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Decoding Whiplash: Chapter 3 – Treatment & Exercise

Updated: 4 days ago


Woman Receiving Manual Therapy

Recovery from Whiplash Associated Disorders (WAD) is typically attainable when comprehensive conservative care is paired with patient education and customized exercise programs. However, it's important to note that WAD symptoms can sometimes evolve into chronic conditions. Early intervention is pivotal to curtail this progression.

Research data suggest chronic neck pain may develop in 15% to 40% of whiplash injury patients. Timely therapeutic interventions significantly diminish the risk of transitioning into these chronic conditions.


Article Index:


Treatment


Exercise


Conclusion & References

 

Which Intervention Strategy Works Best?


Commencing manual therapy promptly after a thorough physical examination, following orthopedic and neurological evaluations, and the necessary diagnostic imaging to rule out fractures and soft tissue injuries, is essential. Current evidence underscores the effectiveness of manual therapy in alleviating pain and improving functional capabilities.


The chosen therapeutic strategy should cater to both soft tissue and joint injuries. Particularly in the initial treatment phases where pain is significant, a multidisciplinary approach is advocated. This involves a musculoskeletal professional providing conservative care, while a medical physician prescribes appropriate medication for acute pain and inflammation management when necessary.



Targeting Soft Tissue Limitations in the Cervical Region


4 Point Neck Pain Protocol - Motion Specific Release

In this video demonstration, we highlight the significance of recognizing and addressing neck pain as a unique dysfunction individual to each case. The intricacy of neck pain calls for a customized strategy for every instance, irrespective of whether the pain originates from structures close to the discomfort site or is part of a broader kinetic chain.



 


Woman Receiving Manual Therapy

Addressing Joint Restrictions


In tandem with alleviating soft-tissue restrictions, rectifying osseous joint restrictions within the cervical spine holds equal importance. The omission of addressing these osseous constraints could leave many patients without a full resolution of their WAD symptoms. Certified practitioners can alleviate these cervical joint restrictions using neck adjustments or neck mobilization techniques.


Neck Adjustment versus Neck Mobilization - What's Best for You?


Discerning the suitability of neck adjustments is pivotal for both the patient and practitioner, contingent on the patient's unique circumstances. For those apprehensive about undergoing neck manipulation, we introduce a safe and effective alternative—neck Mobilization, crafted to mitigate cervical restrictions effectively.


While Neck Manipulation is a powerful tactic for managing joint restrictions, it may not always be the appropriate approach for certain patients. Typically, neck manipulation is bypassed for patients over 70, those harbouring severe osteoarthritis or osteoporosis, and individuals diagnosed with specific autoimmune disorders like Rheumatoid Arthritis, among others.


The final decision rests with the individual, weighing the practitioner's tailored recommendations for their case. The two videos below elucidate cervical adjustments and Mobilization, portraying each technique for enhanced comprehension.


Cervical Adjustments

Chiropractic adjustments are highly effective, especially in addressing complications arising from whiplash injuries. Evidence demonstrates that individuals experiencing neck or back pain due to whiplash significantly benefit from chiropractic interventions. Typically, these patients see hastened pain relief and quicker recovery compared to those not undergoing such treatments.


Cervical Mobilization Procedures

Many patients are often unaware of the available options to tackle restrictions in their neck joints. Whether you lean towards Neck Adjustments or Neck Mobilization techniques, the choice is entirely yours!


 

Exercise is Critical


Exercise plays a pivotal role in the rehabilitation regimen for Whiplash-Associated Disorders (WAD). Substantial evidence highlights that a synergistic approach of exercise paired with manual therapy, encompassing manipulation or mobilization, markedly alleviates pain and enhances mobility post-WAD.


In the initial phase, it's imperative to undertake exercises within a comfortable range of motion to avert triggering abnormal neurological motor responses, known as central sensitization, and to initiate tissue repair. It's vital to acknowledge that while injured tissue requires time for structural remodelling, the absence of a fitting exercise routine heightens the risk of subsequent injury and persistent pain.


Exercise selection is personalized and crafted to meet the patient's specific needs and the extent of their injury. Moreover, providing customized advice for Activities of Daily Living (ADL), such as heat or cold therapy, ideal sleeping positions, and other pertinent guidance, can expedite the recovery journey.


Woman Performing Cat Cow Exercise

The following videos showcase a variety of exercises commonly suggested to our patients. Nonetheless, the precise exercises prescribed hinge on each patient's individual injuries. Our methodology initiates with improving mobility, followed by introducing strengthening exercises, and eventually merging functional exercises aimed at refining balance and proprioception. Incorporating low-intensity aerobic exercise can further accelerate the rehabilitation process.


