[Treatment of dislocations of the cervical vertebrae in so-called "whiplash injuries"]

Abstract

It is estimated that between 15 and 30% of car occupants will suffer neck pain after accidents, and many will remain symptomatic for a prolonged period. This has often been attributed to the effect of associated litigation as a financial deterrent to recovery. Conventional treatment uses an old orthopaedic principle of rest until the symptoms resolve and analgesia is widely accepted, although its use is unlikely to influence the ultimate outcome. Mobilization programmes have become popular, particularly with physiotherapists, but they are often based upon personal experience and are largely scientifically untested. An improvement in both the cervical range of movement and a reduction in the severity of neck pain was claimed in a study in 1986 using early mobilization. In an attempt to identify which features of physiotherapeutic practice appeared to correspond with improved outcome, I studied the outcomes of differing treatment regimens in acute whiplash patients in three randomized groups and showed that after 1 and 2 months there was a significant improvement in cervical movements and in the patients' perception of their neck pain severity, in actively mobilized patients, including those who were instructed about postural correlation and mobilization techniques. The benefit conferred on this group was still evident 2 years post injury. It therefore seems that self-reliance with exercises used when symptoms are troublesome and postural advice can play a significant role in the recovery process.