For James Elliott, PT, PhD, assistant professor in physical therapy and human movement sciences, whiplash is less about the 200 milliseconds it takes for the neck to snap forward and back, and more about the unexplainable: the transition of two in 10 patients from acute to chronic pain.
“The prevailing thought around the world is that something in the neck has been injured, and that initial injury is stimulating a cascade of profound physiological events,” Elliott said. “We can’t excuse psychological variables because they do exist and some psychological factors, such as post-traumatic stress, are robust predictors of chronic pain, but we can’t forget about the biological factors either.”
Growing up in Chicago’s west suburbs, Elliott’s dreams of a long career in professional baseball came to an end after two seasons with the San Diego Padres organization. But just three minutes in front of renowned physiotherapy professor Gwen Jull, PhD, from the University of Queensland in Australia, enlivened entirely different pursuit.
What are your research interests?
My research interest is primarily in whiplash-associated disorders, the kind you suffer in a motor vehicle collision. I became extremely interested in whiplash as a physical therapist in Colorado while working in a specialty practice with a few physicians dealing mostly with people who had had car accidents and transitioned to chronic pain. My research is focused on understanding the pathophysiological mechanisms underlying this transition. This exploration is based on my clinical and research experience and has expanded here at Northwestern University Feinberg School of Medicine through interdisciplinary efforts involving the fields of magnetic resonance physics, radiology, biomedical engineering, neurophysiology, speech language pathology, and physical therapy.
What is the ultimate goal of your research?
I use structural and advanced magnetic resonance imaging (MRI) applications to quantify the progressive development of altered spinal cord biochemistry and neck muscle degeneration as potential cellular and molecular causes of persistent pain. We know those fatty changes in the muscle occur about one month after the injury and in tandem with a complex set of symptoms, like post-traumatic stress disorders and altered processing of pain, in those who transit to chronic pain. We endeavor to use this information to develop a more informed set of treatments aimed at preventing or retarding any of these possibly irreversible changes.
How did you become interested in this area?
After attending the University of Denver, playing baseball, and scouting future talent for the Colorado Rockies organization for five years, I pursued a degree in physical therapy and began working as a PT in Denver.
I noticed that the majority of individuals suffering from whiplash very rarely, if ever, had any structural injury on their MRIs that would point to the problem. But in chronic pain, they all seemed to have muscles that just didn’t look very healthy. Clearly that was simply a qualitative clinical observation, and so I started knocking on the door of every radiologist I could find in Colorado. One in particular agreed that there seemed to be clear evidence of fatty changes in those muscles.
I was very much aware at that time that the major literature on whiplash was (and still is) produced by the Australians, at the University of Queensland in particular. A while later I learned that professor Jull was coming to give a talk in Denver, and I quickly signed up for the course and lined up afterward to have a word with her and show her the pictures of these MRIs. She said, “That is a fantastic PhD question, and I think you should pursue it.”
I went on a fruitless hunt to find someone to take me on as a PhD student. A few months later, after September 11, 2001, I was in Edinburgh, Scotland, and I bumped into Jull at a conference. She mentioned a remote PhD program at University of Queensland and asked me to write a proposal. I wrote it that night in my hotel, and three months later I was in the program working in the Whiplash and Diagnostic Research Unit and the Center for Magnetic Resonance with renowned magnetic resonance physicist Graham Galloway, PhD, University of Queensland.
From our clinical observations, we were able to develop a very simple MRI measure to quantify that fat in those muscles. We found that people who did have chronic whiplash pain-related disability had an awful lot of fat compared with healthy controls in the muscle tissue, so it appeared to be unique to those individuals.
Following my PhD, I embarked on a three-year post-doc with Michele Sterling, PhD, University of Queensland, a world-renowned expert in whiplash-associated disorders. That experience was by far the most influential three years of my professional life.
What types of collaborations are you engaged with?
Jules Dewald, PT, PhD, chair of physical therapy and human movement sciences, has been instrumental in connecting me with people to quantify the temporal expression of altered spinal cord metabolism and identify an acute marker that may provide insight into the risk of transition to chronic pain.
One of my strongest collaborations is Mark Courtney, MD, associate professor in emergency medicine, with the help of Jim Adams, MD, professor and chair of emergency medicine. Mark has really helped get the ball rolling to recruit subjects soon after their motor vehicle collision. I usually see them within an hour of their accident, once they have been medically screened for fractures and they are stable. We have a large prospective study right now that is supported by the Northwestern University Clinical and Translational Sciences KL2 program, where we measure the acute, progressive changes in spinal cord metabolism and muscle degeneration to try to tease out who is at risk for transition to chronic pain.
My other key collaborators are Todd Parrish, PhD, and Timothy Carroll, PhD, who are in radiology and biomedical engineering. Both are magnetic resonance physicists who specialize in MRI applications to get to the cellular level of some of these events. I also work with Wellington Hsu, MD, assistant professor in orthopaedic surgery. I am a firm believer, as a physical therapist with a PhD, that interdisciplinary collaboration is the way to go. I’ve only been here two years, but I’ve never been anywhere where collaboration is stronger and more promoted.
Can you discuss the role of mentoring throughout your career?
From a research perspective, I have had excellent mentoring, and if I can be half as good as Gwen was for me and many others, I’d be a great adviser. I had the experience of co-supervising research students at University of Queensland, but not until recently as the primary mentor, and now I have two new PhD students at Feinberg. I want to see them thrive. I want them to go from the nine billion questions they want to ask initially and help them refine their approach to one or two key, and potentially translational, questions. My role will be as the big-picture person to help them maintain their focus and make a strong impact to the body of knowledge.