Mobility and Flexibility Exercises


Stretching and mobility exercises are cornerstone components of the rehabilitation plan for whiplash patients. Whiplash injuries often instigate abrupt and forceful neck and shoulder movements, causing muscle strain, ligament sprains, joint dysfunction, and an overall decrease in mobility. This can manifest as stiffness, pain, and a limited range of motion, affecting the patient's daily activities and quality of life.


Including stretching and mobility exercises in a treatment regimen can help restore flexibility, enhance range of motion, and mitigate pain. Stretching exercises lengthen shortened or stiff muscles and ligaments, relieving tension and discomfort.


Concurrently, mobility exercises are designed to improve joint function and movement. These exercises promote healthier movement patterns, improve posture, and diminish the risk of subsequent injuries.


5 Minute Neck Pain Relief

Welcome to our "5 Minute Neck Pain Relief" exercise guide, designed to provide effective, quick relief from neck discomfort. This simple routine, which should be performed 3 to 4 times daily, is tailored to help alleviate pain, increase mobility, and promote overall neck health.


PNF Neck Stretches - Mobility, Strength and Power

Studies indicate that PNF stretching techniques efficiently boost and sustain flexibility, augment muscular strength and force, and elevate athletic performance. If you are injured, please ask your physician if these exercises are appropriate for your specific case.


Pain Relief For Problem Headaches

In this video, "Pain Relief For Problem Headaches," we show you a great way to resolve your headache. This Headache Relief video shows you how to release trigger points at the base of your skull, the Suboccipital region. Releasing this area is a key aspect of resolving headaches.


6 Effective Jaw Release Exercises

Whiplash injuries frequently coexist with issues related to the jaw. The upcoming video illustrates six exercises tailored to Temporomandibular Joint Dysfunction, a common complication seen with whiplash. These exercises mirror those we recommend to our patients post-application of Motion Specific Release - MSR procedures for TMJ dysfunctions.


 


Woman Performing Band Exercises

Strength Exercises


Integrating strengthening exercises into the recovery journey from whiplash injuries is a key strategy. The sudden, intense movements typical of whiplash can cause the muscles and ligaments of the neck and upper back to stretch excessively, leading to strains or potential tears. This results in muscle weakening, functional loss, and a compromised ability to effectively support the head and neck.


By initiating purposeful strengthening exercises as part of a therapeutic regimen, the strength and resilience of these affected muscles can be progressively regained. These exercises alleviate present discomfort and pain and serve a preventive role against subsequent injuries. They enhance muscular endurance, rectify posture, and boost neck stability, rendering it more resistant to the impact that led to the original whiplash injury. Therefore, strengthening exercises are invaluable in facilitating the full functional restoration of the neck and upper back post-whiplash trauma.


Neck Strengthening Exercises That Work

Neck and Shoulder exercises are essential to correct bad posture. What you need are neck-strengthening exercises that work! A strong mobile neck can go a long way in preventing future injuries and completely resolving an existing injury. Neck strengthening is also incredibly important for postural improvement.


 


Man Performing Tai Chi Exercises

Nerve Flossing Exercises: A Vital Element in Whiplash Treatment


Nerve flossing exercises are notable within the comprehensive treatment framework for whiplash injuries. Whiplash trauma, marked by abrupt, forceful movements, can cause nerve stretching or compression in the neck, upper back, and surrounding areas. This situation may result in peripheral nerve entrapment, which presents as pain, paresthesia, numbness, and muscle weakness in the affected regions.


Nerve flossing exercises, also known as neural mobilization or gliding techniques, aim to mobilize and gently stretch the entrapped nerves. This movement can ease nerve inflammation and compression, thus fostering optimal nerve function. By incorporating nerve flossing exercises into a therapeutic regimen, patients may experience an extended mobility range, reduced pain, and enhanced overall function in the impacted areas.


The following videos demonstrate examples of nerve flossing exercises, which could be suggested for patients with whiplash injuries. These exercises cover various body regions potentially implicated in a whiplash event, addressing the diverse symptoms linked to such trauma. It's imperative to note that these exercises should be tailored to each individual's unique needs and must be executed under the guidance of a qualified professional.


Median Nerve Flossing Video
Click Image to Watch Video

Median Nerve Flossing

The following video showcases the execution of median nerve gliding exercises. These maneuvers aim to liberate the median nerve from the enveloping tissues, offering a therapeutic benefit to those with whiplash injuries who have developed ancillary issues such as median nerve entrapment.



Releasing Entrapments of the Spinal Accessory Nerve  Video
Click Image to Watch Video

Releasing Entrapments of the Spinal Accessory Nerve

This video demonstrates how to perform exercises to alleviate entrapments of the Spinal Accessory Nerve. Whiplash injuries often impact this nerve, which is integral to the functioning of the neck and shoulder. Entrapment of this nerve can lead to neck and shoulder pain. Hence these exercises can be particularly beneficial for whiplash recovery.



