Exercise

Rating

Category: Allied Health Options

Injury Type: Acute/Chronic

What is it?

Exercise is the activity of exerting your muscles in various ways to improve or maintain physical fitness. Exercises for whiplash or neck pain may include specific neck exercises, shoulder exercises, active exercise, stretching, strengthening, postural, functional, kinaesthetic, eye-fixation and proprioception exercises (the last two exercises help with balance and control of movement). Exercises may be performed in a structured supervised format or may involve unsupervised sessions in a variety of settings. Exercise can also be performed individually or in a group. Exercise typically has effects on the cardiovascular, musculoskeletal and neurological systems of our body.

How does it work?

It is thought that exercise can help improve pain, range of movement/flexibility, function, physical fitness, reduce/maintain body weight, increase/maintain muscle strength and endurance, coordination, balance, control, improve patient satisfaction and quality of life via its effect on the musculoskeletal, cardiovascular and neurological systems. Exercise is also thought to promote the production of endorphins, naturally occurring opioid hormones by the brain that can help with pain control.

Is it effective?

The short answer is that doing some form of exercise is probably more effective than not doing any exercise following a whiplash injury. What is not known is the type of exercise that is most beneficial, or whether exercise is better than any other form of treatment. A systematic review looked at the evidence for various types of exercise and made the following conclusions:

  • There is limited evidence of benefit that active range of motion exercises may reduce pain following whiplash in the short term
  • The evidence for strengthening exercises for chronic neck pain (none were specific to whiplash) for pain relief in the short and long term is unclear
  • Strengthening exercise focused on neck muscles was more promising than strengthening of the shoulder/thoracic region
  • A ‘multimodal care approach’ of exercise combined with mobilisations or manipulations was effective in improving short term and chronic neck pain (not specifically whiplash related)
  • There was benefit from a stretching and strengthening program in the neck or neck and shoulder/trunk region on pain in people with chronic neck pain (not specifically whiplash related) in the short and long term
  • Shoulder strengthening and stretching exercises did not appear to be effective
  • It is not clear whether stretching and strengthening exercises are any better than other treatments such as manual therapy, education, medication and home exercises
  • The relative benefit of different exercise approaches appear similar
  • In patients with subacute neck pain, motor control and endurance/strength training of the neck muscles were associated with similar improvement in disability and pain.
  • A program of eye-fixation/proprioception exercises within a more complete programme improved pain and function following whiplash in the long term
  • There was some evidence that a mobilisation program combined with other treatments was better for pain in the short term over a program of rest then gradual mobilisation in the early stages following whiplash injury
  • There does not seem to be any benefit of home exercises over other treatments in the short term and long term
  • Individualised instruction may be more effective than written information alone for people with neck pain (not specifically whiplash related)

Two studies published after the systematic review have both found that different types of exercise (a rehabilitation programme containing eye, head and neck coordination exercises, and an individualised, progressive combined type of exercise programme) were beneficial in the short term. Another new study published in 2007 found that a new ‘sling’ exercise therapy was not any better than traditional strengthening and endurance exercises.

Another study demonstrated that a personalized exercise program was more effective than advice alone and this was not affected by the patient or the therapist’s preference for a particular type of treatment. A systematic review found strong evidence to support the use of active range of motion exercises commenced within four days of injury.

A recent experimental study found lessened natural brain-driven pain inhibition during exercise in people with chronic WAD implying that exercise could perhaps increase pain in some people in that population. This finding indicates that one should be cautious when evaluating and recommending exercises for people with chronic WAD. Therefore, the authors recommend that when prescribing exercises for people with longstanding WAD, the use of individualised, targeted exercise therapies may be more suitable when compared to generic exercise programs which do not take into account individual needs and requirements.

Are there any disadvantages?

In a systematic review, 12% of studies found side effects as a result of exercise, however, they were not severe and didn't last very long. Side effects have been reported as headaches, arm pain, pins and needles, dizziness and worsening of symptoms.

A recent review found that exercise provides some degree of short term pain relief in neck pain after a motor vehicle accident or without the history of trauma. They also found that exercise may cause a temporary increase in symptoms but have a long term benefit.

