From the Guidelines
The initial management for a patient with whiplash should prioritize gentle early mobilization, pain control, and patient education, avoiding prolonged immobilization and focusing on early activation to prevent deconditioning and promote faster recovery. When considering the management of whiplash, it's crucial to balance the need for pain management with the importance of maintaining mobility and preventing the deconditioning that can occur with prolonged rest. The use of manual cervical stabilization techniques by first aid or lay providers is not recommended as a standard approach for whiplash management, as emphasized in the 2020 international consensus on first aid science with treatment recommendations 1. Instead, patients should be encouraged to maintain normal activities and perform gentle range-of-motion exercises within pain limits. Pain management can include the use of acetaminophen or NSAIDs like ibuprofen, with muscle relaxants such as cyclobenzaprine considered for short-term use in cases of severe muscle spasm. Patient education is also a critical component, including reassurance about the typically benign nature of whiplash and the importance of early mobilization for recovery. For patients with persistent symptoms, physical therapy focusing on gradual strengthening exercises and proper posture may be beneficial. The approach to whiplash management should be guided by the most recent and highest quality evidence, prioritizing interventions that promote recovery while minimizing the risk of long-term disability or chronic pain, as suggested by guidelines such as those found in the Journal of the American College of Radiology 1. Key aspects of management include:
- Gentle early mobilization to prevent deconditioning and promote recovery
- Pain control using acetaminophen, NSAIDs, or short-term muscle relaxants as needed
- Patient education on the importance of early activation and the typically benign nature of whiplash
- Avoidance of prolonged immobilization
- Consideration of physical therapy for patients with persistent symptoms.
From the Research
Initial Management for Whiplash
The initial management for a patient with whiplash (cervical acceleration-deceleration injury) involves a combination of physical therapy, active exercises, and education.
- The primary goals of treatment are a quick return to normal activities and the prevention of chronicity 2.
- Active interventions such as education, exercise therapy, training of functions, and activities are recommended according to the length of time since the accident and the rate of recovery 2.
- A physical therapy regimen which includes active exercises is superior in reducing pain 6 weeks and 6 months after whiplash injury compared to the current standard treatment with a soft collar 3.
Exercise Therapy
Exercise therapy is proposed as one possible intervention strategy for whiplash-associated disorders.
- The results from a systematic review and meta-analysis suggest that exercise therapy may provide additional effect for improvement of neck pain and disability in patients with whiplash-associated disorders 4.
- High pain intensity can modify the effects of a therapeutic exercise program, and research into best methods of pain management is required to facilitate physical rehabilitation 5.
- Exercise programs should be individually prescribed to address particular impairments rather than using generic programs 5.
Other Treatment Options
Other treatment options, such as laser acupuncture, have been studied but found to be ineffective in the management of whiplash injuries.
- Adjuvant laser acupuncture with a 5 mW HeNe laser and an irradiation time of 15 s appears to be ineffective in the management of whiplash injuries 6.
- The use of a cervical collar and a combination of paracetamol and chlormezanone may be used in conjunction with other treatments, but their effectiveness is limited 6.