More than 50% of patients of patients injured in motor vehicle accidents receive whiplash diagnoses. Patients with acute severe neck pain develop chronic neck pain in 15% to 40% following these type of injuries.
Unfortunately over the past years the standard treatment for whiplash prescribed by physicians consisted of rest and a soft neck brace for comfort. This resulted in research conducted by Charles P. Vega, MD from the Dept. of Family Medicine at the University of California, Irvine who concluded that statistically patients improve rapidly with active treatment over rest. This evidence-based study supported early mobilization after 96 hours of rest as the standard of care.
This recommendation is largely influenced by Rosenfeld's work published in SPINE, the premier peer review journal for research on spine-related pathologies. Rosenfeld compared treatment plans for more than 100 whiplash patients. Groups received standard care (advice from a doctor for restricted activity), active care within 96 hours of the injury, and active care within 14 days of the injury. Active care consisted of physical therapy evaluation, postural control, and neck rotation exercises. At six months 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. 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.
Rosenfeld's research adds to an ever-growing body of evidence demonstrating how various approaches (manual therapy, therapeutic modalities, exercises and postural re-education) improve functional outcomes for patients diagnosed with whiplash.
The physiological benefit of initiating physical therapy after a whiplash within a 96 hour time frame has to do with the laying down of new tissues. Put into basic terms, as the body lays down new tissues to heal a sprain or strain, it has only the one blueprint for the best way to lay those tissues down: MOVEMENT. Without movement, the new tissue will form in counterproductive patterns.
Physical therapy intervention will introduce thorough but pain-free movement in the injured areas to help the healing response pattern create new tissues correctly and reduce chronic pain and poor recovery.
References:
Vega, C. Active Intervention Best for Whiplash (CME). Medscape: November 24, 2003.
Rosenfeld, M. et al. Early Intervention in Whiplash-Associated Disorders. Spine, 2000, 25 (14) 1782-1787.
Rosenfeld, M. et al. Active Involvement and Intervention in Patients Exposed to Whiplash Trauma in Automobile Accidents Reduces Costs. A Randomized Controlled Clinical Trial and Health Economic Evaluation. Spine 2006, 31, 1799-1804.
Gary J. Maguire, PT
Physical Therapist
Key Words:
Gary, J., Maguire, PT, Pain, Whiplash, Physical, Therapist, Vancouver, WA, Injury, MVA, Back, Physical Therapist, Physical Therapy, Treatment, Diagnosis, Gary J. Maguire, PT
As we said, not all injuries are immediately apparent, and it may take time before you show any signs of injury at all. The extreme stress and force that hits your body during the accident will work on it from the outside in, and the internal shocks to your overall body will not end in an instant. Motor Accidents Treatment Services
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