kooning M, Daenen L, Verhelpen S, Don S, Voogt L, Roussel N, Ickmans K, Van Loo M, Cras P, Nijs J. Abnormal Pain Response to Visual Feedback During Cervical Movements in Chronic Whiplash: An Experimental Study. Pain Practice. 2016 Feb 23.


Don S, Voogt L, Meeus M, De Kooning M, Nijs J. Sensorimotor Incongruence in People with Musculoskeletal Pain: A Systematic Review. Pain Practice. 2016 May 21.