More than two million people in the Netherlands suffer from neck and/or back pain, making these the most common health conditions in the country. This number is expected to rise due to an ageing population. These complaints place a major burden on society, both directly through healthcare costs and indirectly through work absenteeism, costing at least €3.5 billion annually. "Despite the positive effects of physiotherapy, more than a quarter of people with acute neck pain or back pain develop persistent complaints," explains Wendy Scholten-Peeters. "This is partly because the pain is complex, it’s not just about physical factors like muscle strength or mobility. Social, psychological, and lifestyle factors also play a role, and these factors interact with each other.”
Scholten-Peeters has been studying the mechanisms behind physiotherapy for many years and has witnessed a shift in the field from asking if physiotherapy helps to how it works. As Professor of Working Mechanisms and Management Musculoskeletal Physiotherapy at VU Amsterdam, she aims to map out the underlying factors contributing to the persistence of neck and back pain so that physiotherapy can become more personalised and effective. In this interview, she offers a preview of her upcoming inaugural lecture on 11 September.
Scholten-Peeters’ research lays the groundwork for more personalised care for neck and back pain. “We know that interventions such as exercise therapy or mobilisation can be effective, but we still don’t fully understand why and for whom they work.” In her research, she aims to unravel the biological, physiological, psychosocial, and lifestyle factors that play a role in individual patients. “By better understanding which factors are relevant to each patient and how treatments influence them, we can offer more targeted care.” This not only makes care more effective but also more cost-effective.
Inflammation as a Key Factor
A concrete example of how Scholten-Peeters researches treatment mechanisms comes from a recent study involving patients with a disc herniation in the neck. “PET/CT scans showed clear inflammation around the nerve root, which was absent in healthy subjects.” The question was whether treatments such as neural tissue mobilisations - which aim to improve blood flow and nerve mobility - could reduce this inflammation. Early results show that, after six weeks of treatment, follow-up scans revealed a marked reduction in neuroinflammation, which was associated with a reduction in pain intensity. This type of research is unique in that it uses advanced imaging techniques to illustrate neuroinflammation. “In the past, the advice for a herniated disc in the neck was mainly rest or wearing a neck collar. But now, we seem to be able to show that controlled movement may actually promote recovery.”
Blended Care
Another key development that Scholten-Peeters believes holds significant potential is blended care: a combination of digital and face-to-face therapy. “Patients follow digital modules tailored to their personal issues, including factors such as fear of movement and depression. These provide valuable insights. The patients then discuss their progress during sessions with their physiotherapist. Because therapists can review the patients’ input in advance, they can dive deeper during consultations, which strengthens the patient-therapist relationship. And we know this relationship has a significant impact on treatment outcomes.”
Artificial Intelligence (AI)
The next step in refining personalised care is the use of artificial intelligence (AI), including machine learning. “By using large datasets, we can develop patient profiles and predict which interventions are most likely to help for whom,” Scholten-Peeters explains. These profiles are based on a range of factors related to the persistence of complaints. To develop these AI applications, Scholten-Peeters collaborates with partners both within and beyond Amsterdam UMC and VU Amsterdam.
Implementation
According to Scholten-Peeters, it is essential that new knowledge about mechanisms of action and treatment strategies are effectively integrated into clinical practice. “This starts with implementing them in physiotherapy and exercise therapy guidelines, and into the education of future generations of physiotherapists,” she says. For example, students in the Master’s in Musculoskeletal Physiotherapy Sciences at VU participate in research on the pathophysiology of neck and back pain and the mechanisms of physiotherapy, and they learn how to apply this knowledge in clinical practice. This programme is unique in Europe. The MSG Science Network Physiotherapy, consisting of master’s-level physiotherapists across the Netherlands with special interest in research and implementation, is also an important partner in this effort.
Scholten-Peeters says that significant progress has already been made in physiotherapy in recent years, and that the focus on mechanisms of action is a logical next step. This includes recognising the importance of movement, as it affects many of the underlying processes involved in neck and back pain. “People still aren’t physically active enough. Physical activity not only helps reduce pain, but also contributes to overall health: it lowers the risk of cardiovascular disease, cognitive and mental disorders, and fosters social connectedness.” By exploring all the factors that contribute to pain, Scholten-Peeters aims to help develop a smarter, more personalised, and more effective approach to physiotherapy.