New research from Dr Yanfei Xie at The University of Queensland shows that labels for neck pain influence how people perceive their injury and what treatment they expect following a motor vehicle crash. These perceptions don’t always align with clinical guidelines.
Diagnostic labels matter. Terms like whiplash injury and whiplash-associated disorder have been criticised in the past for having negative connotations and association with litigation. A randomised controlled study is investigating the effect of five labels for neck pain after a motor vehicle crash: whiplash injury, whiplash-associated disorder (WAD), post-traumatic neck pain, neck pain, or neck strain.
Initial research from this study showed that label choice influenced recovery expectations, perceptions of injury seriousness, management preferences, and the intention to make a compensation claim. To better understand the reasons for these differences, Dr Yanfei Xie analysed participants’ free-text responses. She explored how people (with and without a history of neck pain) perceived the labels, what feelings and treatment needs the labels evoked, whether they understood the terms and what confusion the labels caused.
For example, people given the label neck strain had higher recovery expectations than those given the labels whiplash-associated disorder or neck pain. Dr Xie’s qualitative analysis of participants’ comments revealed that neck strain was more frequently viewed positively than other labels, which may explain the higher recovery expectations. She found that neck pain was most often associated with negative expectations. Neck pain was also considered the most confusing label, and whiplash injury the least confusing.
What the study involved
Researchers invited 2,229 English speakers from Australia, New Zealand, the UK, Canada, and the US to envision being the patient in a hypothetical scenario involving neck pain sustained in a motor vehicle crash. An X-ray at the emergency department showed no structural damage. Two weeks later, they still had pain and visited a primary care provider. The participants were randomly allocated one of five diagnostic labels: whiplash injury, whiplash-associated disorder (WAD), post-traumatic neck pain, neck pain, or neck strain. Then, they read a message from the healthcare provider reassuring them that their condition was not serious and encouraging them to return to daily activities.
Treatment expectations linked to different labels
Less than 12 % of participants across all label groups suggested exercise and advice as part of treatment. This highlights the gap between the general public’s expectations and the whiplash guidelines, which recommend returning to usual activity and exercise as first-line care. Participants given neck strain (11.6%) most often expressed a need for exercise, while those given neck pain mentioned it least (5.2%).
Compared to exercise, participants had higher expectations for passive treatments that don’t require physical effort:
- 26-31% of all participants mentioned pharmacological treatments.
- 13%–22% mentioned passive physical therapies such as massage, with the highest percentage among participants assigned the label neck pain (22%).
Beyond treatment, some participants suggested further investigations, such as MRI, CT, CAT scan, ultrasound, and ongoing symptom monitoring. Participants assigned the neck strain label expressed the least desire for imaging (3.4%) compared with those assigned to other labels (6.3%–9.8%).
Words and feelings evoked by the labels
Participants assigned to the label neck strain (18%) most often felt the condition was minor and likely to recover well, compared to those assigned to post-traumatic neck pain (7%) or neck pain (3%). Negative expectations about symptom severity and prognosis were least common among participants assigned to neck strain (5%), but more frequent among those assigned to post-traumatic neck pain (16%) and whiplash-associated disorder (10%). Psychological distress was least linked to neck strain (7%), compared to post-traumatic neck pain (30%), neck pain (14%), and whiplash-associated disorder (13%).
Confusion arising from the labels
Many participants found their assigned label clear, but about 40% viewed neck pain as vague or informal, often suggesting seeking a second opinion. Confusion arose when labels didn’t match people's expectations or injury perceptions, and most people saw neck pain after a motor vehicle crash as a purely physical issue, making psychological support seem unnecessary. Across all label groups, participants wanted detailed explanations about cause, severity, prognosis, and treatment options in addition to a clear diagnosis.
Recommendations
For health practitioners, this study highlights the importance of checking:
- patients’ understanding of common labels related to neck pain following a motor vehicle crash
- their expectations about symptom severity and prognosis, and
- their treatment preferences linked to these labels.
Use these opportunities to explain the label with reassuring language to reduce unhelpful beliefs and align patients’ treatment expectations with guideline-recommended care.
Media contact
For more information, contact Dr Yanfei Xie at yanfei.xie@uq.edu.au
The full article is available at: https://doi.org/10.1016/j.msksp.2025.103433
References
- Xie, Y., Costa, N., Söderlund, A., Zadro, J., Malmström, E., Grant, G., Jull, G., Westergren, H.,, Kasch, H., MacDermid, J., Treleaven, J., Curatolo, M., Lykkegaard Ravn S., Andersen, T., Rebbeck, T., and Sterling, M. The Influence of “Labels” for Neck Pain on Recovery Expectations Following a Motor Vehicle Crash: An Online-Randomized Vignette-Based Experiment, Journal of Orthopaedic & Sports Physical Therapy (2024) 54:11, 711-720. DOI: 10.2519/jospt.2024.12590
- Xie, Y., Mescouto, K., Liimatainen, J., Zadro, J>R., Andersen, T., Curatolo, M., Grant, G., Jull, G., Kasch, H., MacDermid, J., Malmström, E., Lykkegaard Ravn, S., Rebbeck, T., Söderlund, A., Treleaven, J., Westergren, H., Sterling, M. What are people's perspectives on different labels for neck pain after a motor vehicle crash? A content analysis of randomized study data,
Musculoskeletal Science and Practice, (2025) 80. DOI: 10.1016/j.msksp.2025.103433 - State Insurance Regulatory Authority, Papic, C., Rebbeck, T., Carvalho-e-Silva, A. P., Chia, L., Brown, K., Cameron, I. D., & the Whiplash Guideline Panel: Draft Australian Clinical Guidelines for Health Professionals Managing People with Whiplash-Associated Disorders, Fourth Edition. Sydney, Australia: https://www.sira.nsw.gov.au/__data/assets/pdf_file/0007/1141846/Draft-Australian-Clinical-Guidelines-for-Health-Professionals-Managing-People-with-Whiplash-Associated-Disorders.pdf
