Active Treatments

Rating

Category: Allied Health Options

Injury Type: Acute/Chronic

What is it?

Active treatments are based on the principles that early and repeated movements of neck within the pain free range ensure that normality is maintained and encouraged. These active treatments can be in the form of light, repetitive exercises of the neck, posture advice and education, and may even include specific philosophies of management (such as McKenzie). These strategies can be conducted under the supervision of a health professional and/or at home.

How does it work?

Active treatments aim to maintain and enhance available movements in the spine. This results in minimised pain, stiffness and loss of movement which can occur if the spine is immobilised for long periods of time. By encouraging regular movement of the spine in the initial stages and gradually increasing movements with active exercises, while still respecting pain, ensures that normal movement is maintained during the recovery period.

Is it effective?

There are some high level research studies which have investigated the effectiveness of active treatments. The findings from these studies are mixed. In the acute stage of whiplash, active treatments seem to provide positive benefits in terms of pain, range of movement, sick leave and activities of daily living, especially in the short term.

In a recent study undertaken in Denmark, which investigated long term (1 year) outcomes, whiplash patients who received active interventions were no better off than patients who continued with their normal life and those who wore a neck collar for two weeks. However, an older study reported that active intervention when compared to standard treatment (pamphlet, education and collar), when provided early (within 96 hours of injury), helped to reduce pain. The same study, reported in another paper, outlined that when it came to range of movement alone, even in the long term (3 years), active intervention was better than wearing a collar. Similar findings have also been reported by research from Canada which showed that exercising the affected areas helped to reduce pain and disability when compared to just wearing a collar and not moving.

A recent systematic review of scientific studies concluded that there was strong evidence to support the use of 'active exercise' in the management of acute whiplash. The same review found there was consensus opinion among clinicians that functional neck movements (based on the patient's specific requirements) were an effective treatment for chronic whiplash (more than 12 weeks following injury). A separate systematic review found that simple neck rotation (turning side to side) lead to reduced pain levels at 6 months and reduced sick leave at 3 years following whiplash injury.

Are there any disadvantages?

While there were no reported disadvantages or side effects from active treatments, these treatments should be prescribed and monitored by a health professional at regular intervals. If patients' symptoms are not improving with these treatments, health professionals need to review their management regime.

Where do you get it?

Active treatments can be provided by any qualified health professional. This may include doctors, physiotherapists and chiropractors.

Recommendations

While there is some evidence to support the use of active treatments, especially in the early stages, more research is needed to describe its effect in the long term.

Key References

  • Bonk, AD, Ferrari R, Giebel GD, Edelmann M & Huser R 2000, 'Prospective, randomized, controlled study of activity versus collar, and the natural history for whiplash injury, in Germany', Journal of Musculoskeletal Pain, vol. 1, no. 1, pp 123-132.
  • Crawford, JR, Khan, RJK & Varley GW 2004, 'Early management and outcome following soft tissue injuries of the neck – a randomised controlled trail', Injury, vol. 35, pp 891-895.
  • Dehner, C, Elbel, M, Strobel, P, Scheich, M, Schneider, F, Krischak, G & Kramer, M 2009, 'Grade II whiplash injuries to the neck: what is the benefit for patients treated by different physical therapy modalities?', Patient Safety in Surgery , vol. 3, no. 2, doi: 10.1186/1754-9493-3-2.
  • Guzman, J, Haldeman, S, Carroll, L, Carragee, E, Hurwitz, E Peloso, P, Nordin, M, Cassidy, D, Holm, L, Coˆte, P, Van der Velde, G & Hogg-Johnson, S 2008, 'Clinical practice implications of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders; from concepts and findings to recommendations', European Spine Journal, vol. 17, no. 1, pp. 199-213.
  • Hurwitz, E, Carragee, E, Van der Velde, G, Carroll, L, Nordin, M, Guzman, J, Peloso, P, Holm, L, Coˆte, P, Hogg-Johnson, S, Cassidy, D & Haldeman, S 2008, 'Treatment of neck pain: noninvasive interventions; results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders', European Spine Journal, vol. 17, no. 1, pp. 123-152.
  • Kongsted, A, Qerama, E, Kasch, H, Bendix, T, Winther, F, Korsholm, L & Jensen TS 2007, 'Neck Collar, "Act-as-Usual" or Active Mobilisation for Whiplash Injury? A Randomised Parallel-Group Trial', Spine, vol. 32, no. 6, pp. 618-626.
  • Mercer, C, Jackson, A & Moore, A 2007, 'Developing clinical guidelines for the physiotherapy management of whiplash associated disorder (WAD)', International Journal of Osteopathic Medicine, vol. 10, no. 2-3, pp. 50-54.
  • Poorbaugh, K, Brismée, J, Phelps, V & Sizer, P 2008, 'Late whiplash syndrome: a clinical science approach to evidence-based diagnosis and management', Pain Practice, vol. 8, no. 1, pp. 65-89.
  • Rosenfeld, M, Gunnarsson, R & Borenstein, P 2000, 'Early Intervention in Whiplash-Associated Disorders A Comparison of Two Treatment Protocols', Spine, vol. 25, no. 14, pp. 1782-1787.
  • Rosenfeld, M, Seferiadis, A, Carlson J & Gunnarsson, R, 2003, 'Active Interventions in Patients with Whiplash-Associated Disorders Improves Long-Term Prognosis', Spine, vol. 28, no. 22, pp. 2491-2498.
  • Schnabel, M, Ferrari, R, Vassiliou, T & Kaluza, G 2004, 'Randomised, controlled outcome study of active mobilisation compared with collar therapy for whiplash injury', Emergency Medicine Journal, vol. 21, pp. 306-310.
  • Seferiadis A, Rosenfeld M & Gunnarsson R 2004, 'A review of treatment interventions in whiplash-associated disorders', European Spine Journal, vol. 13, pp. 387–397.
  • Verhagen, A, Scholten-Peeters, G, Van Wijngaarden, S, De Bie, R & Bierma-Zeinstra, S 2007, 'Conservative treatments for whiplash', Cochrane Database of Systematic Reviews, Issue 2, Art. No.: CD003338. DOI: 10.1002/14651858.CD003338.pub3.
  • Yadla, S, Ratliff, J & Harrop, J 2008, 'Whiplash: diagnosis, treatment, and associated injuries', Current Reviews in Musculoskeletal Medicine, vol. 1, pp. 65-68
Copyright © Centre of National Research on Disability and Rehabilitation Medicine (CONROD)