Anyone who has had an accident resulting in a whiplash injury knows the neck pain, stiffness, and loss of motion that can develop afterwards. Many people recover in a few days to a few weeks. But just as many develop chronic symptoms referred to as whiplash-associated disorder (WAD). Exercise may be a useful tool in getting past these symptoms and even preventing the transition from an acute problem to a chronic one.
In this article, a physical therapist from Australia (they call them physiotherapists there) offers us a review of the research on the topic of exercise for whiplash. Understanding the impairments in movement and problems with neuromuscular control might help physical therapists develop evidence-based exercise programs.
There are two main goals for this type of research. One is to reduce the number of people who develop chronic whiplash-associated disorders. The second is to reduce the number of repeat episodes of neck pain following a whiplash injury.
Therapists are interested in finding ways to retrain muscle coordination in patients with high levels of pain and disability. It can be a challenge to change the way muscles contract and relax when pain is the main feature preventing normal patterns of muscle activation. Movement patterns that are particularly affected by whiplash injury include the ability to move the head and neck quickly (speed) and smoothly.
Both the superficial (surface) and deeper muscles are often affected. If the problem is severe enough or goes on long enough, changes in muscle behavior and movement patterns begin to affect the nearby joints as well. Over time, the neck problem can become a throat problem (voice changes, hoarseness, difficulty swallowing) and/or an arm problem, too. Any rehab program that is successful must address all of these different components of the problem.
Some studies have shown the need to avoid treating whiplash too early. There is so much variability from one patient to the next that one treatment approach doesn’t fit everyone. Research done so far suggests it’s likely that a multidisciplinary approach is needed. Physical rehabilitation combined with psychologic and behavioral training may work best.
In summary, there are known disturbances in muscle behavior and movement of the head and neck after whiplash injuries. Efforts to study the problem may eventually help physical therapists develop specific exercise programs to prevent or address these problems.
Restoring range of motion as well as normal movement patterns may help prevent transitioning from an acute (short-term) problem to a chronic (life-long) problem. The specifics and timing of such a program remain unknown. It does look like exercise prescription will need to include joint range-of-motion, activation patterns of all muscle groups, and muscle endurance. Further research is needed in this area.