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Medical Factors
The gold-standard treatment for whiplash

At a glance:
Based on the combined results of 23 randomised controlled trials, the best treatments for whiplash associated disorders are:

Acute whiplash (symptoms lasting less than 4 weeks):

Early physical exercise
 
Chronic whiplash:

 Cognitive Behavioural Therapy
Cognitive Behavioural Therapy
a therapy used to modify behaviour by changing a person's assumptions, beliefs and approach to a problem
 combined with physiotherapy

Coordination exercise therapy

Radiofrequency neurotomy (creating a lesion in certain nerves to disrupt the pain signals to the brain).
 
Perspectives:
Employee
Whiplash can cause a range of symptoms, which vary greatly in their severity.

The best treatment for whiplash early after injury is physical exercise. Returning to normal activities as much as possible reduces pain and increases range of motion of the neck. More “medical' treatments are only appropriate for long-term or severe conditions. 75% of people recover on their own and a lot of treatment early on can delay recovery.

 
Employer
In the short term, the best treatment for whiplash is to return to work and other activities as quickly as possible. This protects workers from long-term problems, improves symptoms and reduces sick leave. For most people the condition will resolve on its own.

For a minority of people, the condition can persist into the long term. If the problem is severe, the person may report strange symptoms. This can happen after whiplash; there are many delicate structures in the neck that can be damaged, causing dizziness, cognitive
cognitive
relating to the mental processes of perception, memory, judgment, and reasoning
 difficulty, hearing loss, arm pain, headaches or problems with the nervous system. In this situation, support and understanding from the workplace is of great benefit. Effective treatments are available for chronic
chronic
continuing a long time or recurring frequently
 neck pain and it is still best for the person to return to work.
Treater
As with non-specific neck pain, recommended treatment for acute
acute
A condition develops quickly and is often of short duration. The opposite of acute is chronic, which refers to a long term problem continuing for months to years.
 whiplash-associated disorder is physical exercise and a return to activity.

In the early stage “over –treatment' can be a disadvantage. The prognosis for whiplash is generally good. Intensive medical treatment in the early stages has not been shown to improve outcomes and can increase patient concern. Treatment that does not improve the problem increases frustration, leaves the patient worried about why they are not responding to treatment, and concerned that they need treatment to get better.

Ensuring patients understand the condition helps allay fears about returning to activity.
Insurer
The term “whiplash' describes how an injury came about, not the specific medical problem. Whiplash can involve a range of injuries, varying in their symptoms and severity. Symptoms can include difficulties with balance, hearing, cognitive function and the nervous system, along with pain in the neck, head or arm. Two clients with whiplash can present with totally different conditions.

The best treatment for whiplash early on is physical activity. Chronic problems can benefit from certain invasive medical procedures or a combination of physiotherapy and psychological
psychological
Refers to a person's perceptions, thought processes, emotions, personality and behaviour. Psychologists can treat mental health problems.
 treatment.
Original Article, Authors & Publication Details:
Seferiadis, A.1,2, Rosenfeld, M.3 & Gunnarsson, R.4

A review of treatment interventions in whiplash-associated disorders.European Spine Journal 13, 387-397 (2004).

1Psychitric Physiotherapy Unit, Björkängen, Southern Elfsborg Hospital, Sweden
2Department of Primary Health Care, The Sahlgrenska Academy at Göteborg University, Sweden
3Institute of Occupational Therapy and Physiotherapy, Faculty of Health and Caring Sciences, The Sahlgrenska Academy at Göteborg University, Sweden
4Reserach and Development Unit in Primary Health Care, Southern Elfsborg County, Sweden
 
Background, Study Objectives, How It Was Done:
Whiplash is common after road traffic accidents and can also occur in other types of accidents. It can involve irritation to bones or soft tissues, which in turn can lead to a variety of symptoms, known collectively as “whiplash associated disorders", neck pain, headache and reduced neck mobility are typical early symptoms. Other symptoms can include dizziness, memory loss, difficulty swallowing, jaw pain, deafness or ringing in the ears.