Sciatic Nerve and Spinal Nerve Root Flossing Video
Click Image to Watch Video

Sciatic Nerve and Spinal Nerve Root Flossing

Whiplash injuries often result in low back pain and, in some cases, sciatica-like symptoms. The following video demonstrates exercises aimed at relieving sciatic and lower back pain. These procedures help release the tension on the spinal cord and the sciatic nerve by employing nerve flossing techniques. This can effectively target the entrapment of spinal nerve roots and the sciatic nerve, offering relief to those suffering from whiplash-related pain.


 


Man Receiving Manual Therapy

Treatment Recommendations


A well-coordinated multidisciplinary approach is crucial for the effective rehabilitation and recovery from Whiplash Associated Disorders (WAD) classified as Grade 2.The ensuing treatment blueprint delineates a synergy of manual therapy, functional exercise, and, if deemed necessary, medication management, all converging towards the objective of reverting the patient to their pre-injury condition.


This outline encapsulates manual therapy interventions including chiropractic, physiotherapy, massage, and acupuncture, paired with a functional exercise regimen designed to enhance mobility, strength, balance, and proprioception. Below is an illustrative treatment scenario for a patient diagnosed with a WAD 2 injury, provided solely as an example of a potential treatment pathway.



Phase 1: Initial Intensive Treatment (Weeks 1-3)


Frequency:

  • Chiropractic/Physiotherapy treatments: 2 times per week

  • Massage therapy: 2 times per week

Total Sessions:

  • Chiropractic/Physiotherapy treatments: 6 sessions in three weeks

  • Massage therapy: 6 sessions in three weeks


Phase 2: Transition to Maintenance (Weeks 4-7)


Frequency:

  • Chiropractic/Physiotherapy treatments: 1 time per week

  • Massage therapy: 1 time per week

Total Sessions:

  • Chiropractic/Physiotherapy treatments: 4 sessions

  • Massage therapy: 4 sessions


Phase 3: Evaluation and Continued Maintenance (Post 21 treatments)


Evaluation:

  • Assess the patient's progress post initial 21 treatments. If the condition has resolved to pre-injury status, conclude the treatment plan.

Continuation (if necessary):

  • Request authorization for an additional 5 weeks of treatment (10 visits total: 5 chiropractic/physiotherapy, 5 massage).

Frequency:

  • Chiropractic/Physiotherapy treatments: 1 time per week

  • Massage therapy: 1 time per week


Functional Exercise Program:

  • Initiate a functional exercise program immediately alongside the manual therapies to promote mobility, strength, balance, and proprioception.

  • Adapt the exercise program as necessary based on the patient's progress and tolerance.


Medication Management (if necessary):

  • Consult with the patient's MD to determine if medication is required to manage pain and facilitate a more comfortable progression through the treatment plan.


Ongoing Assessment:

  • Regularly assess the patient's response to treatment, functional progress, and pain levels to ensure the treatment plan remains effective and on track towards achieving the goal of returning to pre-injury status.


Communication:

  • Maintain open communication with all members of the healthcare team, including the MD, to ensure a coordinated and effective approach to treatment.


Patient Education:

  • Educate the patient on self-management strategies, ergonomic adjustments, and lifestyle modifications that may support their recovery and prevent future recurrence of symptoms.


 

Happy Woman Sitting on a Swiss Ball

Conclusion


The management and rehabilitation of Whiplash Associated Disorders (WAD) is complex due to the multifaceted nature of these injuries. Evidence continues demonstrating the value of a comprehensive and individualized treatment plan encompassing manual therapies, patient education, and a progressive exercise program. Addressing soft tissue and joint restrictions through Motion Specific Release, neck adjustments, and cervical mobilization can significantly improve the patient's condition.


Patients should be aware that their active participation in the treatment process, including adherence to prescribed exercise regimens and modifications in daily activities, can profoundly affect their recovery trajectory. By understanding their condition and available treatment options, patients can make informed decisions about their care and actively contribute to the healing process.




 

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DR. BRIAN ABELSON DC. - The Author


Photo of Dr. Brian Abelson

Dr. Abelson is dedicated to using evidence-based practices to improve musculoskeletal health. At Kinetic Health in Calgary, Alberta, he combines the latest research with a compassionate, patient-focused approach. As the creator of the Motion Specific Release (MSR) Treatment Systems, he aims to educate and share techniques to benefit the broader healthcare community. His work continually emphasizes patient-centred care and advancing treatment methods.



 


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