What is the treatment for whiplash?

Treatment for Whiplash

The treatment for whiplash should begin with early mobilization, topical NSAIDs with or without menthol gel, and implementation of the PRICE protocol (Protection, Rest, Ice, Compression, and Elevation) for the first 24-48 hours, followed by gentle range of motion exercises progressing to strengthening exercises as pain allows. 1

Initial Management (First 48-72 Hours)

• Spinal Motion Restriction: Manually stabilize the head to minimize motion of the head, neck, and spine while avoiding immobilization devices unless properly trained in their use 1
• PRICE Protocol:
  • Protection to prevent further injury
  • Rest for 24-48 hours (not prolonged immobilization)
  • Ice application for 15-20 minutes every 2-3 hours (with a barrier such as a thin towel)
  • Compression using elastic bandages
  • Elevation of the injured area when possible 1
• Topical Pain Relief: Apply topical NSAIDs directly to the affected area 3-4 times daily, possibly combined with menthol gel for enhanced effect 1
• Oral Medications: For moderate to severe pain, consider:
  • NSAIDs when topical treatment is insufficient
  • Acetaminophen as an alternative when NSAIDs are contraindicated 1
  • Muscle relaxants like cyclobenzaprine may be used for short periods (up to 2-3 weeks) to relieve muscle spasm 2

Rehabilitation Phase (After 48-72 Hours)

• Early Mobilization: Begin gentle range of motion exercises after the acute phase, which is superior to passive treatments 3
• Progressive Exercise: Gradually advance to strengthening exercises as pain allows, focusing on regaining flexibility and strength 1
• Manual Therapy: Consider as part of multimodal care, not as standalone treatment 1
• Non-Pharmacological Options:
  • Massage therapy has shown moderate evidence for pain reduction 4
  • Transcutaneous Electrical Nerve Stimulation (TENS) may help reduce pain 1
  • Acupressure can improve pain and physical function 1

Management of Persistent Symptoms

• Further Evaluation: Consider additional diagnostic workup if symptoms persist beyond 3 months to identify specific pain generators, with the cervical facet joint being the most common source of chronic neck pain after whiplash 1, 5
• Interventional Procedures: For persistent facet joint pain confirmed by medial branch blocks, radiofrequency neurotomy can provide substantial relief for approximately 8-12 months 5, 6
• Chronic Pain Management: Regular individualized daily exercise regimens should be implemented 1
• Workplace Considerations: Implement ergonomic modifications and consider vocational rehabilitation for those with occupational injuries 1

Important Considerations and Cautions

• Prognosis: Most patients recover within 3 months, though persistent neck pain after 2 years is reported by more than 30% of patients 1, 7
• Imaging: Routine imaging is not recommended unless there are red flags suggesting serious pathology 1
• Avoid Prolonged Immobilization: Use of cervical collars should be minimized during the first 2-3 weeks and then avoided 7
• Medication Cautions:
  • Cyclobenzaprine should be used only for short periods (up to 2-3 weeks) 2
  • Elderly patients should start with lower doses (5 mg) of cyclobenzaprine and titrate slowly upward 2
  • Patients with hepatic impairment should use cyclobenzaprine with caution, starting with 5 mg 2
  • Avoid opioids, including tramadol, in treating acute musculoskeletal injuries 1
• Risk Factors for Poor Recovery: Older age, interscapular/upper back pain, occipital headache, multiple symptoms, reduced cervical range of motion, neurological deficits, and pre-existing degenerative changes 1, 7

Special Populations

• Elderly: May need longer recovery periods and modified exercise programs 1
• Workers with Occupational Injuries: May require workplace modifications and vocational rehabilitation 1