Early rehabilitation will help to prevent chronic pain and disability. Passive modalities include the application of heat, ice, electrical stimulation, massage, myofascial release, and traction. Passive modalities are often used to decrease inflammation or pain and to facilitate participation in an active rehabilitation program, which involves strengthening and stretching. Use of modalities with no more active program is usually inappropriate.
Active therapy refers to healing exercises that are directed at improving the patient’s strength, endurance, flexibility, posture, and body mechanics. The goal is to get community fitness program or an independent house program at the conclusion of formal therapy. The treatment prescription is recommended 3 times per week.
Scientific evidence for the physiotherapeutic management of whiplash is sparse. An active strategy is recommended to enhance functions, and prevent further injury. In patients with whiplash-associated disorders caused by an automobile accident, treatment with often repeated active submaximal movements combined with mechanical diagnosis and other treatment methods is more effective in reducing pain than a standard program of initial rest, use of a soft collar, and gradual self-mobilization.
In patients with whiplash-associated disorders, active intervention is more effective than standard intervention in reducing pain intensity and sick leave, as well as at retaining or regaining total ROM.
Appropriately trained caregivers may start and encourage active intervention, that is, often repeated, active cervical rotation, which may be followed, if needed, by assessment and intervention, according to the McKenzie protocol. Strength and endurance training for 12 months are effective for decreasing disability and pain in women with nonspecific neck pain. Fitness and stretching training are advised for patients with chronic neck pain, but stretching and aerobic exercising alone are less effective than strength training.
Specific neck exercises to the management of chronic neck pain, including active activation of the deep neck muscles and dynamic strengthening, may significantly improve disability scores. Consistent evidence (in two randomized, controlled trials) supports mobilization as an effective, noninvasive intervention for acute whiplash-associated disorders.
A study by Treleaven et al suggested that neck-specific exercise led by a physiotherapist, using a behavioral approach included, is more effective in treating dizziness, as well as other symptoms, associated with chronic whiplash than neck-specific physiotherapist-led exercise without a behavioral strategy or general physical activity. The study included 140 patients, who were followed up for 12 months.
Using the same kinds of exercise as from the Treleaven study, Landén et al found that in terms of pain, self-rated functioning and disability, and self-efficacy, in people with chronic whiplash, neck-specific exercise with or without a behavioral approach was associated with significantly greater improvement than was general physical activity at 1-year follow-up, but not at 2 decades. The analysis included 216 patients.
In examining the costs and effects of two kinds of intervention after whiplash injuries in automobile collisions, active intervention utilizing physical therapy and treatment was found to be less expensive and more effective than short-term immobilization with a cervical collar followed by a slow self-exercise program taught by means of a leaflet.
Another study questioned the effectiveness of therapeutic interventions. The report found that 1 year after experiencing whiplash injury from an auto accident, or other incident, a strategy using immobilization, “act-as-usual,” or mobilization had a similar effect to the other 2 methods in terms of pain avoidance, disability, and work capacity.
Occupational therapy may be indicated unless a concurrent problem involves a distal upper-extremity function or ergonomic factors in causation. If biomechanical stresses of work activity are factors in the causation or exacerbation of the problem, a workstation ergonomic evaluation may be indicated.
The degree of neck pain or disorder can be assessed by using standardized scales. A scale’s choice should be tailored according to evaluation’s goal and the target population. The Neck Disability Index is helpful for evaluating groups of individuals, and the Patient Specific Scale is a great tool for assessing individual patients.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Whiplash, among other automobile accident injuries, are frequently reported by victims of an auto collision, regardless of the severity and grade of the accident. The sheer force of an impact can cause damage or injury to the cervical spine, as well as to the rest of the spine. Whiplash is generally the result of an abrupt, back-and-forth jolt of the head and neck in any direction. Fortunately, a variety of treatments are available to treat automobile accident injuries.
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