Whiplash Injuries and Chronicity – How should we be managing this?

How do we typically manage these injuries?

Whiplash-associated disorder (WAD) is a highly common injury sustained during a motor vehicle accident (MVA), accounting for approximately 75% of all survivable MVA injuries in Australia. Most people who have been injured in an MVA will consult with their GP, where approximately 34% of patients are referred on for imaging. It’s also common to be referred for physiotherapy interventions in the early stages. However, imaging is not recommended following this type of injury (unless in the presence of red flags such as inability to cervically rotate beyond 45 degrees) as their findings may not be indicative of pain and disability following spinal injury; see our Health Information sheet The Myth About Pain and Physical Damage for more. There is also a common societal belief that manipulation following a whiplash injury is an effective method of treatment and is endorsed by approximately 80% of GP’s and 84% of physiotherapists, despite evidence suggesting its’ lack of effectiveness.

What should we be doing?

A systematic review of treatments for WAD suggests that the most effective forms of treatment include an early physical activity intervention during the acute phase, and a combination of cognitive behavioural therapy with physical therapy interventions. When WAD becomes chronic, recommendations remain to incorporate exercise therapy, but with a greater focus on coordination. If conservative treatment modalities remain unsuccessful, radiofrequency neurotomy may be indicated.

An area that is too often missed in the progression of WAD into chronicity is identification of modifiable risk factors in the acute phase of treatment – which may place the injured person at a higher risk of progressing into chronicity. Factors such as pain catastrophising, psychosocial concerns, and central nervous system hypersensitivity may play a role in the progression to chronicity and can be well addressed much earlier through cognitive behavioural therapies, coupled with appropriate exercise prescription.

What is the take-home point?

Most people will recover well from WAD. The evidence suggests that people who retain a positive mindset and resume their normal daily activities, as tolerated, may recover faster than those who significantly alter or reduce their activity levels following their injury. The best way forward is to consult with your treatment provider and to develop strategies to assist in returning to meaningful activity and work duties as appropriate through targeted exercise and education. As a starting point, consult our Pain Management Guidebook.

References

Blanpied, P., et al., 2017. Neck Pain: Revision 2017. Journal of Orthopaedic & Sports Physical Therapy, 47(7), pp.A1-A83.

Brijnath, B., et al., 2016. General practitioners knowledge and management of whiplash associated disorders and post-traumatic stress disorder: implications for patient care. BMC Family Practice, 17(1).

Curatolo, Michele M.D., Ph.D., et al., Central Hypersensitivity in Chronic Pain After Whiplash Injury, The Clinical Journal of Pain: December 2001 – Volume 17 – Issue 4 – p 306-315

Nikles, J., Yelland, M., Bayram, C., Miller, G. and Sterling, M., 2017. Management of Whiplash Associated Disorders in Australian general practice. BMC Musculoskeletal Disorders, 18(1).

Scott, W., Wideman, T. and Sullivan, M., 2014. Clinically Meaningful Scores on Pain Catastrophizing Before and After Multidisciplinary Rehabilitation. The Clinical Journal of Pain, 30(3), pp.183-190.

Seferiadis, A., Rosenfeld, M. and Gunnarsson, R., 2004. A review of treatment interventions in whiplash-associated disorders. European Spine Journal, 13(5). 

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