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.
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.
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- 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.
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