“We are what we think. All that we are arises with our thoughts. With our thoughts, we make the world.”  – Buddha.

Mental health has a significant impact on recovery from many musculoskeletal diagnoses including low back pain, neck pain, and shoulder pain.  Our thoughts and perceptions about our bodies and their ability to recover from injury and illness strongly influence our course for recovery and healing.  In prior posts we have described the limitations of imaging such as MRI and CT for musculoskeletal diagnoses.  In particular, we can find the same pathology (disc herniation or rotator cuff tears) in people with and without symptoms.  Thus, imaging does not correlate strongly with how patients function and what symptoms they experience due to these imaging findings.  

A recent study in the Journal of Bone and Joint Surgery highlights both the limitations of imaging findings and the importance of mental health on patient function (Wylie et al. 2016).  The authors recruited close to 200 patients with complete rotator cuff tears to determine which clinical and diagnostic factors correlated best with the patients’ symptoms of shoulder pain and function.  Interestingly, a patient’s mental health had the strongest association with the patient’s reporting of pain and shoulder function.  This association was stronger than the correlation between the severity of the shoulder injury on MRI and their reporting of pain and function.  

This study adds evidence to support the assessment of mental health variables in individuals suffering from musculoskeletal pain and may help us understand which patients can or cannot function well given a positive imaging finding.  In our experience, patients with a positive outlook on their recovery have the most optimal outcomes with Physical Therapy.