WAD stands for whiplash associated disorder. WAD is a neck injury resulting from rapid acceleration followed by deceleration, and is commonly caused by traffic accidents. The actual pathology is a bit abstruse and lacks a thorough understanding, because the exact cause of the symptoms are controversial. WAD symptoms are subjective, yet highly prevalent.1 Although the pathology is controversial, there are four widely used grades of classification developed by the Quebec Task Force.2 Classification grades include grades 1, 2, 3, and 4. Grade one describes pain, stiffness, and tenderness isolated to the neck with no physiological signs of damage. If Decreased ROM is also observed, along with point specific tenderness, the classification is increased to a grade 2. Ninety-three percent of WAD patients are classified as grade two.2,3 Grade three includes neurological signs, and grade four includes fractures or dislocations.2 Approximately 300,000 individuals receive a whiplash injury annually in the UK.4 WAD rates have been on a steady rise since the 1980’s, leading to an increase in WAD patients seeking treatment.2,4 Sufferers of WAD exhibit symptoms such as: pain, disability, swelling, muscle spasms, difficulty moving the neck, radiculopathy, and severe headaches, fear, anxiety, and psychological disorders such as depression.1,2 However, There is often an incongruent contrast between the magnitude of injury and the magnitude of disability.
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Approximately 50% of patients who sustain a symptomatic whiplash report chronic, and potentially more widespread, disabling symptoms lasting over a year.2, 4 Systematic reviews report limited effectiveness on treating chronic WAD. Also, systematic reviews have not conclusively shown early management approaches to have significant effects on the transition from acute to chronic symptoms. Clinical trials show opposing results regarding the effectiveness of physical therapy intervention.4 Since WAD can be debilitating and costly for individuals as well as society, is therapeutic exercise the most appropriate treatment for Whiplash associated disorder in regards to pain, cost, and function? Therapeutic exercises specific for the neck include isometric and isotonic exercises with variable, constant, or dynamic resistance.5 The aim is to facilitate deep neck muscle activity with flexion, extension, lateral flexion, and rotation exercises.5 The exercises should not provoke symptoms.5 Are these exercises however, effective for treating WAD? The study satisfaction with the outcome of PT exercise in chronic WAD (RCT) compared three interventions of a three month duration. One group received NSE (neck specific exercise with a physical therapist), another received NSE augmented with a behavioral therapy approach, and the third group where merely given a physical activity prescription letter involving no exercises specific to the neck.5 This study found that overall, exercise based treatment increased reported satisfaction, enablement, expectation fulfillment, however people who received NSE (regardless of receiving the behavioral component) reported greater and sooner results than the prescription only group.5 This implicated that a structured PT exercise program may lead to better results by enhancing patients satisfaction, coping, and understanding of WAD.5 Another article however, revealed contrasting results. The article Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): A pragmatic randomised controlled trial randomly assigned 172 patients with type 1 or 2 WAD to a 20 session “comprehensive exercise program” group or to an “advice and telephone support only” group.6 contradictory to the previous study, this study did not find a significant difference in pain or range of motion between the between comprehensive exercise and no comprehensive exercise.6 This article claims to challenge …show more content…
PGAP uses targeted techniques such as thought recording, reappraisal, and cognitive restructuring.8 The study A psychosocial risk factor--targeted intervention for the prevention of chronic pain and disability following whiplash injury compared 130 patients with grade 1 and 2 acute whiplash. The experimental group consisted of 70 patients with psychosocial risk factors who coupled PGAP with functional physical therapy (mobility, flexibility, and endurance exercises). The control group consisted of 60 patients with psychosocial risk factors who received only the physical therapy interventions. The PT plus PGAP group yielded 75% return to work rates, whereas PT alone was associated with 50% return to work rates.8 The PT alone group however, and the PGAP group, both yielded similar results of perceived of disability and fear of reinjury scores. The article concluded that psychosocial intervention with physical therapy may emerge as a cost effective approach for prevention of prolonged pain and disability.
Approximately 50% of patients who sustain a symptomatic whiplash report chronic, and potentially more widespread, disabling symptoms lasting over a year.2, 4 Systematic reviews report limited effectiveness on treating chronic WAD. Also, systematic reviews have not conclusively shown early management approaches to have significant effects on the transition from acute to chronic symptoms. Clinical trials show opposing results regarding the effectiveness of physical therapy intervention.4 Since WAD can be debilitating and costly for individuals as well as society, is therapeutic exercise the most appropriate treatment for Whiplash associated disorder in regards to pain, cost, and function? Therapeutic exercises specific for the neck include isometric and isotonic exercises with variable, constant, or dynamic resistance.5 The aim is to facilitate deep neck muscle activity with flexion, extension, lateral flexion, and rotation exercises.5 The exercises should not provoke symptoms.5 Are these exercises however, effective for treating WAD? The study satisfaction with the outcome of PT exercise in chronic WAD (RCT) compared three interventions of a three month duration. One group received NSE (neck specific exercise with a physical therapist), another received NSE augmented with a behavioral therapy approach, and the third group where merely given a physical activity prescription letter involving no exercises specific to the neck.5 This study found that overall, exercise based treatment increased reported satisfaction, enablement, expectation fulfillment, however people who received NSE (regardless of receiving the behavioral component) reported greater and sooner results than the prescription only group.5 This implicated that a structured PT exercise program may lead to better results by enhancing patients satisfaction, coping, and understanding of WAD.5 Another article however, revealed contrasting results. The article Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): A pragmatic randomised controlled trial randomly assigned 172 patients with type 1 or 2 WAD to a 20 session “comprehensive exercise program” group or to an “advice and telephone support only” group.6 contradictory to the previous study, this study did not find a significant difference in pain or range of motion between the between comprehensive exercise and no comprehensive exercise.6 This article claims to challenge …show more content…
PGAP uses targeted techniques such as thought recording, reappraisal, and cognitive restructuring.8 The study A psychosocial risk factor--targeted intervention for the prevention of chronic pain and disability following whiplash injury compared 130 patients with grade 1 and 2 acute whiplash. The experimental group consisted of 70 patients with psychosocial risk factors who coupled PGAP with functional physical therapy (mobility, flexibility, and endurance exercises). The control group consisted of 60 patients with psychosocial risk factors who received only the physical therapy interventions. The PT plus PGAP group yielded 75% return to work rates, whereas PT alone was associated with 50% return to work rates.8 The PT alone group however, and the PGAP group, both yielded similar results of perceived of disability and fear of reinjury scores. The article concluded that psychosocial intervention with physical therapy may emerge as a cost effective approach for prevention of prolonged pain and disability.