Whiplash TreatmentTreating Whiplash in the Acute Phase
Treating Whiplash in the Acute Phase
More than 50% of patients injured in motor vehicle accidents receive whiplash diagnoses. Patients with acute neck pain develop chronic neck pain in 15% to 40% of cases.1 Can pearls of wisdom from high quality research help America do better with this troubling diagnosis? Only five years ago, Charles P Vega, MD (Dept. of Family Medicine, University of California, Irvine) wrote that standard treatment for whiplash primarily consisted of rest and a soft cervical collar for comfort.2 Of course, he reported this in the midst of an evidence-based article unequivocally recommending active treatment including early mobilization as the new standard of care. Dr. Vega supported the recommendation that active whiplash treatment such as physical therapy begin within 96 hours of the accident.
Treatment plans for Whiplash Injury
This recommendation is largely influenced by Rosenfeld’s work published in Spine, the premier peer review journal for research on spine-related pathologies.3-5 Rosenfeld compared treatment plans for more than 100 whiplash patients. Groups received standard care (advice from a doctor for restricted activity and advice on stretching that was to begin several weeks after the accident), active care within 96 hours of the injury, and active care within 14 days of the injury. Active care consisted of physical therapy evaluation, posture control, and neck rotation exercises. At six month follow-up and at 3-year follow-up, the active treatment groups experienced significantly less pain and sick leave. Rosenfeld and colleagues also compared cervical range of motion between treatment groups and a control group that had received no trauma to the neck. At three years, only the group that had received active treatment within 96 hours of the accident enjoyed cervical range of motion approaching that of the uninjured group (P=.06-.08). In terms of pain and range of motion after three years, it was better to receive active treatment within 96 hours of the accident.4 Rosenfeld also did an economic study taking into account the cost of physical therapy and the cost of time off work. They demonstrated that active treatment was less costly and more effective.5
Rosenfeld’s work adds to an ever-growing body of evidence demonstrating how various approaches available in physical therapy improve outcomes for patients diagnosed with whiplash.6-10 One of the reasons New Heights Physical Therapy Plus encourages whiplash injury treatment, as soon as possible, during the acute phase has to do with the laying down of new tissues. Put in basic terms, as the body lays down new tissues to heal a sprain, it has only one blueprint for the best way to lay those tissues down: movement. Without movement, the new tissue will form in counterproductive patterns. The knowledgeable therapists at New Heights will introduce thorough but pain-free movement in the injured areas to help the healing response pattern new tissues correctly.
Experience in Whiplash Treatment
Our senior physical therapists have an average of more than ten years clinical experience with extensive continuing education. This makes a big difference in the positive outcomes our patients enjoy.
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1. Schofferman J, Bogduk N, Slosar P. Chronic whiplash and whiplash associated disorders: an evidence-based approach. J Am Acad Orthop Surg, Vol 15, No 10, October 2007, 596-606.
2. Vega C. Active Intervention Best for Whiplash (CME). Medscape: November 24, 2003. Online resource last accessed 1/12/2009. Available at: www.medscape.com/viewarticle/464912_print.
3. Rosenfeld M, Gunnarsson R, Borenstein P. Early intervention in whiplash-associated disorders. Spine, 2000, 25 (14): 1782-87.
4. Rosenfeld M, Seferiadis A, Carlsson UJ, et al. Active intervention in patients with whiplash associated disorders improves long term prognosis. A randomised controlled clinical trial. Spine 2003, 28, 2491-2498.
5. Rosenfeld M, Seferiadis, Gunnarsson. Active invlovlement and intervention in patients exposed to whiplash trauma in automobile pressures reduces costs. A randomised controlled clinical trial and health economic evaluation. Spine 2006, 31, 1799-1804.
6. Conlin A, Bhogal S, Sequeira K. Treatment of whiplash associated disorders. Part I: Non-invasive interventions. Pain Res Manage 2005, 10 (10): 21-32.
7. De las Penas C, Fernadez-Carnero J, Palomeque del Cerro L, et al Manipulative treatment vs. conventional physiotherapy treatment in whiplash injury: A randomized controlled trial. Jouranl of Whiplash & Related Disorders, 2004, 3 (2): 73-90.
8. Vassiliou T, Kaluza G, Pulzke C, et al. Physical Therapy and active exercises – An adequate treatment for prevention of late whiplash syndrome? Randomized controlled trial in 200 patients. Pain, 124 (1): 69-76.
9. Wang W, Olson S, Campbell A, et al. Effectiveness of physical therapy for patients with neck pain: an individualized approach using a clinical decision-making algorithm. American Journal of Physical Medicine & Rehabilitation, March 2003, 82(3): 203-218.
10.Bunketorp L, Lindh M, Carlsson J, et al. The effective ness of a supervised physical training model tailored to the individual needs of patients with whiplash-associated disorders – a randomized controlled trial. Clinical Rehabilitation, 2006, 20 (3): 201-217.