Usually exercise is quite safe, but you should always seek advice from your doctor or health professional regarding exercise following a whiplash injury.

Where do you get it?

Specific exercises may be prescribed to you by your doctor or treating therapist. You may perform exercises under their direct supervision, at home, or in a class. You may also join an exercise group with other people in the wider community. Exercises can be performed just about anywhere – gyms, clinics, home, outdoors, pools etc.

Recommendations

Following a whiplash injury you are likely to be better off if you perform some type of exercise, rather than avoiding it. Although there does not appear to be one type of exercise more beneficial than another, it is best to seek advice from your doctor or health provider before performing these activities.

Key References

Following a whiplash injury you are likely to be better off if you perform some type of exercise, rather than avoiding it. Although there does not appear to be one type of exercise more beneficial than another, it is best to seek advice from your doctor or health provider before performing these activities.

Ask, T, Strand, LI & Skouen, JS 2009, ‘The effect of two exercise regimes; motor control versus endurance/strength training for patients with whiplash associated disorders: a randomized controlled pilot study’, Clinical Rehabilitation, vol. 23, pp. 812-823.

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.

Guzman, J, Haldeman, S, Carroll, LJ, Carragee, EJ, Hurwitz, EL, Peloso, P, Nordin, M, Cassidy, JD, Holm, LW, Côté, P, Velde, G & Hogg-Johnson, S 2009, ‘Task force on neck pain and its associated disorders’, Journal of Manipulative and Physiological Therapeutics, vol. 32, pp. 227-243.

Humphreys, BK & Irgens, PM2002, ‘The effect of a rehabilitation exercise program on head-repositioning accuracy and reported levels of pain in chronic neck pain subjects’, Journal of Whiplash Related Disorders, vol. 1, pp. 99-112.

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.

Kay, TM, Gross, A, Goldsmith, C, Santaguida, PL, Hoving, J, Bronfort, G, Cervical Overview Group, ‘Exercises for mechanical neck disorders’, Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD004250. DOI: 10.1002/14651858.CD004250.pub3.

Leaver, AM, Refshauge, KM, Maher, CG & McAuley, JH 2010, ‘Conservative interventions provide short-term relief for non-specific neck pain: a systematic review’, Journal of Physiotherapy, vol. 56, pp. 73–85.

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.

Miller, J, Gross, A, D'Sylva, J, Burnie, SJ, Goldsmith, CH, Graham, N, Haines, T, Brønfort, G & Hoving, JL 2010, ‘Manual therapy and exercise for neck pain: A systematic review’, Manual Therapy, vol. 15, pp. 334-354.

Oosterwijck, JV, Nijs, N, Meeus, M, Loo MV & Paul, L 2012, ‘Lack of endogenous pain inhibition during exercise in people with chronic whiplash associated disorders: an experimental study’, The Journal of Pain, vol. 13, no. 3, pp 242-254.

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.

Stewart, MJ, Maher, CG, Refshauge, KM, Herbert, RD, Bogduk, N & Nicholas, M 2007, ‘Randomized controlled trial of exercise for chronic whiplash-associated disorders’, Pain, vol. 128, no. 1-2, pp. 59-68.

Schofferman, J, Bogduk, N & Slosar, P 2007, ‘Chronic whiplash and whiplash associated disorders: an evidence based approach’, Journal of the American Academy of Orthopaedic Surgeons, vol. 15, no. 10, pp. 596-606.

Stewart, M, Maher a, C, Refshauge, K, Herbert, R &Nicholas, M 2007 ‘Patient and clinician treatment preferences do not moderate the effect of exercise treatment in chronic whiplash-associated disorders’, European Journal of Pain, b doi:10.1016/j.ejpain.2007.12.009.

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.

Vikne, J, Oedegaard, A, Laerum, E, Ihlebaek, C & Kirkesola, G 2007, ‘A randomized study of new sling exercise treatment vs traditional physiotherapy for patients with chronic whiplash-associated disorders with unsettled compensation claims’, Journal of Rehabilitation Medicine, vol. 39, no. 3, pp. 252-259.

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