Early Mobilization of Acute Whiplash Injuries
Acute whiplash injuries are a common cause of soft tissue trauma for which the standard treatment is rest and initial immobilization with a soft cervical collar. Because the efficacy of this treatment is unknown a randomized study in 61 patients was carried out comparing the standard treatment with an alternative regimen of early active mobilization. Results showed that eight weeks after the accident the degree of improvement seen in the actively treated group compared with the group given standard treatment was significantly greater for both cervical movement (p<0.05) and intensity of pain (p<0.0125).
The results of this study indicate that early mobility of the neck following whiplash accident compared with a cervical collar and instructions to rest results in significantly less pain and stiffness.
Whiplash injuries are due to sudden flexion and hyperextension of the spine with hyperextension as the main cause of damage. Standard treatment consists of a period of immobility using a soft cervical collar and simple analgesia before gradual mobilization. The purpose of this study is to evaluate the efficacy of this standard treatment compared with an alternative treatment of daily neck exercises and mobilization using the Maitland technique.
Subjects were patients with acute whiplash injuries who had not suffered a cervical fracture. Intensity of pain was assessed and cervical mobility was measured via a goniometer from which the total cervical movement was calculated. Patients were then randomized into two groups:
Group 1 - Standard treatment- soft cervical collar and instruction to rest for two weeks before beginning gradual mobilization; analgesia was given as required.
Group 2 - Active treatment- application of ice in the first 24 hours and then neck mobilization using the Maitland technique (repetitive and passive movements within the patients' tolerance with tiny movements and movements with a restricted amplitude for pain and spasm, and movements with larger amplitude for stiffness) and daily exercises of the cervical spine within pain limits every hour at home; application of local heat after each treatment; no analgesia was required.
Both groups were assessed for residual pain and cervical movement at four and eight weeks after the accident.
Results proved that patients who are treated actively show significantly greater improvement in both cervical movement and intensity of pain compared with patients treated the standard way. At four weeks, a significant increase in cervical movement occurred in the patients given active treatment but not in those given standard treatment. At eight weeks, the same findings were yielded indicating that the increase in cervical mobility occurred earlier and to a significantly greater degree with active treatment. In terms of pain, the improvement was greater at both four and eight weeks in the group given active treatment compared with those given standard treatment.
These results confirm the expectations that initial immobility (lack of movement) after whiplash injuries gives rise to persistent pain and stiffness whereas a more rapid improvement can occur by early active management without any consequent increase in discomfort.
- British Medical Journal 1986; 292:656-657. From the Department of Orthopedics, St. James's Hospital, Dublin 8, Ireland.