When you’re in pain, it’s easy to focus purely on the physical side, muscles, joints, or injury. But this paper highlights that thoughts, emotions, and stress (known as “yellow flags”) can play a major role in how pain feels and how well you recover .
These factors don’t mean the pain isn’t real, they influence how your body responds to it.
What the Study Shows
● Psychological factors like fear, anxiety, low mood, and stress are strongly linked to pain and recovery
● There is a two-way relationship: pain can increase distress, and distress can increase pain
● Higher levels of these “yellow flags” are linked to:
○ Greater pain levels
○ Reduced function
○ Slower recovery
○ Increased healthcare use
● Many of these factors are modifiable, meaning they can be improved with the right approach
What This Means for You
If your pain isn’t improving as expected:
● It may not just be a physical issue
● Things like fear of movement, stress, or negative thoughts about pain can hold recovery back
● Addressing these factors can improve outcomes just as much as physical rehab Good rehab may include:
● Gradual exposure to movement (building confidence)
● Education about pain
● Strategies to improve coping and reduce fear
● In some cases, support from other healthcare professionals
Takeaway
Pain is influenced by both the body and the mind. Ignoring one side can slow recovery, but addressing both can speed it up.
The best rehab approach treats the whole person, not just the injury.
Newsletter By: Emre Oz (Head of Integrated MSK & Sports Medicine Operations/Specialist MSK Physiotherapist at Crouch Physio).
Reference
Stearns, Z.R., Carvalho, M.L., Beneciuk, J.M., & Lentz, T.A. (2021). Screening for Yellow Flags in Orthopaedic Physical Therapy: A Clinical Framework. Journal of Orthopaedic & Sports Physical Therapy.
