KELVIN FRANKE, DO
INJURY PHYSIATRIST
PRACTICING AT
🧠 Phase 1 · Foundation

The Mind-Body-Spirit Connection: Deep Dive

How trauma reshapes body, brain, and recovery after motor vehicle injury

After trauma: why symptoms linger

Even when a crash or other injury is brief, the body's alarm system can stay switched on. Many people describe neck or back pain, tight muscles, poor sleep, or difficulty concentrating long after the event. These symptoms are not imagined. They reflect real changes in how the brain, spinal cord, and muscles process danger and protection.

The body's alarm system

After trauma, two things happen at once: tissues are strained, and the nervous system activates survival mode. Normally this alarm quiets once safety returns, but in some people it stays primed. The amygdala—the brain's alarm center—can remain hypervigilant, keeping muscle tone high and pain circuits active. This persistent amplification of danger signals is called central sensitization. It makes normal sensations feel painful and small strains overwhelming. Studies describe this pattern—especially after motor vehicle collisions or whiplash—as a biological learning process that can improve when the nervous system relearns safety and control [1-7].

When the alarm persists: the spino-parabrachial-amygdala pathway

Short bursts of pain input can leave long-lasting changes in brain circuits. The spino-parabrachial-amygdala pathway links pain signals in the spinal cord to emotional centers that process threat. Once this network is activated, it can keep firing even after tissues heal. This explains why pain, muscle tension, and startle responses often persist long after the danger is gone. This pathway is the biological bridge between physical pain and emotional alarm [8, 9].

How mind-body disconnect slows healing

  • Myofascial injury: Protective postures and sustained vigilance promote chronic muscle tension and fascial adhesions. Real tissue relaxation often requires a restored sense of safety.
  • Neurologic injury: Peripheral nerve irritability (and delayed normalization on EMG) can be exacerbated by central sensitization and emotional stress.
  • Joint/soft tissue: Guarding and asymmetry increase mechanical load and local inflammation, creating new pain sources weeks later.

Recovery isn't only repairing what tore or sprained. It's retraining what overreacted.

Objective testing and EMG reassurance

Objective data help quiet fear. During electromyography (EMG) and nerve conduction studies (NCS), patients can see the difference between a calm muscle and a guarded one in real time. When the signal quiets, the body is learning safety again. This visual feedback often lowers catastrophizing and clarifies whether symptoms stem from muscle, nerve, or central amplification. Structured sensory mapping further distinguishes myofascial, dermatomal, and plexus-level patterns, guiding targeted care [12, 13].

Phase-based, coordinated recovery

Early (0-6 weeks): Calming and Safety

  • Gentle physical treatment such as chiropractic, physical therapy, or soft-tissue work
  • Pacing and gradual activity instead of total rest
  • Sleep and stress strategies
  • Early counseling when anxiety, PTSD features, or fear-avoidance appear

Intermediate (6 weeks-9 months): Guided Reactivation

  • Active rehabilitation and postural retraining
  • Diagnostic clarity with exam, EMG/NCS, or targeted imaging
  • Hydrostatic IMS as needed to reduce muscle hypertonicity and prevent transition to chronic myofascial pain

Late (9-12 months +): Strength and Integration

  • Targeted strengthening and conditioning for endurance and confidence
  • Focal procedures if needed (sacroiliac, facet, or epidural; steroid vs prolotherapy vs PRP)
  • Ongoing psychological support to consolidate gains and maintain resilience

The role of integration

As a physiatrist, my job is to connect the physical, neurologic, and emotional parts of recovery. When stress, PTSD, or post-concussion issues are slowing progress, identifying them early allows for timely collaboration. Recovery works best when all disciplines—manual therapy, rehabilitation, psychology, and interventional care—share a single narrative and pace. A calm-first, strengthen-second sequence usually succeeds.

Summary: Persistent pain after trauma reflects a primed threat network working alongside real tissue injury. The combination of amygdala hypervigilance, central sensitization, and protective muscle tone explains why healing can lag. These changes are biologically grounded and reversible. A coordinated, phase-matched plan—anchored by physiatrically guided integration, supportive physical care, and timely psychological input—restores safety, movement, and confidence.

Evidence at a Glance

  1. Willaert W et al. Phys Ther. 2021;101(7):pzab105.
  2. Tan AC et al. Injury. 2022;53(10):3201-3208.
  3. Feinberg RK et al. Pain. 2017;158(4):682-690.
  4. Fitzcharles MA et al. Lancet. 2021;397(10289):2098-2110.
  5. Malfliet A et al. JAMA Netw Open. 2025;8(8):e2526674.
  6. Sterling M et al. Spine. 2011;36(25 Suppl):S322-9.
  7. Manuel J et al. Psychosom Med. 2023;85(4):351-357.
  8. Kisiwaa SA, Bagley EE. J Physiol. 2018. doi:10.1113/JP273976.
  9. Raver C et al. J Neurosci. 2020;40(17):3424-3442.
  10. Wheeler AH. Drugs. 2004;64(1):45-62.
  11. Lv H et al. J Biomech. 2018;66:44-50.
  12. Garcia-Larrea L. Neurophysiol Clin. 2012;42(4):187-197.
  13. Kane NM, Oware A. J Neurol. 2012;259(7):1502-1508.
  14. Maire C et al. Sci Rep. 2025;15(1):30896.
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