Whiplash associated disorders are classified by how severe they are. The condition is graded as most severe when there are signs of damage to the nervous system such as weakness and loss of sensation, or when there is a fracture
fracture
A cracked or broken bone.
 or dislocation. Patients with more severe conditions are at greater risk of having continuing problems. When the condition becomes long-term, a wider range of symptoms is often seen.

The term “acute whiplash disorder' refers to symptoms lasting less than 4 weeks, while “chronic whiplash' disorder refers to symptoms lasting more than 3 months.

In this systematic review,
systematic review
A comprehensive review of research studies in a particular area. The review follows guidelines to ensure the studies included are valid.
 26 randomized controlled trials
randomized controlled trial
A research study that groups participants into "treatment" and "control" groups. The treatment group is given an intervention
intervention
A treatment or management program. Interventions often combine several approaches. In this field approaches include training in problem solving, adaptation of work duties, graded activity, an exercise and stretching program and pain relief.
 while the control group is not. Outcomes for the groups are compared to see the difference made by the intervention. This ensures that the study results are valid and not influenced by another factor. Example: In a randomised controlled trial of treating back pain with anti-inflammatory tablets 60% of people improved over two weeks. However, if 60% of the control group who were given a placebo
placebo
A substance containing no active drug, administered as a control to a patient participating in a research study. Using a placebo helps researchers assess whether the treatment under study is actually responsible for any improvement or worsening of the problem.
 also improved over two weeks the results indicate the tablets did not help overall. It is important participants to be given the medication are chosen randomly. If there was a reason for putting those people in that group, such as worse pain, it might alter the results.
 were assessed for their scientific quality, and their results combined to identify the most effective treatments for whiplash.
 
Study Findings:
Acute whiplash

The treatments for acute whiplash with the strongest scientific support were:

1. Early physical activity

People in the early stages of a whiplash are advised to “act as normal' and continue with physical activity. This reduces pain, increases the range of motion and reduces sick leave.

2. High-dose methyl prednisolone therapy for serious injuries, such as nerve root damage

One high quality trial found that high-dose methyl prednisolone administered within 8 hours of the injury is effective. However this treatment requires hospitalization and involves considerable cost and practical difficulties. For this reason, it is only recommended for people at higher risk of a long-term problem, such as patients with a limited range of motion or signs of damage to the nervous system.

3. Electromagnetic-field therapy

Although electromagnetic field therapy was found to be effective, the equipment used was mounted on a collar. This is not recommended because of the importance of early movement and activity. There may be other ways to administer electromagnetic field therapy without restricting movement, but there were no studies found on in which such a treatment was used.

Chronic whiplash

The treatments for chronic whiplash with the strongest scientific support were:

1. Cognitive Behavioural Therapy combined with physiotherapy

Three studies found that cognitive behaviour therapy combined with physiotherapy significantly reduced pain and sick leave.

2. Co-ordination exercise therapy

Coordination exercises were found to significantly reduce pain, although the quality of evidence was limited.

3. Radiofrequency neurotomy (creating a lesion in certain nerves to disrupt the pain signals to the brain).

In about 50% of whiplash cases, problems with the facet joints between vertebrae
vertebrae
(singular: vertebra) The individual irregular bones that make up the spinal column.
 are involved. This review advised checking for facet joint
facet joint
A joint between the vertebrae in the spine that prevents twisting.There are two facet joints between each adjacent vertebrae. Some doctors consider the facet joint is a cause of back pain for certain people.
 pain. In treating facet joint pain, radiofrequency neurotomy is more effective than intra-articular corticosteroid injections, but is a difficult procedure to perform.

4. Melatonin therapy

People with chronic whiplash often have sleeping difficulties. Melatonin is a hormone involved in sleep, and melatonin therapy is designed to improve the sleep-wake cycle. While this is effective for patients with delayed melatonin onset (meaning the body is slow to increase melatonin levels at night time) wasn't found to improve pain, quality of life or cognitive function.
 
Conclusions:
Based on their effectiveness and practicality, the following treatments are recommended for whiplash:

Acute whiplash (lasting less than 4 weeks):

Early physical exercise (including returning to work and other activities).

Chronic whiplash:

Cognitive Behavioural Therapy combined with physiotherapy

Coordination exercise therapy

Radiofrequency neurotomy
 
References:
PubMed Abstract

 
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